Full Text of SB0345 99th General Assembly
SB0345sam002 99TH GENERAL ASSEMBLY | Sen. Don Harmon Filed: 5/5/2016
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| 1 | | AMENDMENT TO SENATE BILL 345
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 345 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Autism and Co-Occurring Medical Conditions Awareness Act. | 6 | | Section 5. Findings. The General Assembly finds the | 7 | | following: | 8 | | (1) The medical consensus is that autism is an | 9 | | idiopathic disorder that has complex and multiple | 10 | | etiologies. The development of autism appears to be a | 11 | | complex interaction of multiple genetic and environmental | 12 | | factors. Both the prevalence and incidence of autism has | 13 | | risen in recent decades. | 14 | | (2) The Centers for Disease Control estimates that one | 15 | | in 68 children born in 2002 and one in 42 boys have been | 16 | | identified as living with autism. |
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| 1 | | (3) A 2012 survey conducted by the Centers for Disease | 2 | | Control of U.S. households estimated one in 50 children | 3 | | ages 6 to 17 has an autism spectrum disorder. | 4 | | (4) Autism spectrum disorders occur among all racial, | 5 | | ethnic, and socioeconomic groups. | 6 | | (5) Autism spectrum disorders are almost 5 times more | 7 | | common among boys than among girls. | 8 | | (6) According to the Centers for Disease Control, | 9 | | autism rates increased 78% between 2002 and 2008. The most | 10 | | recent estimate is roughly 30% higher than the estimate for | 11 | | 2008 (one in 88), 60% higher than the estimate for 2006 | 12 | | (one in 110), and 120% higher than the estimates for 2000 | 13 | | and 2002 (one in 150). | 14 | | (7) While autism spectrum disorders have primarily | 15 | | been diagnosed in measuring deficits in the areas of | 16 | | communication, socialization, and behavior, recent | 17 | | clinical and scientific investigations have determined | 18 | | that co-occurring pathophysiological conditions may occur | 19 | | more commonly in persons also diagnosed with autism.
These | 20 | | pathologies include, but are not limited to, allergies, | 21 | | autoimmune conditions, gastrointestinal diseases, immune | 22 | | dysregulation, metabolic disturbances, mitochondrial | 23 | | abnormalities, oxidative stress, neuroinflammation, and | 24 | | seizure disorders. | 25 | | (8) Scientific inquiry is providing evidence of | 26 | | biological markers, including, but not limited to, single |
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| 1 | | nucleotide polymorphisms, indications of cellular | 2 | | inflammation, increased cellular oxidation and damage, and | 3 | | abnormal DNA methylation, that may be clinically | 4 | | significant in the provision of appropriate medical care | 5 | | for persons also diagnosed with an autism spectrum | 6 | | disorder. | 7 | | Therefore, it is the intention of the General Assembly to | 8 | | promote a greater awareness and the detection, diagnosis, and | 9 | | treatment of underlying and co-occurring medical conditions | 10 | | that occur more commonly in persons with autism to further | 11 | | awareness, scientific understanding, and health outcomes for | 12 | | persons living with autism. | 13 | | Section 10. Definitions. In this Act: | 14 | | "Autism spectrum disorder" means a neurobiological | 15 | | disorder, including autism, regressive autism, Asperger | 16 | | Syndrome, and pervasive developmental disorders not otherwise | 17 | | specified. | 18 | | "Clinical symptomatology" means any indication of disorder | 19 | | or disease when experienced by an individual as a change from | 20 | | normal function, sensation, or appearance. | 21 | | "Co-occurring or otherwise diagnosed medical condition" | 22 | | means a simultaneous illness, condition, injury, disease, | 23 | | pathology, or disability that is not primarily diagnosed as an | 24 | | autism spectrum disorder. | 25 | | "Department" means the Department of Financial and |
