State of Illinois
92nd General Assembly

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[ Introduced ][ House Amendment 001 ]


HB1807 Engrossed                              LRB9204967DJgcA

 1        AN ACT in relation to health.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 1. Short title. This Act  may  be  cited  as  the
 5    Anti-Obesity and Related Comorbidities Therapy Act.

 6        Section  5.  Public  policy.  It is declared that for the
 7    benefit  of  the  people  of  the  State  of  Illinois,   the
 8    Department  of Public Health, in cooperation with other State
 9    agencies, shall be responsible for supporting programs  aimed
10    at  reducing  the  incidence  and  effects of obesity and its
11    related comorbidities.  The State acknowledges  that  obesity
12    is  the  second-leading  cause  of death in the United States
13    after smoking, resulting in  more  than  300,000  preventable
14    deaths  each  year.   There  is a causal relationship between
15    obesity and other serious  health  complications,  including,
16    but  not  limited to, coronary heart disease, cerebrovascular
17    disease (stroke), type II  diabetes  mellitus,  hypertension,
18    sleep   apnea,  dyslipidemia,  gallbladder  disease,  gastric
19    reflux disease, gout, osteoarthritis of the hips  and  knees,
20    cancer,  infertility,  and  respiratory  difficulties, all of
21    which lead to an increase in  obesity-related  morbidity  and
22    mortality.   In  addition  to  the  health  implications, the
23    economic  consequences  of  the  skyrocketing  incidence   of
24    obesity rates are substantial.  The direct cost of diagnosis,
25    treatment,  and  management  of  obesity  and obesity-related
26    diseases is estimated to be $45.8 billion, or 6.8%  of  total
27    national health care expenditures. The reduction in workplace
28    productivity  due  to  an increase in the number of sick days
29    and physical limitations  is  estimated  to  have  an  annual
30    impact on our economy of $52 billion per year.
31        Obesity  continues  to  dramatically increase both in the
HB1807 Engrossed            -2-               LRB9204967DJgcA
 1    United  States  and  in  Illinois.   One-third  of  the  U.S.
 2    population is  considered  to  be  obese.   The  Centers  for
 3    Disease  Control  and  Prevention  reported that 33.5% of the
 4    Illinois population was obese in 1998.  Obesity, while on the
 5    rise in all adult demographic categories, is  more  prevalent
 6    among   African-American  and  Hispanic  populations.   Among
 7    children, there has been a 42% increase in childhood  obesity
 8    rates  since  1980, placing children at an increased risk for
 9    diabetes, hypertension, heart disease, and  stroke  later  in
10    life.
11        It  is clear that obesity has a significant impact on the
12    health of people in  Illinois,  and  the  State  economy,  by
13    reducing   productivity   dramatically  increasing  avoidable
14    medical costs.  Clinical studies demonstrate that weight loss
15    in overweight and obese individuals decreases  the  risk  for
16    developing serious health conditions and leads to improvement
17    in  health  for  many  persons  with  those  conditions.   By
18    investing  in  programs  aimed  at  reducing  obesity and its
19    related comorbidities, the State  can  improve  the  physical
20    health  of a significant portion of its citizenry and control
21    the skyrocketing costs of health care attributed to obesity's
22    comorbidities.   For  example,   research   begun   in   1995
23    demonstrates that intentional weight loss in overweight women
24    with existing obesity-related diseases led to a 20% reduction
25    in  total  mortality,  a  40-50%  reduction in mortality from
26    obesity-related   cancers   and   a   30-40%   reduction   in
27    diabetes-related deaths.
28        In recent years, new scientific breakthroughs have led to
29    new drug therapies  that  are  both  safe  and  effective  in
30    treating  both  obesity and its related comorbidities.  These
31    innovative drug therapies assist obese individuals in  losing
32    weight,  improving  their health, and reducing their need for
33    complex and costly medical services that are paid for by  the
34    State's medical assistance program.  It is the policy of this
HB1807 Engrossed            -3-               LRB9204967DJgcA
 1    State  that  where  prophylactic  therapies  actually  reduce
 2    health care costs and improve patient health, those therapies
 3    must  be  supported.   The  legislature  finds  that there is
 4    sufficient scientific and  empirical  evidence  to  establish
 5    that  existing FDA-approved anti-obesity drug therapies, when
 6    properly supervised  by  a  qualified  physician,  fit  these
 7    criteria.

