Full Text of HB2438 101st General Assembly
HB2438enr 101ST GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 370c as follows:
| 6 | | (215 ILCS 5/370c) (from Ch. 73, par. 982c)
| 7 | | Sec. 370c. Mental and emotional disorders.
| 8 | | (a)(1) On and after the effective date of this amendatory | 9 | | Act of the 101st General Assembly this amendatory Act of the | 10 | | 100th General Assembly ,
every insurer that amends, delivers, | 11 | | issues, or renews
group accident and health policies providing | 12 | | coverage for hospital or medical treatment or
services for | 13 | | illness on an expense-incurred basis shall provide coverage for | 14 | | reasonable and necessary treatment and services
for mental, | 15 | | emotional, nervous, or substance use disorders or conditions | 16 | | consistent with the parity requirements of Section 370c.1 of | 17 | | this Code.
| 18 | | (2) Each insured that is covered for mental, emotional, | 19 | | nervous, or substance use
disorders or conditions shall be free | 20 | | to select the physician licensed to
practice medicine in all | 21 | | its branches, licensed clinical psychologist,
licensed | 22 | | clinical social worker, licensed clinical professional | 23 | | counselor, licensed marriage and family therapist, licensed |
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| 1 | | speech-language pathologist, or other licensed or certified | 2 | | professional at a program licensed pursuant to the Substance | 3 | | Use Disorder Illinois Alcoholism and Other Drug Abuse and | 4 | | Dependency Act of
his choice to treat such disorders, and
the | 5 | | insurer shall pay the covered charges of such physician | 6 | | licensed to
practice medicine in all its branches, licensed | 7 | | clinical psychologist,
licensed clinical social worker, | 8 | | licensed clinical professional counselor, licensed marriage | 9 | | and family therapist, licensed speech-language pathologist, or | 10 | | other licensed or certified professional at a program licensed | 11 | | pursuant to the Substance Use Disorder Illinois Alcoholism and | 12 | | Other Drug Abuse and Dependency Act up
to the limits of | 13 | | coverage, provided (i)
the disorder or condition treated is | 14 | | covered by the policy, and (ii) the
physician, licensed | 15 | | psychologist, licensed clinical social worker, licensed
| 16 | | clinical professional counselor, licensed marriage and family | 17 | | therapist, licensed speech-language pathologist, or other | 18 | | licensed or certified professional at a program licensed | 19 | | pursuant to the Substance Use Disorder Illinois Alcoholism and | 20 | | Other Drug Abuse and Dependency Act is
authorized to provide | 21 | | said services under the statutes of this State and in
| 22 | | accordance with accepted principles of his profession.
| 23 | | (3) Insofar as this Section applies solely to licensed | 24 | | clinical social
workers, licensed clinical professional | 25 | | counselors, licensed marriage and family therapists, licensed | 26 | | speech-language pathologists, and other licensed or certified |
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| 1 | | professionals at programs licensed pursuant to the Substance | 2 | | Use Disorder Illinois Alcoholism and Other Drug Abuse and | 3 | | Dependency Act, those persons who may
provide services to | 4 | | individuals shall do so
after the licensed clinical social | 5 | | worker, licensed clinical professional
counselor, licensed | 6 | | marriage and family therapist, licensed speech-language | 7 | | pathologist, or other licensed or certified professional at a | 8 | | program licensed pursuant to the Substance Use Disorder | 9 | | Illinois Alcoholism and Other Drug Abuse and Dependency Act has | 10 | | informed the patient of the
desirability of the patient | 11 | | conferring with the patient's primary care
physician.
| 12 | | (4) "Mental, emotional, nervous, or substance use disorder | 13 | | or condition" means a condition or disorder that involves a | 14 | | mental health condition or substance use disorder that falls | 15 | | under any of the diagnostic categories listed in the mental and | 16 | | behavioral disorders chapter of the current edition of the | 17 | | International Classification of Disease or that is listed in | 18 | | the most recent version of the Diagnostic and Statistical | 19 | | Manual of Mental Disorders. "Mental, emotional, nervous, or | 20 | | substance use disorder or condition" includes any mental health | 21 | | condition that occurs during pregnancy or during the postpartum | 22 | | period and includes, but is not limited to, postpartum | 23 | | depression. | 24 | | (b)(1) (Blank).