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| 1 | | Professional Regulation. | 2 | | "Pathophysiological" means the functional alterations in | 3 | | the body related to a disease or syndrome. | 4 | | "Provider" means any provider of healthcare services in | 5 | | this State. | 6 | | Section 15. Study and education. Public partnerships and | 7 | | private partnerships supporting the discovery of biomarkers | 8 | | and their implications in pathophysiological conditions shall | 9 | | be encouraged and information derived from such discoveries | 10 | | shall be disseminated to providers and made available to the | 11 | | general public through research initiatives that may be | 12 | | promoted by universities, medical clinics, health care | 13 | | providers, consortiums, State agencies, private organizations, | 14 | | public organizations, and any party that may contribute to the | 15 | | scientific understanding of medical conditions associated or | 16 | | occurring more often in persons also diagnosed with an autism | 17 | | spectrum disorder than in the general population. | 18 | | Universities, private organizations, public organizations, | 19 | | and associations are encouraged to develop for providers who | 20 | | treat persons with autism spectrum disorders continuing | 21 | | education courses which address training in evaluation, | 22 | | diagnosis, and treatments for co-occurring and otherwise | 23 | | diagnosed pathophysiological conditions in autism spectrum | 24 | | disorders to promote and align standard of care practices to | 25 | | reflect emerging clinical findings and promising practices |
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| 1 | | derived from improved patient outcomes. | 2 | | Section 20. Treatment or service of persons with an autism | 3 | | spectrum disorder. Providers are strongly encouraged to | 4 | | evaluate persons diagnosed with an autism spectrum disorder for | 5 | | co-occurring or otherwise diagnosed medical conditions when | 6 | | clinical symptomatology is present or suspected and prescribe | 7 | | appropriate treatments or services in alignment with care | 8 | | practices for the condition, illness, injury, disease, or | 9 | | disability. Providers may consider, without limitation, | 10 | | whether or not a medication or any ingredient, allergen, | 11 | | potential toxicant, or artificial agent may exacerbate | 12 | | clinical symptomatology of autism spectrum disorder or a | 13 | | related or co-occurring or otherwise diagnosed medical | 14 | | condition and, if so, may consider adopting measures that would | 15 | | result in the reduction or elimination of risk to the patient. | 16 | | Section 25. Complaints. Any person with an autism spectrum | 17 | | disorder, or the person's parent or legal guardian on his or | 18 | | her behalf, who believes they have not received an appropriate | 19 | | medical assessment, evaluation, diagnosis, service or | 20 | | treatment from a provider because he or she is also diagnosed | 21 | | with an autism spectrum disorder may report the incident to the | 22 | | Department. | 23 | | Section 30. Right to seek new care. A person with an autism |
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| 1 | | spectrum disorder, or the person's parent or legal guardian on | 2 | | his or her behalf, retains the right to seek further medical | 3 | | opinions or care from other providers. | 4 | | A parent or legal guardian shall not be threatened with | 5 | | loss of parental or legal guardianship rights for a person with | 6 | | autism spectrum disorder for pursuing additional medical | 7 | | expertise, especially in the case of trying to ascertain | 8 | | appropriate identification and diagnosis of underlying or | 9 | | co-occurring medical conditions that may or may not be | 10 | | exacerbating symptoms primarily associated with an autism | 11 | | spectrum disorder. This Section does not abrogate or restrict | 12 | | any responsibilities set forth under the Abused and Neglected | 13 | | Child Reporting Act. | 14 | | Any person diagnosed as having an autism spectrum disorder | 15 | | or his or her parent or legal guardian shall not be denied the | 16 | | right to pursue appropriate and available medical | 17 | | interventions or treatments that may help to ameliorate or | 18 | | improve the symptoms primarily associated with an autism | 19 | | spectrum disorder or co-occurring or otherwise diagnosed | 20 | | medical condition. | 21 | | Any person diagnosed as having an autism spectrum disorder | 22 | | or his or her parent or legal guardian shall not be denied the | 23 | | right to decline a medical treatment or intervention. | 24 | | Section 35. Repeal. In order to consider the most | 25 | | innovative medical study and research involving autism and |