 8        Section 10. Definitions. In this Act:
 9        (1)  "At-risk  overweight" means having a body mass index
10    greater than or equal to 27 kilograms per  square  meter  but
11    less  than  30  kilograms  per square meter and having one or
12    more of the following comorbidities:
13             (1) Coronary heart disease.
14             (2) Cerebrovascular disease (stroke).
15             (3) Dyslipidemia.
16             (4) Cancer.
17             (5) Hypertension.
18             (6) Sleep apnea.
19             (7) Type II diabetes mellitus.
20        "Body mass index"  is  a  mathematical  formula  used  to
21    determine  a  person's  body  weight in relation to height as
22    measured by dividing a person's weight in kilograms by height
23    in meters squared.
24        "Chronic  treatment"  means  any   daily   drug   therapy
25    indicated  by  labeling approved by the federal Food and Drug
26    Administration for use for more than 60 days.
27        "Medically  indigent  patients"  means  persons  who  are
28    determined  to  be  eligible  for  medical  assistance  under
29    Article V of the Illinois Public Aid Code.
30        "Obese" means having a body mass index  greater  than  or
31    equal to 30 kilograms per square meter.

32        Section  15.  Anti-obesity  program.  The  Department  of
HB1807 Engrossed            -4-               LRB9204967DJgcA
 1    Public  Health,  in conjunction with the Department of Public
 2    Aid and other appropriate State  agencies,  shall  develop  a
 3    program  to  provide  obese  or  at-risk overweight medically
 4    indigent  patients  with  services  for  the  treatment   and
 5    prevention  of  obesity  and  its related comorbidities.  The
 6    program shall include education, monitoring,  and  outpatient
 7    prescription  drug  coverage  of  anti-obesity drug therapies
 8    that  are  approved  by  the  United  States  Food  and  Drug
 9    Administration if the patient's treating physician prescribes
10    the therapy as  being  medically  necessary  to  his  or  her
11    healthcare.

12        Section  20.  Rules.  The Department of Public Health may
13    adopt rules to enable it to carry out the provisions of  this
14    Act  and  may  coordinate  its  actions  with  other State or
15    federal agencies to comply with this Act.  The provisions  of
16    the  Illinois  Administrative  Procedure  Act  are  expressly
17    adopted  and apply to all administrative rules and procedures
18    adopted by the Department under this Act, except that Section
19    5-35  of  the Illinois Administrative Procedure Act  relating
20    to  procedures  for rule-making  does   not  apply   to   the
21    adoption  of  any  rule required by federal law in connection
22    with  which  the  Department  is  precluded  by    law   from
23    exercising any discretion.

