97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1501

 

Introduced , by Rep. Greg Harris

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/355  from Ch. 73, par. 967
215 ILCS 5/355.01 new
215 ILCS 5/367  from Ch. 73, par. 979
215 ILCS 125/2-11.1 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2

    Amends the Illinois Insurance Code. Sets forth provisions concerning the filing of premium rates with respect to health insurance coverage offered by a health insurance issuer and premium rate changes. Provides that in addition to filing premium rates, a company shall notify the Director of Insurance whenever a policy form has been closed for sale. Sets forth provisions concerning health insurance premium rates and prior approval of the Director. Contains provisions concerning appeal and requests for actuarial reasoning and data. Makes changes to the provision concerning group accident and health insurance. Amends the Health Maintenance Organization Act. Sets forth provisions concerning premium rates and filing and prior approval. Requires that the schedule of base rates for a group or individual contract or evidence of coverage to be used in conjunction with the contract or evidence of coverage be filed with the Director. Further amends the Act to comport with the provisions of the Illinois Insurance Code concerning health insurance premium rates and prior approval. Effective on January 1, 2012.


LRB097 08008 RPM 48129 b

 

 

A BILL FOR

 

HB1501LRB097 08008 RPM 48129 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. This Act may be cited as the Health Insurance
5Rate Fairness and Affordability Act.
 
6    Section 5. The Illinois Insurance Code is amended by
7changing Sections 355 and 367 and by adding Section 355.01 as
8follows:
 
9    (215 ILCS 5/355)  (from Ch. 73, par. 967)
10    Sec. 355. Accident and health policies-Provisions.)
11    (a) No individual or group policy of insurance against loss
12or damage from the sickness, or from the bodily injury or death
13of the insured by accident shall be issued or delivered to any
14person in this State until a copy of the form thereof and of
15the classification of risks and the premium rates pertaining
16thereto have been filed with the Director; nor shall it be so
17issued or delivered until the Director shall have approved such
18policy pursuant to the provisions of Section 143. If the
19Director disapproves the policy form he shall make a written
20decision stating the respects in which such form does not
21comply with the requirements of law and shall deliver a copy
22thereof to the company and it shall be unlawful thereafter for

 

 

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1any such company to issue any policy in such form.
2    (b) With respect to health insurance coverage offered by a
3health insurance issuer, a filing of premium rates pursuant to
4subsection (a) of this Section shall not be complete unless it
5contains all information necessary to justify the premium rate
6and such other information as the Director may require to
7determine the rate's compliance with Section 355.01 of this
8Code. Each rate filing must also include a certification by a
9qualified actuary that to the best of the actuary's knowledge
10and judgment the rate filing is in compliance with applicable
11laws and regulations and that the benefits are reasonable in
12relation to premiums.
13    (c) With respect to premium rate changes, the filing under
14subsection (a) of this Section shall clearly indicate the
15percentage change from the previously filed rate and the
16percentage change from the rate that was in effect 12 months
17prior to the proposed effective date of such rate.
18    (d) In addition to filing premium rates, a company shall
19notify the Director whenever a policy form subject to this
20Section has been closed for sale.
21    (e) As used in this Section, the terms "health insurance
22coverage" and "health insurance issuer" have the meanings given
23those terms in the Illinois Health Insurance Portability and
24Accountability Act.
25(Source: P.A. 79-777.)
 

 

 

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1    (215 ILCS 5/355.01 new)
2    Sec. 355.01. Health insurance premium rates; prior
3approval.
4    (a) With respect to health insurance coverage offered by a
5health insurance issuer, no such policy, plan, or contract
6shall be issued or delivered to any person in this State until
7the classification of risks and the premium rates pertaining
8thereto have been approved by the Director under this Section.
9Any subsequent addition to or change in premium rates shall
10also be subject to the Director's approval under this Section.
11In all cases the Director shall approve or disapprove a premium
12rate within 60 days after submission unless the Director
13extends by not more than an additional 60 days the period
14within which the Director shall approve or disapprove such
15premium rate by giving written notice to the health insurance
16issuer of the extension before expiration of the initial 60-day
17period.
18    (b) The Director shall disapprove a premium rate under this
19Section if:
20        (1) the benefits provided are not reasonable in
21    relation to the premium charged; or
22        (2) the proposed premium rate is excessive,
23    inadequate, unjustified, or unfairly discriminatory.
24    The party proposing a rate has the burden of proving by
25clear and convincing evidence that the rate does not violate
26this Section.