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| 1 | | co-occurring medical conditions, this Act is repealed 5 year | 2 | | after the effective date of this Act of the 99th General | 3 | | Assembly. | 4 | | Section 90. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.14 and by adding Section 356z.24 as | 6 | | follows: | 7 | | (215 ILCS 5/356z.14) | 8 | | Sec. 356z.14. Autism spectrum disorders. | 9 | | (a) A group or individual policy of accident and health | 10 | | insurance or managed care plan amended, delivered, issued, or | 11 | | renewed after the effective date of this amendatory Act of the | 12 | | 95th General Assembly must provide individuals under 21 years | 13 | | of age coverage for the diagnosis of autism spectrum disorders | 14 | | and for the treatment of autism spectrum disorders to the | 15 | | extent that the diagnosis and treatment of autism spectrum | 16 | | disorders are not already covered by the policy of accident and | 17 | | health insurance or managed care plan. | 18 | | (b) Coverage provided under this Section shall be subject | 19 | | to a maximum benefit of $36,000 per year, but shall not be | 20 | | subject to any limits on the number of visits to a service | 21 | | provider. After December 30, 2009, the Director of the Division | 22 | | of Insurance shall, on an annual basis, adjust the maximum | 23 | | benefit for inflation using the Medical Care Component of the | 24 | | United States Department of Labor Consumer Price Index for All |
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| 1 | | Urban Consumers. Payments made by an insurer on behalf of a | 2 | | covered individual for any care, treatment, intervention, | 3 | | service, or item, the provision of which was for the treatment | 4 | | of a health condition not diagnosed as an autism spectrum | 5 | | disorder, shall not be applied toward any maximum benefit | 6 | | established under this subsection. | 7 | | (c) Coverage under this Section shall be subject to | 8 | | copayment, deductible, and coinsurance provisions of a policy | 9 | | of accident and health insurance or managed care plan to the | 10 | | extent that other medical services covered by the policy of | 11 | | accident and health insurance or managed care plan are subject | 12 | | to these provisions. | 13 | | (d) This Section shall not be construed as limiting | 14 | | benefits that are otherwise available to an individual under a | 15 | | policy of accident and health insurance or managed care plan | 16 | | and benefits provided under this Section may not be subject to | 17 | | dollar limits, deductibles, copayments, or coinsurance | 18 | | provisions that are less favorable to the insured than the | 19 | | dollar limits, deductibles, or coinsurance provisions that | 20 | | apply to physical illness generally. | 21 | | (e) An insurer may not deny or refuse to provide otherwise | 22 | | covered services, or refuse to renew, refuse to reissue, or | 23 | | otherwise terminate or restrict coverage under an individual | 24 | | contract to provide services to an individual because the | 25 | | individual or their dependent is diagnosed with an autism | 26 | | spectrum disorder or due to the individual utilizing benefits |
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| 1 | | in this Section. | 2 | | (f) Upon request of the reimbursing insurer, a provider of | 3 | | treatment for autism spectrum disorders shall furnish medical | 4 | | records, clinical notes, or other necessary data that | 5 | | substantiate that initial or continued medical treatment is | 6 | | medically necessary and is resulting in improved clinical | 7 | | status. When treatment is anticipated to require continued | 8 | | services to achieve demonstrable progress, the insurer may | 9 | | request a treatment plan consisting of diagnosis, proposed | 10 | | treatment by type, frequency, anticipated duration of | 11 | | treatment, the anticipated outcomes stated as goals, and the | 12 | | frequency by which the treatment plan will be updated. | 13 | | (g) When making a determination of medical necessity for a | 14 | | treatment modality for autism spectrum disorders, an insurer | 15 | | must make the determination in a manner that is consistent with | 16 | | the manner used to make that determination with respect to | 17 | | other diseases or illnesses covered under the policy, including | 18 | | an appeals process. During the appeals process, any challenge | 19 | | to medical necessity must be viewed as reasonable only if the | 20 | | review includes a physician with expertise in the most current | 21 | | and effective treatment modalities for autism spectrum | 22 | | disorders. | 23 | | (h) Coverage for medically necessary early intervention | 24 | | services must be delivered by certified early intervention | 25 | | specialists, as defined in 89 Ill. Admin. Code 500 and any | 26 | | subsequent amendments thereto. |