24        Section  90.   The Illinois Public Aid Code is amended by
25    changing Section 5-5 as follows:

26        (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
27        Sec. 5-5.  Medical services. The Illinois Department,  by
28    rule,  shall  determine  the  quantity and quality of and the
29    rate of reimbursement for the medical  assistance  for  which
30    payment  will  be  authorized, and the medical services to be
31    provided, which may include all or part of the following: (1)
HB1807 Engrossed            -5-               LRB9204967DJgcA
 1    inpatient  hospital   services;   (2)   outpatient   hospital
 2    services;  (3)  other  laboratory  and  X-ray  services;  (4)
 3    skilled  nursing  home  services;  (5)  physicians'  services
 4    whether  furnished  in  the  office,  the  patient's  home, a
 5    hospital, a skilled nursing home, or elsewhere;  (6)  medical
 6    care,  or  any  other  type  of  remedial  care  furnished by
 7    licensed practitioners; (7) home health  care  services;  (8)
 8    private  duty  nursing  service;  (9)  clinic  services; (10)
 9    dental services; (11) physical therapy and related  services;
10    (12)  prescribed drugs, dentures, and prosthetic devices; and
11    eyeglasses prescribed by a physician skilled in the  diseases
12    of  the  eye,  or by an optometrist, whichever the person may
13    select; (13) other  diagnostic,  screening,  preventive,  and
14    rehabilitative  services;  (14) transportation and such other
15    expenses as may  be  necessary;  (15)  medical  treatment  of
16    sexual  assault  survivors,  as  defined in Section 1a of the
17    Sexual  Assault  Survivors  Emergency  Treatment   Act,   for
18    injuries  sustained  as  a  result  of  the  sexual  assault,
19    including  examinations  and  laboratory  tests  to  discover
20    evidence  which  may  be used in criminal proceedings arising
21    from the sexual assault; (16) the diagnosis and treatment  of
22    sickle  cell anemia; and (17) any other medical care, and any
23    other type of remedial care recognized under the laws of this
24    State, but not including abortions, or  induced  miscarriages
25    or  premature  births, unless, in the opinion of a physician,
26    such procedures are necessary for  the  preservation  of  the
27    life  of  the  woman  seeking  such  treatment,  or except an
28    induced premature birth intended to  produce  a  live  viable
29    child  and  such procedure is necessary for the health of the
30    mother or her unborn child. The Illinois Department, by rule,
31    shall  prohibit  any   physician   from   providing   medical
32    assistance  to anyone eligible therefor under this Code where
33    such  physician  has  been  found  guilty  of  performing  an
34    abortion procedure in a wilful and wanton manner upon a woman
HB1807 Engrossed            -6-               LRB9204967DJgcA
 1    who was not pregnant at the time such abortion procedure  was
 2    performed.  The  term "any other type of remedial care" shall
 3    include nursing care and nursing home service for persons who
 4    rely on treatment by spiritual means alone through prayer for
 5    healing.
 6        Notwithstanding any other provision of  this  Section,  a
 7    comprehensive  tobacco  use  cessation  program that includes
 8    purchasing prescription drugs or prescription medical devices
 9    approved by the Food and Drug administration shall be covered
10    under the medical assistance program under this  Article  for
11    persons  who are otherwise eligible for assistance under this
12    Article.
13        Notwithstanding any other provision  of  this  Code,  the
14    Illinois  Department  may  not  require,  as  a  condition of
15    payment  for  any  laboratory  test  authorized  under   this
16    Article,  that  a physician's handwritten signature appear on
17    the laboratory test order form.  The Illinois Department may,
18    however,  impose  other  appropriate  requirements  regarding
19    laboratory test order documentation.
20        The Illinois Department of Public Aid shall  provide  the
21    following  services  to persons eligible for assistance under
22    this Article who are participating in education, training  or
23    employment  programs  operated  by  the  Department  of Human
24    Services as successor to the Department of Public Aid:
25             (1)  dental services, which shall include but not be
26        limited to prosthodontics; and
27             (2)  eyeglasses prescribed by a physician skilled in
28        the diseases of the eye, or by an optometrist,  whichever
29        the person may select.
30        The  Illinois  Department  shall provide services for the
31    treatment  and  prevention  of  obesity   and   its   related
32    comorbidities,    including    education,   monitoring,   and
33    outpatient prescription drug coverage  of  anti-obesity  drug
34    therapies  that  are  approved  by the United States Food and
HB1807 Engrossed            -7-               LRB9204967DJgcA
 1    Drug  Administration  if  the  patient's  treating  physician
 2    prescribes the therapy as being medically necessary to his or
 3    her healthcare and the  patient  is  otherwise  eligible  for
 4    medical assistance under this Article.
 5        The  Illinois  Department,  by  rule, may distinguish and