| 25 | | (2) (Blank).
| 26 | | (2.5) (Blank). |
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| 1 | | (3) Unless otherwise prohibited by federal law and | 2 | | consistent with the parity requirements of Section 370c.1 of | 3 | | this Code, the reimbursing insurer that amends, delivers, | 4 | | issues, or renews a group or individual policy of accident and | 5 | | health insurance, a qualified health plan offered through the | 6 | | health insurance marketplace, or a provider of treatment of | 7 | | mental, emotional, nervous,
or substance use disorders or | 8 | | conditions shall furnish medical records or other necessary | 9 | | data
that substantiate that initial or continued treatment is | 10 | | at all times medically
necessary. An insurer shall provide a | 11 | | mechanism for the timely review by a
provider holding the same | 12 | | license and practicing in the same specialty as the
patient's | 13 | | provider, who is unaffiliated with the insurer, jointly | 14 | | selected by
the patient (or the patient's next of kin or legal | 15 | | representative if the
patient is unable to act for himself or | 16 | | herself), the patient's provider, and
the insurer in the event | 17 | | of a dispute between the insurer and patient's
provider | 18 | | regarding the medical necessity of a treatment proposed by a | 19 | | patient's
provider. If the reviewing provider determines the | 20 | | treatment to be medically
necessary, the insurer shall provide | 21 | | reimbursement for the treatment. Future
contractual or | 22 | | employment actions by the insurer regarding the patient's
| 23 | | provider may not be based on the provider's participation in | 24 | | this procedure.
Nothing prevents
the insured from agreeing in | 25 | | writing to continue treatment at his or her
expense. When | 26 | | making a determination of the medical necessity for a treatment
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| 1 | | modality for mental, emotional, nervous, or substance use | 2 | | disorders or conditions, an insurer must make the determination | 3 | | in a
manner that is consistent with the manner used to make | 4 | | that determination with
respect to other diseases or illnesses | 5 | | covered under the policy, including an
appeals process. Medical | 6 | | necessity determinations for substance use disorders shall be | 7 | | made in accordance with appropriate patient placement criteria | 8 | | established by the American Society of Addiction Medicine. No | 9 | | additional criteria may be used to make medical necessity | 10 | | determinations for substance use disorders.
| 11 | | (4) A group health benefit plan amended, delivered, issued, | 12 | | or renewed on or after January 1, 2019 ( the effective date of | 13 | | Public Act 100-1024) this amendatory Act of the 100th General | 14 | | Assembly or an individual policy of accident and health | 15 | | insurance or a qualified health plan offered through the health | 16 | | insurance marketplace amended, delivered, issued, or renewed | 17 | | on or after January 1, 2019 ( the effective date of Public Act | 18 | | 100-1024) this amendatory Act of the 100th General Assembly :
| 19 | | (A) shall provide coverage based upon medical | 20 | | necessity for the
treatment of a mental, emotional, | 21 | | nervous, or substance use disorder or condition consistent | 22 | | with the parity requirements of Section 370c.1 of this | 23 | | Code; provided, however, that in each calendar year | 24 | | coverage shall not be less than the following:
| 25 | | (i) 45 days of inpatient treatment; and
| 26 | | (ii) beginning on June 26, 2006 (the effective date |
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| 1 | | of Public Act 94-921), 60 visits for outpatient | 2 | | treatment including group and individual
outpatient | 3 | | treatment; and | 4 | | (iii) for plans or policies delivered, issued for | 5 | | delivery, renewed, or modified after January 1, 2007 | 6 | | (the effective date of Public Act 94-906),
20 | 7 | | additional outpatient visits for speech therapy for | 8 | | treatment of pervasive developmental disorders that | 9 | | will be in addition to speech therapy provided pursuant | 10 | | to item (ii) of this subparagraph (A); and
| 11 | | (B) may not include a lifetime limit on the number of | 12 | | days of inpatient
treatment or the number of outpatient | 13 | | visits covered under the plan.