 

 

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1    (c) With respect to premium rate changes, the Director's
2review of a proposed rate change shall include an examination
3of the factors set forth in regulation promulgated by the
4Secretary of the U.S. Department of Health and Human Services
5pursuant to Section 2794 of the Public Health Service Act, as
6added by the Patient Protection and Affordable Care Act (Pub.
7L. 111-148), for the purpose of determining whether a State has
8an effective rate review program.
9    (d) The Director shall notify a health insurance issuer in
10writing of the approval or disapproval of a premium rate under
11this Section, and the notice shall be posted on the
12Department's website. If the Director disapproves the premium
13rate, then the written notice shall clearly state the respects
14in which the premium rate does not comply with the requirements
15of law and it shall be unlawful thereafter for any such health
16insurance issuer to use the premium rate. The written notice of
17disapproval shall also advise the health insurance issuer of
18the right to a hearing under subsection (f) of this Section.
19    (e) With respect to a rate change approved under this
20Section, the rate change shall take effect no sooner than 30
21days after the written approval is mailed by the Director. The
22rate change shall be stayed if within the 30-day period a
23written request for a hearing is filed with the Director under
24subsection (f) of this Section. A health insurance issuer shall
25notify in writing all policyholders to which such rate change
26applies at least 30 days prior to the effective date of the

 

 

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1rate change. The written notice shall also advise the
2policyholders of the right to a hearing under subsection (d) of
3this Section.
4    (f) A health insurance issuer may appeal a decision by the
5Director under this Section by making a written request for a
6hearing before the Director within 30 days after receiving the
7written notice under subsections (d) or (g) of this Section.
8One percent or 25 of the covered lives (whichever is greater)
9to which such rate change applies may appeal a decision by the
10Director under this Section by submitting a written request to
11the Department for a hearing before the Director within 30 days
12after the Department posts public notice under subsection (d)
13of this Section.
14    (g) The Director may request actuarial reasons and data, as
15well as other information, needed to determine if a previously
16approved rate continues to satisfy the requirements of this
17Section. The Director may withdraw approval of any rate that
18has been previously approved on any of the grounds stated in
19subsection (b) of this Section. The Director shall notify a
20health insurance issuer in writing of the withdrawal of
21approval. The written notice shall clearly state the respects
22in which the premium rate ceases to comply with the
23requirements of law and shall advise the health insurance
24issuer of the right to a hearing under subsection (f) of this
25Section. The written withdrawal of approval shall take effect
2630 days after the date of mailing but shall be stayed if within

 

 

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1the 30-day period a written request for hearing is filed with
2the Director under subsection (f) of this Section.
3    (h) As used in this Section, the terms "health insurance
4coverage" and "health insurance issuer" have the meanings given
5those terms in the Illinois Health Insurance Portability and
6Accountability Act.
 
7    (215 ILCS 5/367)  (from Ch. 73, par. 979)
8    Sec. 367. Group accident and health insurance.
9    (1) Group accident and health insurance is hereby declared
10to be that form of accident and health insurance covering not
11less than 2 employees, members, or employees of members,
12written under a master policy issued to any governmental
13corporation, unit, agency or department thereof, or to any
14corporation, copartnership, individual employer, or to any
15association upon application of an executive officer or trustee
16of such association having a constitution or bylaws and formed
17in good faith for purposes other than that of obtaining
18insurance, where officers, members, employees, employees of
19members or classes or department thereof, may be insured for
20their individual benefit. In addition a group accident and
21health policy may be written to insure any group which may be
22insured under a group life insurance policy. The term
23"employees" shall include the officers, managers and employees
24of subsidiary or affiliated corporations, and the individual
25proprietors, partners and employees of affiliated individuals

 

 

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1and firms, when the business of such subsidiary or affiliated
2corporations, firms or individuals, is controlled by a common
3employer through stock ownership, contract or otherwise.
4    (2) Any insurance company authorized to write accident and
5health insurance in this State shall have power to issue group
6accident and health policies. No policy of group accident and
7health insurance may be issued or delivered in this State
8unless a copy of the form thereof and of the classification of
9risks and the premium rates pertaining thereto shall have been
10filed with the department and approved by it in accordance with
11Section 355 and Section 355.01, and it contains in substance
12those provisions contained in Sections 357.1 through 357.30 as
13may be applicable to group accident and health insurance and
14the following provisions:
15        (a) A provision that the policy, the application of the
16    employer, or executive officer or trustee of any
17    association, and the individual applications, if any, of
18    the employees, members or employees of members insured
19    shall constitute the entire contract between the parties,
20    and that all statements made by the employer, or the
21    executive officer or trustee, or by the individual
22    employees, members or employees of members shall (in the
23    absence of fraud) be deemed representations and not
24    warranties, and that no such statement shall be used in
25    defense to a claim under the policy, unless it is contained
26    in a written application.