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| 1 | | (h-5) If an individual has been diagnosed as having an | 2 | | autism spectrum disorder, meeting the diagnostic criteria in | 3 | | place at the time of diagnosis, and treatment is determined | 4 | | medically necessary, then that individual shall remain | 5 | | eligible for coverage under this Section even if subsequent | 6 | | changes to the diagnostic criteria are adopted by the American | 7 | | Psychiatric Association. If no changes to the diagnostic | 8 | | criteria are adopted after April 1, 2012, and before December | 9 | | 31, 2014, then this subsection (h-5) shall be of no further | 10 | | force and effect. | 11 | | (h-10) An insurer may not require, as a condition for | 12 | | coverage of other covered services, that an individual | 13 | | diagnosed with an autism spectrum disorder receive any | 14 | | medication or intervention that has been determined by the | 15 | | individual's health care provider to be medically | 16 | | contraindicated for the individual. An insurer may not deny or | 17 | | refuse to provide covered services, or refuse to renew, refuse | 18 | | to reissue, or otherwise terminate or restrict coverage under | 19 | | an individual contract, for a person diagnosed with an autism | 20 | | spectrum disorder on the basis that the individual declined an | 21 | | alternative medication or covered service when the | 22 | | individual's health care provider determined that such | 23 | | medication or covered service may exacerbate clinical | 24 | | symptomatology and is medically contraindicated for the | 25 | | individual. For the purposes of this subsection (h-10), | 26 | | "clinical symptomatology" means any indication of disorder or |
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| 1 | | disease when experienced by an individual as a change from | 2 | | normal function, sensation, or appearance. | 3 | | (h-15) If, at any time, the Secretary of the United States | 4 | | Department of Health and Human Services, or its successor | 5 | | agency, promulgates rules or regulations to be published in the | 6 | | Federal Register or publishes a comment in the Federal Register | 7 | | or issues an opinion, guidance, or other action that would | 8 | | require the State, pursuant to any provision of the Patient | 9 | | Protection and Affordable Care Act (Public Law 111–148), | 10 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | 11 | | successor provision, to defray the cost of any coverage | 12 | | outlined in subsection (h-10), then subsection (h-10) is | 13 | | inoperative with respect to all coverage outlined in subsection | 14 | | (h-10) other than that authorized under Section 1902 of the | 15 | | Social Security Act, 42 U.S.C. 1396a, and the State shall not | 16 | | assume any obligation for the cost of the coverage set forth in | 17 | | subsection (h-10). | 18 | | (i) As used in this Section: | 19 | | "Autism spectrum disorders" means pervasive developmental | 20 | | disorders as defined in the most recent edition of the | 21 | | Diagnostic and Statistical Manual of Mental Disorders, | 22 | | including autism, Asperger's disorder, and pervasive | 23 | | developmental disorder not otherwise specified. | 24 | | "Diagnosis of autism spectrum disorders" means one or more | 25 | | tests, evaluations, or assessments to diagnose whether an | 26 | | individual has autism spectrum disorder that is prescribed, |
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| 1 | | performed, or ordered by (A) a physician licensed to practice | 2 | | medicine in all its branches or (B) a licensed clinical | 3 | | psychologist with expertise in diagnosing autism spectrum | 4 | | disorders. | 5 | | "Medically necessary" means any care, treatment, | 6 | | intervention, service or item which will or is reasonably | 7 | | expected to do any of the following: (i) prevent the onset of | 8 | | an illness, condition, injury, disease or disability; (ii) | 9 | | reduce or ameliorate the physical, mental or developmental | 10 | | effects of an illness, condition, injury, disease or | 11 | | disability; or (iii) assist to achieve or maintain maximum | 12 | | functional activity in performing daily activities. | 