| 14 | | (C) (Blank).
| 15 | | (5) An issuer of a group health benefit plan or an | 16 | | individual policy of accident and health insurance or a | 17 | | qualified health plan offered through the health insurance | 18 | | marketplace may not count toward the number
of outpatient | 19 | | visits required to be covered under this Section an outpatient
| 20 | | visit for the purpose of medication management and shall cover | 21 | | the outpatient
visits under the same terms and conditions as it | 22 | | covers outpatient visits for
the treatment of physical illness.
| 23 | | (5.5) An individual or group health benefit plan amended, | 24 | | delivered, issued, or renewed on or after September 9, 2015 | 25 | | ( the effective date of Public Act 99-480) this amendatory Act | 26 | | of the 99th General Assembly shall offer coverage for medically |
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| 1 | | necessary acute treatment services and medically necessary | 2 | | clinical stabilization services. The treating provider shall | 3 | | base all treatment recommendations and the health benefit plan | 4 | | shall base all medical necessity determinations for substance | 5 | | use disorders in accordance with the most current edition of | 6 | | the Treatment Criteria for Addictive, Substance-Related, and | 7 | | Co-Occurring Conditions established by the American Society of | 8 | | Addiction Medicine. The treating provider shall base all | 9 | | treatment recommendations and the health benefit plan shall | 10 | | base all medical necessity determinations for | 11 | | medication-assisted treatment in accordance with the most | 12 | | current Treatment Criteria for Addictive, Substance-Related, | 13 | | and Co-Occurring Conditions established by the American | 14 | | Society of Addiction Medicine. | 15 | | As used in this subsection: | 16 | | "Acute treatment services" means 24-hour medically | 17 | | supervised addiction treatment that provides evaluation and | 18 | | withdrawal management and may include biopsychosocial | 19 | | assessment, individual and group counseling, psychoeducational | 20 | | groups, and discharge planning. | 21 | | "Clinical stabilization services" means 24-hour treatment, | 22 | | usually following acute treatment services for substance | 23 | | abuse, which may include intensive education and counseling | 24 | | regarding the nature of addiction and its consequences, relapse | 25 | | prevention, outreach to families and significant others, and | 26 | | aftercare planning for individuals beginning to engage in |
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| 1 | | recovery from addiction. | 2 | | (6) An issuer of a group health benefit
plan may provide or | 3 | | offer coverage required under this Section through a
managed | 4 | | care plan.
| 5 | | (6.5) An individual or group health benefit plan amended, | 6 | | delivered, issued, or renewed on or after January 1, 2019 ( the | 7 | | effective date of Public Act 100-1024) this amendatory Act of | 8 | | the 100th General Assembly : | 9 | | (A) shall not impose prior authorization requirements, | 10 | | other than those established under the Treatment Criteria | 11 | | for Addictive, Substance-Related, and Co-Occurring | 12 | | Conditions established by the American Society of | 13 | | Addiction Medicine, on a prescription medication approved | 14 | | by the United States Food and Drug Administration that is | 15 | | prescribed or administered for the treatment of substance | 16 | | use disorders; | 17 | | (B) shall not impose any step therapy requirements, | 18 | | other than those established under the Treatment Criteria | 19 | | for Addictive, Substance-Related, and Co-Occurring | 20 | | Conditions established by the American Society of | 21 | | Addiction Medicine, before authorizing coverage for a | 22 | | prescription medication approved by the United States Food | 23 | | and Drug Administration that is prescribed or administered | 24 | | for the treatment of substance use disorders; | 25 | | (C) shall place all prescription medications approved | 26 | | by the United States Food and Drug Administration |
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| 1 | | prescribed or administered for the treatment of substance | 2 | | use disorders on, for brand medications, the lowest tier of | 3 | | the drug formulary developed and maintained by the | 4 | | individual or group health benefit plan that covers brand | 5 | | medications and, for generic medications, the lowest tier | 6 | | of the drug formulary developed and maintained by the | 7 | | individual or group health benefit plan that covers generic | 8 | | medications; and | 9 | | (D) shall not exclude coverage for a prescription | 10 | | medication approved by the United States Food and Drug | 11 | | Administration for the treatment of substance use | 12 | | disorders and any associated counseling or wraparound | 13 | | services on the grounds that such medications and services | 14 | | were court ordered. | 15 | | (7) (Blank).