 6    classify  the  medical  services  to  be  provided  only   in
 7    accordance  with the classes of persons designated in Section
 8    5-2.
 9        The Illinois Department shall authorize the provision of,
10    and  shall  authorize  payment  for,  screening  by  low-dose
11    mammography for the presence  of  occult  breast  cancer  for
12    women  35  years of age or older who are eligible for medical
13    assistance  under  this  Article,  as  follows:   a  baseline
14    mammogram for women 35 to 39  years  of  age  and  an  annual
15    mammogram for women 40 years of age or older.  All screenings
16    shall   include   a  physical  breast  exam,  instruction  on
17    self-examination and information regarding the  frequency  of
18    self-examination  and  its  value as a preventative tool.  As
19    used in this Section, "low-dose mammography" means the  x-ray
20    examination   of   the   breast   using  equipment  dedicated
21    specifically  for  mammography,  including  the  x-ray  tube,
22    filter, compression device, image  receptor,  and  cassettes,
23    with  an average radiation exposure delivery of less than one
24    rad mid-breast, with 2 views for each breast.
25        Any medical or health  care  provider  shall  immediately
26    recommend,  to  any  pregnant  woman  who  is  being provided
27    prenatal services and  is  suspected  of  drug  abuse  or  is
28    addicted  as  defined  in the Alcoholism and Other Drug Abuse
29    and Dependency Act,  referral  to  a  local  substance  abuse
30    treatment  provider  licensed  by  the  Department  of  Human
31    Services  or  to a licensed hospital which provides substance
32    abuse treatment services.  The Department of Public Aid shall
33    assure coverage for the cost of treatment of the  drug  abuse
34    or  addiction  for pregnant recipients in accordance with the
HB1807 Engrossed            -8-               LRB9204967DJgcA
 1    Illinois Medicaid Program in conjunction with the  Department
 2    of Human Services.
 3        All  medical  providers  providing  medical assistance to
 4    pregnant women under this Code shall receive information from
 5    the Department on the availability of services under the Drug
 6    Free  Families  with  a  Future  or  any  comparable  program
 7    providing  case  management  services  for  addicted   women,
 8    including  information  on  appropriate  referrals  for other
 9    social services that may  be  needed  by  addicted  women  in
10    addition to treatment for addiction.
11        The   Illinois   Department,   in  cooperation  with  the
12    Departments of Human Services (as successor to the Department
13    of Alcoholism and Substance Abuse) and Public Health, through
14    a  public  awareness  campaign,   may   provide   information
15    concerning  treatment  for  alcoholism  and  drug  abuse  and
16    addiction, prenatal health care, and other pertinent programs
17    directed at reducing the number of drug-affected infants born
18    to recipients of medical assistance.
19        Neither  the  Illinois  Department  of Public Aid nor the
20    Department of Human Services  shall  sanction  the  recipient
21    solely on the basis of her substance abuse.
22        The  Illinois Department shall establish such regulations
23    governing  the  dispensing  of  health  services  under  this
24    Article as it shall deem appropriate.  In  formulating  these
25    regulations  the  Illinois  Department shall consult with and
26    give substantial weight to the recommendations offered by the
27    Citizens  Assembly/Council  on  Public  Aid.  The  Department
28    should  seek  the  advice  of  formal  professional  advisory
29    committees  appointed  by  the  Director  of   the   Illinois
30    Department  for  the  purpose  of providing regular advice on
31    policy and administrative matters, information  dissemination
32    and  educational  activities  for  medical  and  health  care
33    providers,  and  consistency  in  procedures  to the Illinois
34    Department.
HB1807 Engrossed            -9-               LRB9204967DJgcA
 1        The Illinois Department may  develop  and  contract  with
 2    Partnerships of medical providers to arrange medical services
 3    for   persons  eligible  under  Section  5-2  of  this  Code.
 4    Implementation  of  this  Section  may  be  by  demonstration
 5    projects in certain geographic areas.  The Partnership  shall
 6    be represented by a sponsor organization.  The Department, by
 7    rule,   shall   develop   qualifications   for   sponsors  of
 8    Partnerships.  Nothing in this Section shall be construed  to
 9    require   that   the   sponsor   organization  be  a  medical
10    organization.
11        The sponsor must negotiate formal written contracts  with
12    medical  providers  for  physician  services,  inpatient  and
13    outpatient hospital care, home health services, treatment for
14    alcoholism and substance abuse, and other services determined
15    necessary  by the Illinois Department by rule for delivery by
16    Partnerships.  Physician services must include  prenatal  and
17    obstetrical  care.   The  Illinois Department shall reimburse
18    medical  services  delivered  by  Partnership  providers   to
19    clients  in  target  areas  according  to  provisions of this
20    Article and the Illinois Health Finance  Reform  Act,  except
