101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3503

 

Introduced , by Rep. Natalie A. Manley

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.30a new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage for hearing instruments and related services for all individuals 65 years of age and older when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for hearing instruments subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 24 months prior to the date of filing the claim with the insurer and the claim was paid by any insurer.


LRB101 09822 AMC 54924 b

 

 

A BILL FOR

 

HB3503LRB101 09822 AMC 54924 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 100-1170)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
17356z.29, and 356z.32 of the Illinois Insurance Code. The
18program of health benefits must comply with Sections 155.22a,
19155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
81-8-19.)
 
9    (Text of Section after amendment by P.A. 100-1170)
10    Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
19356z.30a, and 356z.32 of the Illinois Insurance Code. The
20program of health benefits must comply with Sections 155.22a,
21155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section with respect to Sections 370c and
24370c.1 of the Illinois Insurance Code; all other requirements
25of this Section shall be enforced by the Department of Central

 

 

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1Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
11100-1170, eff. 6-1-19.)
 
12    Section 10. The Counties Code is amended by changing
13Section 5-1069.3 as follows:
 
14    (55 ILCS 5/5-1069.3)
15    Sec. 5-1069.3. Required health benefits. If a county,
16including a home rule county, is a self-insurer for purposes of
17providing health insurance coverage for its employees, the
18coverage shall include coverage for the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
22356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
23356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
24356z.30a, and 356z.32 of the Illinois Insurance Code. The

 

 

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1coverage shall comply with Sections 155.22a, 355b, 356z.19, and
2370c of the Illinois Insurance Code. The Department of
3Insurance shall enforce the requirements of this Section. The
4requirement that health benefits be covered as provided in this
5Section is an exclusive power and function of the State and is
6a denial and limitation under Article VII, Section 6,
7subsection (h) of the Illinois Constitution. A home rule county
8to which this Section applies must comply with every provision
9of this Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, 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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
17100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
181-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1910-3-18.)
 
20    Section 15. The Illinois Municipal Code is amended by
21changing Section 10-4-2.3 as follows:
 
22    (65 ILCS 5/10-4-2.3)
23    Sec. 10-4-2.3. Required health benefits. If a
24municipality, including a home rule municipality, is a

 

 

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1self-insurer for purposes of providing health insurance
2coverage for its employees, the coverage shall include coverage
3for the post-mastectomy care benefits required to be covered by
4a policy of accident and health insurance under Section 356t
5and the coverage required under Sections 356g, 356g.5,
6356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
7356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
8and 356z.26, and 356z.29, 356z.30a, and 356z.32 of the Illinois
9Insurance Code. The coverage shall comply with Sections
10155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
11Code. The Department of Insurance shall enforce the
12requirements of this Section. The requirement that health
13benefits be covered as provided in this is an exclusive power
14and function of the State and is a denial and limitation under
15Article VII, Section 6, subsection (h) of the Illinois
16Constitution. A home rule municipality to which this Section
17applies must comply with every provision of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
25100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
261-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised

 

 

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110-4-18.)
 
2    Section 20. The School Code is amended by changing Section
310-22.3f as follows:
 
4    (105 ILCS 5/10-22.3f)
5    Sec. 10-22.3f. Required health benefits. Insurance
6protection and benefits for employees shall provide the
7post-mastectomy care benefits required to be covered by a
8policy of accident and health insurance under Section 356t and
9the coverage required under Sections 356g, 356g.5, 356g.5-1,
10356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
12356z.29, 356z.30a, and 356z.32 of the Illinois Insurance Code.
13Insurance policies shall comply with Section 356z.19 of the
14Illinois Insurance Code. The coverage shall comply with
15Sections 155.22a, 355b, and 370c of the Illinois Insurance
16Code. The Department of Insurance shall enforce the
17requirements of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
3    Section 25. The Illinois Insurance Code is amended by
4adding Section 356z.30a as follows:
 
5    (215 ILCS 5/356z.30a new)
6    Sec. 356z.30a. Coverage for hearing instruments.
7    (a) As used in this Section:
8    "Hearing care professional" means a person who is a
9licensed audiologist or a licensed physician.
10    "Hearing instrument" means any wearable non-disposable
11instrument or device designed to aid or compensate for impaired
12human hearing and any parts, attachments, or accessories for
13the instrument or device, including an ear mold but excluding
14batteries and cords.
15    "Related services" means those services necessary to
16assess, select, and adjust or fit the hearing instrument to
17ensure optimal performance, including, but not limited to:
18audiological exams, replacement ear molds, and repairs to the
19hearing instrument.
20    (b) An individual or group policy of accident and health
21insurance or managed care plan that is amended, delivered,
22issued, or renewed after the effective date of this amendatory
23Act of the 101st General Assembly must provide coverage for
24hearing instruments and related services for all individuals 65