| 16 | | (8)
(Blank).
| 17 | | (9) With respect to all mental, emotional, nervous, or | 18 | | substance use disorders or conditions, coverage for inpatient | 19 | | treatment shall include coverage for treatment in a residential | 20 | | treatment center certified or licensed by the Department of | 21 | | Public Health or the Department of Human Services. | 22 | | (c) This Section shall not be interpreted to require | 23 | | coverage for speech therapy or other habilitative services for | 24 | | those individuals covered under Section 356z.15
of this Code. | 25 | | (d) With respect to a group or individual policy of | 26 | | accident and health insurance or a qualified health plan |
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| 1 | | offered through the health insurance marketplace, the | 2 | | Department and, with respect to medical assistance, the | 3 | | Department of Healthcare and Family Services shall each enforce | 4 | | the requirements of this Section and Sections 356z.23 and | 5 | | 370c.1 of this Code, the Paul Wellstone and Pete Domenici | 6 | | Mental Health Parity and Addiction Equity Act of 2008, 42 | 7 | | U.S.C. 18031(j), and any amendments to, and federal guidance or | 8 | | regulations issued under, those Acts, including, but not | 9 | | limited to, final regulations issued under the Paul Wellstone | 10 | | and Pete Domenici Mental Health Parity and Addiction Equity Act | 11 | | of 2008 and final regulations applying the Paul Wellstone and | 12 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 13 | | 2008 to Medicaid managed care organizations, the Children's | 14 | | Health Insurance Program, and alternative benefit plans. | 15 | | Specifically, the Department and the Department of Healthcare | 16 | | and Family Services shall take action: | 17 | | (1) proactively ensuring compliance by individual and | 18 | | group policies, including by requiring that insurers | 19 | | submit comparative analyses, as set forth in paragraph (6) | 20 | | of subsection (k) of Section 370c.1, demonstrating how they | 21 | | design and apply nonquantitative treatment limitations, | 22 | | both as written and in operation, for mental, emotional, | 23 | | nervous, or substance use disorder or condition benefits as | 24 | | compared to how they design and apply nonquantitative | 25 | | treatment limitations, as written and in operation, for | 26 | | medical and surgical benefits; |
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| 1 | | (2) evaluating all consumer or provider complaints | 2 | | regarding mental, emotional, nervous, or substance use | 3 | | disorder or condition coverage for possible parity | 4 | | violations; | 5 | | (3) performing parity compliance market conduct | 6 | | examinations or, in the case of the Department of | 7 | | Healthcare and Family Services, parity compliance audits | 8 | | of individual and group plans and policies, including, but | 9 | | not limited to, reviews of: | 10 | | (A) nonquantitative treatment limitations, | 11 | | including, but not limited to, prior authorization | 12 | | requirements, concurrent review, retrospective review, | 13 | | step therapy, network admission standards, | 14 | | reimbursement rates, and geographic restrictions; | 15 | | (B) denials of authorization, payment, and | 16 | | coverage; and | 17 | | (C) other specific criteria as may be determined by | 18 | | the Department. | 19 | | The findings and the conclusions of the parity compliance | 20 | | market conduct examinations and audits shall be made public. | 21 | | The Director may adopt rules to effectuate any provisions | 22 | | of the Paul Wellstone and Pete Domenici Mental Health Parity | 23 | | and Addiction Equity Act of 2008 that relate to the business of | 24 | | insurance. | 25 | | (e) Availability of plan information. | 26 | | (1) The criteria for medical necessity determinations |