 

 

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1        (b) A provision that the insurer will issue to the
2    employer, or to the executive officer or trustee of the
3    association, for delivery to the employee, member or
4    employee of a member, who is insured under such policy, an
5    individual certificate setting forth a statement as to the
6    insurance protection to which he is entitled and to whom
7    payable.
8        (c) A provision that to the group or class thereof
9    originally insured shall be added from time to time all new
10    employees of the employer, members of the association or
11    employees of members eligible to and applying for insurance
12    in such group or class.
13    (3) Anything in this code to the contrary notwithstanding,
14any group accident and health policy may provide that all or
15any portion of any indemnities provided by any such policy on
16account of hospital, nursing, medical or surgical services,
17may, at the insurer's option, be paid directly to the hospital
18or person rendering such services; but the policy may not
19require that the service be rendered by a particular hospital
20or person. Payment so made shall discharge the insurer's
21obligation with respect to the amount of insurance so paid.
22Nothing in this subsection (3) shall prohibit an insurer from
23providing incentives for insureds to utilize the services of a
24particular hospital or person.
25    (4) Special group policies may be issued to school
26districts providing medical or hospital service, or both, for

 

 

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1pupils of the district injured while participating in any
2athletic activity under the jurisdiction of or sponsored or
3controlled by the district or the authorities of any school
4thereof. The provisions of this Section governing the issuance
5of group accident and health insurance shall, insofar as
6applicable, control the issuance of such policies issued to
7schools.
8    (5) No policy of group accident and health insurance may be
9issued or delivered in this State unless it provides that upon
10the death of the insured employee or group member the
11dependents' coverage, if any, continues for a period of at
12least 90 days subject to any other policy provisions relating
13to termination of dependents' coverage.
14    (6) No group hospital policy covering miscellaneous
15hospital expenses issued or delivered in this State shall
16contain any exception or exclusion from coverage which would
17preclude the payment of expenses incurred for the processing
18and administration of blood and its components.
19    (7) No policy of group accident and health insurance,
20delivered in this State more than 120 days after the effective
21day of the Section, which provides inpatient hospital coverage
22for sicknesses shall exclude from such coverage the treatment
23of alcoholism. This subsection shall not apply to a policy
24which covers only specified sicknesses.
25    (8) No policy of group accident and health insurance, which
26provides benefits for hospital or medical expenses based upon

 

 

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1the actual expenses incurred, issued or delivered in this State
2shall contain any specific exception to coverage which would
3preclude the payment of actual expenses incurred in the
4examination and testing of a victim of an offense defined in
5Sections 12-13 through 12-16 of the Criminal Code of 1961, or
6an attempt to commit such offense, to establish that sexual
7contact did occur or did not occur, and to establish the
8presence or absence of sexually transmitted disease or
9infection, and examination and treatment of injuries and trauma
10sustained by the victim of such offense, arising out of the
11offense. Every group policy of accident and health insurance
12which specifically provides benefits for routine physical
13examinations shall provide full coverage for expenses incurred
14in the examination and testing of a victim of an offense
15defined in Sections 12-13 through 12-16 of the Criminal Code of
161961, or an attempt to commit such offense, as set forth in
17this Section. This subsection shall not apply to a policy which
18covers hospital and medical expenses for specified illnesses
19and injuries only.
20    (9) For purposes of enabling the recovery of State funds,
21any insurance carrier subject to this Section shall upon
22reasonable demand by the Department of Public Health disclose
23the names and identities of its insureds entitled to benefits
24under this provision to the Department of Public Health
25whenever the Department of Public Health has determined that it
26has paid, or is about to pay, hospital or medical expenses for

 

 

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1which an insurance carrier is liable under this Section. All
2information received by the Department of Public Health under
3this provision shall be held on a confidential basis and shall
4not be subject to subpoena and shall not be made public by the
5Department of Public Health or used for any purpose other than
6that authorized by this Section.
7    (10) Whenever the Department of Public Health finds that it
8has paid all or part of any hospital or medical expenses which
9an insurance carrier is obligated to pay under this Section,
10the Department of Public Health shall be entitled to receive
11reimbursement for its payments from such insurance carrier
12provided that the Department of Public Health has notified the
13insurance carrier of its claim before the carrier has paid the
14benefits to its insureds or the insureds' assignees.
15    (11) (a) No group hospital, medical or surgical expense
16    policy shall contain any provision whereby benefits
17    otherwise payable thereunder are subject to reduction
18    solely on account of the existence of similar benefits
19    provided under other group or group-type accident and
20    sickness insurance policies where such reduction would
21    operate to reduce total benefits payable under these
22    policies below an amount equal to 100% of total allowable
23    expenses provided under these policies.
24        (b) When dependents of insureds are covered under 2
25    policies, both of which contain coordination of benefits
26    provisions, benefits of the policy of the insured whose