21    that:
22             (1)  Physicians  participating  in a Partnership and
23        providing certain services, which shall be determined  by
24        the  Illinois  Department, to persons in areas covered by
25        the Partnership may receive an additional  surcharge  for
26        such services.
27             (2)  The   Department  may  elect  to  consider  and
28        negotiate   financial   incentives   to   encourage   the
29        development of Partnerships and the efficient delivery of
30        medical care.
31             (3)  Persons  receiving  medical  services   through
32        Partnerships  may  receive  medical  and  case management
33        services above the  level  usually  offered  through  the
34        medical assistance program.
HB1807 Engrossed            -10-              LRB9204967DJgcA
 1        Medical  providers  shall  be  required  to  meet certain
 2    qualifications to participate in Partnerships to  ensure  the
 3    delivery   of   high   quality   medical   services.    These
 4    qualifications  shall  be  determined by rule of the Illinois
 5    Department  and  may  be  higher  than   qualifications   for
 6    participation in the medical assistance program.  Partnership
 7    sponsors  may  prescribe reasonable additional qualifications
 8    for participation by medical providers, only with  the  prior
 9    written approval of the Illinois Department.
10        Nothing  in  this  Section shall limit the free choice of
11    practitioners, hospitals,  and  other  providers  of  medical
12    services  by  clients.  In order to ensure patient freedom of
13    choice, the Illinois Department shall immediately  promulgate
14    all  rules  and  take  all  other  necessary  actions so that
15    provided  services  may  be  accessed  from   therapeutically
16    certified  optometrists  to  the  full extent of the Illinois
17    Optometric  Practice  Act  of  1987  without   discriminating
18    between service providers.
19        The  Department  shall apply for a waiver from the United
20    States Health Care Financing Administration to allow for  the
21    implementation of Partnerships under this Section.
22        The   Illinois   Department  shall  require  health  care
23    providers to maintain records that document the medical  care
24    and  services  provided  to  recipients of Medical Assistance
25    under this Article.  The Illinois  Department  shall  require
26    health  care  providers to make available, when authorized by
27    the patient, in writing, the  medical  records  in  a  timely
28    fashion  to  other  health care providers who are treating or
29    serving persons eligible for Medical  Assistance  under  this
30    Article.    All  dispensers  of  medical  services  shall  be
31    required to maintain and  retain  business  and  professional
32    records  sufficient  to  fully  and  accurately  document the
33    nature,  scope,  details  and  receipt  of  the  health  care
34    provided to persons eligible  for  medical  assistance  under
HB1807 Engrossed            -11-              LRB9204967DJgcA
 1    this  Code, in accordance with regulations promulgated by the
 2    Illinois Department. The rules and regulations shall  require
 3    that  proof  of  the receipt of prescription drugs, dentures,
 4    prosthetic devices and eyeglasses by eligible  persons  under
 5    this Section accompany each claim for reimbursement submitted
 6    by the dispenser of such medical services. No such claims for
 7    reimbursement  shall  be approved for payment by the Illinois
 8    Department without such proof of receipt, unless the Illinois
 9    Department shall have put into effect and shall be  operating
10    a  system  of post-payment audit and review which shall, on a
11    sampling basis, be deemed adequate by the Illinois Department
12    to assure that such drugs, dentures, prosthetic  devices  and
13    eyeglasses for which payment is being made are actually being
14    received  by  eligible  recipients.  Within 90 days after the
15    effective date of this amendatory Act of 1984,  the  Illinois
16    Department  shall  establish  a  current  list of acquisition
17    costs  for  all  prosthetic  devices  and  any  other   items
18    recognized  as  medical  equipment  and supplies reimbursable
19    under this Article and shall update such list on a  quarterly
20    basis,  except that the acquisition costs of all prescription
21    drugs shall be updated no less frequently than every 30  days
22    as required by Section 5-5.12.
23        The  rules  and  regulations  of  the Illinois Department
24    shall require that a written statement including the required
25    opinion  of  a  physician  shall  accompany  any  claim   for
26    reimbursement  for  abortions,  or  induced  miscarriages  or
27    premature   births.    This  statement  shall  indicate  what
28    procedures were used in providing such medical services.
29        The Illinois Department shall require that all dispensers
30    of medical services, other than an individual practitioner or
31    group  of  practitioners,  desiring  to  participate  in  the
32    Medical Assistance program established under this Article  to
33    disclose all financial, beneficial, ownership, equity, surety
34    or  other  interests  in  any  and  all  firms, corporations,