13 | | "Treatment for autism spectrum disorders" shall include | 14 | | the following care prescribed, provided, or ordered for an | 15 | | individual diagnosed with an autism spectrum disorder by (A) a | 16 | | physician licensed to practice medicine in all its branches or | 17 | | (B) a certified, registered, or licensed health care | 18 | | professional with expertise in treating effects of autism | 19 | | spectrum disorders when the care is determined to be medically | 20 | | necessary and ordered by a physician licensed to practice | 21 | | medicine in all its branches: | 22 | | (1) Psychiatric care, meaning direct, consultative, or | 23 | | diagnostic services provided by a licensed psychiatrist. | 24 | | (2) Psychological care, meaning direct or consultative | 25 | | services provided by a licensed psychologist. | 26 | | (3) Habilitative or rehabilitative care, meaning |
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| 1 | | professional, counseling, and guidance services and | 2 | | treatment programs, including applied behavior analysis, | 3 | | that are intended to develop, maintain, and restore the | 4 | | functioning of an individual. As used in this subsection | 5 | | (i), "applied behavior analysis" means the design, | 6 | | implementation, and evaluation of environmental | 7 | | modifications using behavioral stimuli and consequences to | 8 | | produce socially significant improvement in human | 9 | | behavior, including the use of direct observation, | 10 | | measurement, and functional analysis of the relations | 11 | | between environment and behavior. | 12 | | (4) Therapeutic care, including behavioral, speech, | 13 | | occupational, and physical therapies that provide | 14 | | treatment in the following areas: (i) self care and | 15 | | feeding, (ii) pragmatic, receptive, and expressive | 16 | | language, (iii) cognitive functioning, (iv) applied | 17 | | behavior analysis, intervention, and modification, (v) | 18 | | motor planning, and (vi) sensory processing. | 19 | | (j) Rulemaking authority to implement this amendatory Act | 20 | | of the 95th General Assembly, if any, is conditioned on the | 21 | | rules being adopted in accordance with all provisions of the | 22 | | Illinois Administrative Procedure Act and all rules and | 23 | | procedures of the Joint Committee on Administrative Rules; any | 24 | | purported rule not so adopted, for whatever reason, is | 25 | | unauthorized.
| 26 | | (Source: P.A. 96-1000, eff. 7-2-10; 97-972, eff. 1-1-13.) |
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| 1 | | (215 ILCS 5/356z.24 new) | 2 | | Sec. 356z.24. Immune gamma globulin therapy. | 3 | | (a) Patients with primary immunodeficiency are susceptible | 4 | | to the ravages of infection because they have impaired antibody | 5 | | response and quality. Immune gamma globulin therapy is intended | 6 | | for continuous replacement therapy for primary | 7 | | immunodeficiency and may be delivered through intravenous | 8 | | immunoglobulin or subcutaneous immunoglobulin. For patients | 9 | | with a primary immunodeficiency, immune gamma globulin therapy | 10 | | protects against life-threatening infections, reduces | 11 | | hospitalizations, preserves organ function, increases life | 12 | | span, and is lifesaving. Immune gamma globulin is a human | 13 | | plasma product regulated by the United States Food and Drug | 14 | | Administration and approved for the treatment of primary | 15 | | immunodeficiency. No generic immune gamma globulin product | 16 | | exists. Patients diagnosed with primary immunodeficiency may | 17 | | have varying clinical responses to a prescribed drug, including | 18 | | those that may qualify as a serious medical contraindication. | 19 | | Infusions should not be interrupted to learn about a patient's | 20 | | tolerance for frequency of infusion as this will put the | 21 | | patient's life at risk and to do so would be consistent with | 22 | | medical malpractice. Some patients with primary | 23 | | immunodeficiency have normal levels of immunoglobulins at | 24 | | diagnosis but cannot make the antibodies that will neutralize | 25 | | infection. In these cases, trough dosing is not clinically |