 

 

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1    birthday falls earlier in the year are determined before
2    those of the policy of the insured whose birthday falls
3    later in the year. Birthday, as used herein, refers only to
4    the month and day in a calendar year, not the year in which
5    the person was born. The Department of Insurance shall
6    promulgate rules defining the order of benefit
7    determination pursuant to this paragraph (b).
8    (12) Every group policy under this Section shall be subject
9to the provisions of Sections 356g and 356n of this Code.
10    (13) No accident and health insurer providing coverage for
11hospital or medical expenses on an expense incurred basis shall
12deny reimbursement for an otherwise covered expense incurred
13for any organ transplantation procedure solely on the basis
14that such procedure is deemed experimental or investigational
15unless supported by the determination of the Office of Health
16Care Technology Assessment within the Agency for Health Care
17Policy and Research within the federal Department of Health and
18Human Services that such procedure is either experimental or
19investigational or that there is insufficient data or
20experience to determine whether an organ transplantation
21procedure is clinically acceptable. If an accident and health
22insurer has made written request, or had one made on its behalf
23by a national organization, for determination by the Office of
24Health Care Technology Assessment within the Agency for Health
25Care Policy and Research within the federal Department of
26Health and Human Services as to whether a specific organ

 

 

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1transplantation procedure is clinically acceptable and said
2organization fails to respond to such a request within a period
3of 90 days, the failure to act may be deemed a determination
4that the procedure is deemed to be experimental or
5investigational.
6    (14) Whenever a claim for benefits by an insured under a
7dental prepayment program is denied or reduced, based on the
8review of x-ray films, such review must be performed by a
9dentist.
10(Source: P.A. 91-549, eff. 8-14-99.)
 
11    Section 10. The Health Maintenance Organization Act is
12amended by changing Section 5-3 and by adding Section 2-11.1 as
13follows:
 
14    (215 ILCS 125/2-11.1 new)
15    Sec. 2-11.1. Premium rates; filing and prior approval.
16    (a) Notwithstanding any other provision of law, no group or
17individual contract or evidence of coverage shall be issued or
18delivered in this State until the schedule of base rates to be
19used in conjunction with the contract or evidence of coverage
20has been filed with the Director; nor shall it be issued or
21delivered until the Director shall have approved such base
22rates pursuant to the provisions of Section 355.01 of the
23Illinois Insurance Code. Any subsequent addition to or change
24in rates is also subject to this Section.

 

 

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1    (b) A filing of rates under this Section shall not be
2complete unless it contains all information necessary to
3justify the premium rate and such other information as the
4Director may require to determine the rate's compliance with
5Section 355.01 of the Illinois Insurance Code. Each rate filing
6must also include a certification by a qualified actuary that
7to the best of the actuary's knowledge and judgment the rate
8filing is in compliance with the applicable laws and
9regulations of this State and that the benefits are reasonable
10in relation to premiums.
11    (c) With respect to rate changes, the filing under this
12Section shall clearly indicate the percentage change from the
13previously filed rate and the percentage change from the rate
14that was in effect 12 months prior to the proposed effective
15date of such rate.
16    (d) In addition to filing premium rates, a health
17maintenance organization shall notify the Director whenever a
18plan subject to this Section has been closed for sale.
 
19    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
20    Sec. 5-3. Insurance Code provisions.
21    (a) Health Maintenance Organizations shall be subject to
22the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
23141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
24154.6, 154.7, 154.8, 155.04, 355.01, 355.2, 356g.5-1, 356m,
25356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8,

 

 

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1356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
2356z.17, 356z.18, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
3368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
4409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
5Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
6XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
7    (b) For purposes of the Illinois Insurance Code, except for
8Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
9Maintenance Organizations in the following categories are
10deemed to be "domestic companies":
11        (1) a corporation authorized under the Dental Service
12    Plan Act or the Voluntary Health Services Plans Act;
13        (2) a corporation organized under the laws of this
14    State; or
15        (3) a corporation organized under the laws of another
16    state, 30% or more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a "domestic company" under Article VIII
20    1/2 of the Illinois Insurance Code.
21    (c) In considering the merger, consolidation, or other
22acquisition of control of a Health Maintenance Organization
23pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24        (1) the Director shall give primary consideration to
25    the continuation of benefits to enrollees and the financial
26    conditions of the acquired Health Maintenance Organization