HB1807 Engrossed            -12-              LRB9204967DJgcA
 1    partnerships,  associations,  business   enterprises,   joint
 2    ventures,  agencies,  institutions  or  other  legal entities
 3    providing any form of health  care  services  in  this  State
 4    under this Article.
 5        The  Illinois  Department may require that all dispensers
 6    of medical services desiring to participate  in  the  medical
 7    assistance  program  established under this Article disclose,
 8    under such terms and conditions as  the  Illinois  Department
 9    may  by  rule  establish,  all  inquiries  from  clients  and
10    attorneys  regarding  medical  bills  paid  by  the  Illinois
11    Department,   which   inquiries   could   indicate  potential
12    existence of claims or liens for the Illinois Department.
13        The  Illinois  Department   shall   establish   policies,
14    procedures,   standards   and   criteria   by  rule  for  the
15    acquisition,  repair  and   replacement   of   orthotic   and
16    prosthetic devices and durable medical equipment.  Such rules
17    shall provide, but not be limited to, the following services:
18    (1)  immediate  repair  or  replacement  of  such  devices by
19    recipients without medical  authorization;  and  (2)  rental,
20    lease,   purchase   or   lease-purchase  of  durable  medical
21    equipment   in   a   cost-effective   manner,   taking   into
22    consideration the recipient's medical prognosis,  the  extent
23    of  the recipient's needs, and the requirements and costs for
24    maintaining  such  equipment.   Such  rules  shall  enable  a
25    recipient to  temporarily  acquire  and  use  alternative  or
26    substitute   devices   or   equipment   pending   repairs  or
27    replacements of any device or equipment previously authorized
28    for such recipient by the Department. Rules under clause  (2)
29    above  shall  not  provide  for purchase or lease-purchase of
30    durable medical equipment or supplies used for the purpose of
31    oxygen delivery and respiratory care.
32        The Department shall execute,  relative  to  the  nursing
33    home  prescreening  project,  written inter-agency agreements
34    with the Department of Human Services and the  Department  on
HB1807 Engrossed            -13-              LRB9204967DJgcA
 1    Aging,  to  effect  the  following: (i) intake procedures and
 2    common  eligibility  criteria  for  those  persons  who   are
 3    receiving    non-institutional   services;   and   (ii)   the
 4    establishment and development of  non-institutional  services
 5    in  areas of the State where they are not currently available
 6    or are undeveloped.
 7        The Illinois Department shall  develop  and  operate,  in
 8    cooperation  with other State Departments and agencies and in
 9    compliance with  applicable  federal  laws  and  regulations,
10    appropriate  and  effective systems of health care evaluation
11    and programs for monitoring of  utilization  of  health  care
12    services  and  facilities, as it affects persons eligible for
13    medical assistance under this Code. The  Illinois  Department
14    shall  report  regularly the results of the operation of such
15    systems and programs  to  the  Citizens  Assembly/Council  on
16    Public  Aid  to  enable the Committee to ensure, from time to
17    time, that these programs are effective and meaningful.
18        The Illinois Department  shall  report  annually  to  the
19    General Assembly, no later than the second Friday in April of
20    1979 and each year thereafter, in regard to:
21             (a)  actual  statistics and trends in utilization of
22        medical services by public aid recipients;
23             (b)  actual statistics and trends in  the  provision
24        of the various medical services by medical vendors;
25             (c)  current rate structures and proposed changes in
26        those  rate  structures  for the various medical vendors;
27        and
28             (d)  efforts at utilization review  and  control  by
29        the Illinois Department.
30        The  period  covered  by each report shall be the 3 years
31    ending on the June 30 prior to the report.  The report  shall
32    include   suggested  legislation  for  consideration  by  the
33    General Assembly.  The filing of one copy of the report  with
34    the  Speaker,  one copy with the Minority Leader and one copy
HB1807 Engrossed            -14-              LRB9204967DJgcA
 1    with the Clerk of the House of Representatives, one copy with
 2    the President, one copy with the Minority Leader and one copy
 3    with  the  Secretary  of  the  Senate,  one  copy  with   the
 4    Legislative  Research  Unit,  such additional copies with the
 5    State Government Report Distribution Center for  the  General
 6    Assembly  as  is required under paragraph (t) of Section 7 of
 7    the  State  Library  Act  and  one  copy  with  the  Citizens
 8    Assembly/Council on Public Aid  or  its  successor  shall  be
 9    deemed sufficient to comply with this Section.
10    (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344,
11    eff.  1-1-00;  91-462,  eff.  8-6-99;  91-666, eff. 12-22-99;
12    revised 1-6-00.) 4967

13        Section 99.  Effective date.  This Act takes effect  upon
14    becoming law.

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