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| 1 | | appropriate. | 2 | | (b) A group or individual policy of accident and health | 3 | | insurance or managed care plan amended, delivered, issued, or | 4 | | renewed after the effective date of this amendatory Act of the | 5 | | 99th General Assembly may not allow for the delay, | 6 | | discontinuation, or interruption of immune gamma globulin | 7 | | therapy for persons who are diagnosed with a primary | 8 | | immunodeficiency when prescribed immune gamma globulin therapy | 9 | | by a physician licensed to practice medicine in all of its | 10 | | branches. Administration of immune gamma globulin therapy | 11 | | shall not be delayed or interrupted by an insurer once a | 12 | | diagnosis is established and immune gamma globulin is | 13 | | prescribed. For the purposes of this Section, delay, | 14 | | interruption, or discontinuation of therapy means interfering | 15 | | with treatment as prescribed by the licensed physician by | 16 | | altering the prescribed dose, frequency, route, venue, | 17 | | product, or administration, which is determined by the | 18 | | physician based on patient tolerability, individual patient | 19 | | characteristics, needs, and clinical response. Product | 20 | | interchangeability not authorized by a prescribing physician | 21 | | is prohibited. | 22 | | (c) Upon the diagnosis of primary immunodeficiency by the | 23 | | prescribing physician, authorization or reauthorization by | 24 | | insurers of immune gamma globulin therapy shall be expedited by | 25 | | insurers. Due to the potential lifesaving necessity of immune | 26 | | gamma globulin, determination of authorization or |
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| 1 | | reauthorization may not take more than 2 weeks and | 2 | | reauthorization may not be required more frequently than every | 3 | | 12 months unless a more frequent duration has been indicated by | 4 | | the prescribing physician. Since immune gamma globulin therapy | 5 | | is intended for continuous replacement of antibodies, once a | 6 | | diagnosis of primary immunodeficiency is made, the previous | 7 | | diagnosis and current clinical judgment of the prescribing | 8 | | physician shall be sufficient for renewed authorization or | 9 | | authorization for continuation of care if the patient requires | 10 | | new authorization due to change in insurers. | 11 | | (d) Review of a patient's clinical history for meaningful | 12 | | infections and the available laboratory findings, genetic | 13 | | findings, and imaging studies, along with physical evidence of | 14 | | end-organ damage from recurrent infections and the favorable | 15 | | effect of immune gamma globulin replacement on clinical course | 16 | | and the treating physician's clinical judgment is sufficient to | 17 | | validate an antibody deficiency diagnosis. Trough levels of | 18 | | antibodies and normal immune globulin levels may be used by | 19 | | clinicians to monitor treatment and shall not be used to | 20 | | discontinue or otherwise deny coverage of immune gamma globulin | 21 | | therapy for a patient determined by a physician to have a | 22 | | primary immunodeficiency. | 23 | | (e) Any standards, policies, provisions, or practices by | 24 | | insurers that require a person who is diagnosed with a primary | 25 | | immunodeficiency to delay, discontinue, or interrupt immune | 26 | | gamma globulin therapy that could result in a potentially life |
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| 1 | | threatening situation are prohibited when prescribed by a | 2 | | physician licensed to practice medicine in all its branches. | 3 | | (f) If, at any time, the Secretary of the United States | 4 | | Department of Health and Human Services, or its successor | 5 | | agency, promulgates rules or regulations to be published in the | 6 | | Federal Register or publishes a comment in the Federal Register | 7 | | or issues an opinion, guidance, or other action that would | 8 | | require the State, pursuant to any provision of the Patient | 9 | | Protection and Affordable Care Act (Public Law 111–148), | 10 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | 11 | | successor provision, to defray the cost of any coverage | 12 | | outlined in subsections (b) and (c), then subsections (b) and | 13 | | (c) are inoperative with respect to all coverage outlined in | 14 | | subsections (b) and (c) other than that authorized under | 15 | | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and | 16 | | the State shall not assume any obligation for the cost of the | 17 | | coverage set forth in subsections (b) and (c). | 18 | | Section 99. Effective date. This Act takes effect upon | 19 | | becoming law.".
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