 

 

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1    after the merger, consolidation, or other acquisition of
2    control takes effect;
3        (2)(i) the criteria specified in subsection (1)(b) of
4    Section 131.8 of the Illinois Insurance Code shall not
5    apply and (ii) the Director, in making his determination
6    with respect to the merger, consolidation, or other
7    acquisition of control, need not take into account the
8    effect on competition of the merger, consolidation, or
9    other acquisition of control;
10        (3) the Director shall have the power to require the
11    following information:
12            (A) certification by an independent actuary of the
13        adequacy of the reserves of the Health Maintenance
14        Organization sought to be acquired;
15            (B) pro forma financial statements reflecting the
16        combined balance sheets of the acquiring company and
17        the Health Maintenance Organization sought to be
18        acquired as of the end of the preceding year and as of
19        a date 90 days prior to the acquisition, as well as pro
20        forma financial statements reflecting projected
21        combined operation for a period of 2 years;
22            (C) a pro forma business plan detailing an
23        acquiring party's plans with respect to the operation
24        of the Health Maintenance Organization sought to be
25        acquired for a period of not less than 3 years; and
26            (D) such other information as the Director shall

 

 

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1        require.
2    (d) The provisions of Article VIII 1/2 of the Illinois
3Insurance Code and this Section 5-3 shall apply to the sale by
4any health maintenance organization of greater than 10% of its
5enrollee population (including without limitation the health
6maintenance organization's right, title, and interest in and to
7its health care certificates).
8    (e) In considering any management contract or service
9agreement subject to Section 141.1 of the Illinois Insurance
10Code, the Director (i) shall, in addition to the criteria
11specified in Section 141.2 of the Illinois Insurance Code, take
12into account the effect of the management contract or service
13agreement on the continuation of benefits to enrollees and the
14financial condition of the health maintenance organization to
15be managed or serviced, and (ii) need not take into account the
16effect of the management contract or service agreement on
17competition.
18    (f) Except for small employer groups as defined in the
19Small Employer Rating, Renewability and Portability Health
20Insurance Act and except for medicare supplement policies as
21defined in Section 363 of the Illinois Insurance Code, a Health
22Maintenance Organization may by contract agree with a group or
23other enrollment unit to effect refunds or charge additional
24premiums under the following terms and conditions:
25        (i) the amount of, and other terms and conditions with
26    respect to, the refund or additional premium are set forth

 

 

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1    in the group or enrollment unit contract agreed in advance
2    of the period for which a refund is to be paid or
3    additional premium is to be charged (which period shall not
4    be less than one year); and
5        (ii) the amount of the refund or additional premium
6    shall not exceed 20% of the Health Maintenance
7    Organization's profitable or unprofitable experience with
8    respect to the group or other enrollment unit for the
9    period (and, for purposes of a refund or additional
10    premium, the profitable or unprofitable experience shall
11    be calculated taking into account a pro rata share of the
12    Health Maintenance Organization's administrative and
13    marketing expenses, but shall not include any refund to be
14    made or additional premium to be paid pursuant to this
15    subsection (f)). The Health Maintenance Organization and
16    the group or enrollment unit may agree that the profitable
17    or unprofitable experience may be calculated taking into
18    account the refund period and the immediately preceding 2
19    plan years.
20    The Health Maintenance Organization shall include a
21statement in the evidence of coverage issued to each enrollee
22describing the possibility of a refund or additional premium,
23and upon request of any group or enrollment unit, provide to
24the group or enrollment unit a description of the method used
25to calculate (1) the Health Maintenance Organization's
26profitable experience with respect to the group or enrollment

 

 

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1unit and the resulting refund to the group or enrollment unit
2or (2) the Health Maintenance Organization's unprofitable
3experience with respect to the group or enrollment unit and the
4resulting additional premium to be paid by the group or
5enrollment unit.
6    In no event shall the Illinois Health Maintenance
7Organization Guaranty Association be liable to pay any
8contractual obligation of an insolvent organization to pay any
9refund authorized under this Section.
10    (g) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
1795-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
1895-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
191-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
206-1-10; 96-1000, eff. 7-2-10.)
 
21    Section 99. Effective date. This Act takes effect January
221, 2012.