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| 1 | | made under a group health plan, an individual policy of | 2 | | accident and health insurance, or a qualified health plan | 3 | | offered through the health insurance marketplace with | 4 | | respect to mental health or substance use disorder benefits | 5 | | (or health insurance coverage offered in connection with | 6 | | the plan with respect to such benefits) must be made | 7 | | available by the plan administrator (or the health | 8 | | insurance issuer offering such coverage) to any current or | 9 | | potential participant, beneficiary, or contracting | 10 | | provider upon request. | 11 | | (2) The reason for any denial under a group health | 12 | | benefit plan, an individual policy of accident and health | 13 | | insurance, or a qualified health plan offered through the | 14 | | health insurance marketplace (or health insurance coverage | 15 | | offered in connection with such plan or policy) of | 16 | | reimbursement or payment for services with respect to | 17 | | mental, emotional, nervous, or substance use disorders or | 18 | | conditions benefits in the case of any participant or | 19 | | beneficiary must be made available within a reasonable time | 20 | | and in a reasonable manner and in readily understandable | 21 | | language by the plan administrator (or the health insurance | 22 | | issuer offering such coverage) to the participant or | 23 | | beneficiary upon request. | 24 | | (f) As used in this Section, "group policy of accident and | 25 | | health insurance" and "group health benefit plan" includes (1) | 26 | | State-regulated employer-sponsored group health insurance |
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| 1 | | plans written in Illinois or which purport to provide coverage | 2 | | for a resident of this State; and (2) State employee health | 3 | | plans. | 4 | | (g) (1) As used in this subsection: | 5 | | "Benefits", with respect to insurers, means
the benefits | 6 | | provided for treatment services for inpatient and outpatient | 7 | | treatment of substance use disorders or conditions at American | 8 | | Society of Addiction Medicine levels of treatment 2.1 | 9 | | (Intensive Outpatient), 2.5 (Partial Hospitalization), 3.1 | 10 | | (Clinically Managed Low-Intensity Residential), 3.3 | 11 | | (Clinically Managed Population-Specific High-Intensity | 12 | | Residential), 3.5 (Clinically Managed High-Intensity | 13 | | Residential), and 3.7 (Medically Monitored Intensive | 14 | | Inpatient) and OMT (Opioid Maintenance Therapy) services. | 15 | | "Benefits", with respect to managed care organizations, | 16 | | means the benefits provided for treatment services for | 17 | | inpatient and outpatient treatment of substance use disorders | 18 | | or conditions at American Society of Addiction Medicine levels | 19 | | of treatment 2.1 (Intensive Outpatient), 2.5 (Partial | 20 | | Hospitalization), 3.5 (Clinically Managed High-Intensity | 21 | | Residential), and 3.7 (Medically Monitored Intensive | 22 | | Inpatient) and OMT (Opioid Maintenance Therapy) services. | 23 | | "Substance use disorder treatment provider or facility" | 24 | | means a licensed physician, licensed psychologist, licensed | 25 | | psychiatrist, licensed advanced practice registered nurse, or | 26 | | licensed, certified, or otherwise State-approved facility or |
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| 1 | | provider of substance use disorder treatment. | 2 | | (2) A group health insurance policy, an individual health | 3 | | benefit plan, or qualified health plan that is offered through | 4 | | the health insurance marketplace, small employer group health | 5 | | plan, and large employer group health plan that is amended, | 6 | | delivered, issued, executed, or renewed in this State, or | 7 | | approved for issuance or renewal in this State, on or after | 8 | | January 1, 2019 ( the effective date of Public Act 100-1023) | 9 | | this amendatory Act of the 100th General Assembly shall comply | 10 | | with the requirements of this Section and Section 370c.1. The | 11 | | services for the treatment and the ongoing assessment of the | 12 | | patient's progress in treatment shall follow the requirements | 13 | | of 77 Ill. Adm. Code 2060. | 14 | | (3) Prior authorization shall not be utilized for the | 15 | | benefits under this subsection. The substance use disorder | 16 | | treatment provider or facility shall notify the insurer of the | 17 | | initiation of treatment. For an insurer that is not a managed | 18 | | care organization, the substance use disorder treatment | 19 | | provider or facility notification shall occur for the | 20 | | initiation of treatment of the covered person within 2 business | 21 | | days. For managed care organizations, the substance use | 22 | | disorder treatment provider or facility notification shall | 23 | | occur in accordance with the protocol set forth in the provider | 24 | | agreement for initiation of treatment within 24 hours. If the | 25 | | managed care organization is not capable of accepting the | 26 | | notification in accordance with the contractual protocol |
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| 1 | | during the 24-hour period following admission, the substance | 2 | | use disorder treatment provider or facility shall have one | 3 | | additional business day to provide the notification to the | 4 | | appropriate managed care organization. Treatment plans shall | 5 | | be developed in accordance with the requirements and timeframes | 6 | | established in 77 Ill. Adm. Code 2060. If the substance use | 7 | | disorder treatment provider or facility fails to notify the | 8 | | insurer of the initiation of treatment in accordance with these | 9 | | provisions, the insurer may follow its normal prior | 10 | | authorization processes. | 11 | | (4) For an insurer that is not a managed care organization, | 12 | | if an insurer determines that benefits are no longer medically | 13 | | necessary, the insurer shall notify the covered person, the | 14 | | covered person's authorized representative, if any, and the | 15 | | covered person's health care provider in writing of the covered | 16 | | person's right to request an external review pursuant to the | 17 | | Health Carrier External Review Act. The notification shall | 18 | | occur within 24 hours following the adverse determination. | 19 | | Pursuant to the requirements of the Health Carrier External | 20 | | Review Act, the covered person or the covered person's | 21 | | authorized representative may request an expedited external | 22 | | review.
An expedited external review may not occur if the | 23 | | substance use disorder treatment provider or facility | 24 | | determines that continued treatment is no longer medically | 25 | | necessary. Under this subsection, a request for expedited | 26 | | external review must be initiated within 24 hours following the |
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| 1 | | adverse determination notification by the insurer. Failure to | 2 | | request an expedited external review within 24 hours shall | 3 | | preclude a covered person or a covered person's authorized | 4 | | representative from requesting an expedited external review. | 5 | | If an expedited external review request meets the criteria | 6 | | of the Health Carrier External Review Act, an independent | 7 | | review organization shall make a final determination of medical | 8 | | necessity within 72 hours. If an independent review | 9 | | organization upholds an adverse determination, an insurer | 10 | | shall remain responsible to provide coverage of benefits | 11 | | through the day following the determination of the independent | 12 | | review organization. A decision to reverse an adverse | 13 | | determination shall comply with the Health Carrier External | 14 | | Review Act. | 15 | | (5) The substance use disorder treatment provider or | 16 | | facility shall provide the insurer with 7 business days' | 17 | | advance notice of the planned discharge of the patient from the | 18 | | substance use disorder treatment provider or facility and | 19 | | notice on the day that the patient is discharged from the | 20 | | substance use disorder treatment provider or facility. | 21 | | (6) The benefits required by this subsection shall be | 22 | | provided to all covered persons with a diagnosis of substance | 23 | | use disorder or conditions. The presence of additional related | 24 | | or unrelated diagnoses shall not be a basis to reduce or deny | 25 | | the benefits required by this subsection. | 26 | | (7) Nothing in this subsection shall be construed to |
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| 1 | | require an insurer to provide coverage for any of the benefits | 2 | | in this subsection. | 3 | | (Source: P.A. 99-480, eff. 9-9-15; 100-305, eff. 8-24-17; | 4 | | 100-1023, eff. 1-1-19; 100-1024, eff. 1-1-19; revised | 5 | | 10-18-18.)
| 6 | | Section 99. Effective date. This Act takes effect upon | 7 | | becoming law.
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