 

 

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1years of age and older when a hearing care professional
2prescribes a hearing instrument to augment communication.
3    (c) An insurer shall provide coverage, subject to all
4applicable copayments, coinsurance, deductibles, and
5out-of-pocket limits for the cost of a hearing instrument for
6each ear, as needed, as well as related services, with a
7maximum for the hearing instrument and related services of no
8less than $1,500 per hearing instrument every 24 months.
9    (d) An insurer shall not be required to pay a claim filed
10by its insured for the payment of the cost of a hearing
11instrument covered by this Section if less than 24 months
12before the date of the claim its insured filed a claim for
13payment of the cost of the hearing instrument and the claim was
14paid by the insurer.
 
15    Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
 
17    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
18    Sec. 5-3. Insurance Code provisions.
19    (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
23355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
24356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,

 

 

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1356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
2356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a,
3356z.32, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
4368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
5408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
6(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
7XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
8    (b) For purposes of the Illinois Insurance Code, except for
9Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
10Maintenance Organizations in the following categories are
11deemed to be "domestic companies":
12        (1) a corporation authorized under the Dental Service
13    Plan Act or the Voluntary Health Services Plans Act;
14        (2) a corporation organized under the laws of this
15    State; or
16        (3) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a "domestic company" under Article VIII
21    1/2 of the Illinois Insurance Code.
22    (c) In considering the merger, consolidation, or other
23acquisition of control of a Health Maintenance Organization
24pursuant to Article VIII 1/2 of the Illinois Insurance Code,
25        (1) the Director shall give primary consideration to
26    the continuation of benefits to enrollees and the financial

 

 

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

 

 

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

 

 

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

 

 

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1profitable experience with respect to the group or enrollment
2unit and the resulting refund to the group or enrollment unit
3or (2) the Health Maintenance Organization's unprofitable
4experience with respect to the group or enrollment unit and the
5resulting additional premium to be paid by the group or
6enrollment unit.
7    In no event shall the Illinois Health Maintenance
8Organization Guaranty Association be liable to pay any
9contractual obligation of an insolvent organization to pay any
10refund authorized under this Section.
11    (g) Rulemaking authority to implement Public Act 95-1045,
12if any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
18100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
198-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2010-4-18.)
 
21    Section 35. The Limited Health Service Organization Act is
22amended by changing Section 4003 as follows:
 
23    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
24    Sec. 4003. Illinois Insurance Code provisions. Limited

 

 

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1health service organizations shall be subject to the provisions
2of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
3143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
4154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
5356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
6356z.30a, 356z.32, 368a, 401, 401.1, 402, 403, 403A, 408,
7408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2,
8XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
9Insurance Code. For purposes of the Illinois Insurance Code,
10except for Sections 444 and 444.1 and Articles XIII and XIII
111/2, limited health service organizations in the following
12categories are deemed to be domestic companies:
13        (1) a corporation under the laws of this State; or
14        (2) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a domestic company under Article VIII
19    1/2 of the Illinois Insurance Code.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
23    Section 40. The Voluntary Health Services Plans Act is
24amended by changing Section 10 as follows:
 

 

 

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1    (215 ILCS 165/10)  (from Ch. 32, par. 604)
2    Sec. 10. Application of Insurance Code provisions. Health
3services plan corporations and all persons interested therein
4or dealing therewith shall be subject to the provisions of
5Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
6143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
7356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
8356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
9356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
10356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
11356z.30a, 356z.32, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
12403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
13Section 367 of the Illinois Insurance Code.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
23    Section 45. The Illinois Public Aid Code is amended by
24changing Section 5-16.8 as follows:
 

 

 

HB3503- 16 -LRB101 09822 AMC 54924 b

1    (305 ILCS 5/5-16.8)
2    Sec. 5-16.8. Required health benefits. The medical
3assistance program shall (i) provide the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
7356z.29, 356z.30a, and 356z.32 of the Illinois Insurance Code
8and (ii) be subject to the provisions of Sections 356z.19,
9364.01, 370c, and 370c.1 of the Illinois Insurance Code.
10    On and after July 1, 2012, the Department shall reduce any
11rate of reimbursement for services or other payments or alter
12any methodologies authorized by this Code to reduce any rate of
13reimbursement for services or other payments in accordance with
14Section 5-5e.
15    To ensure full access to the benefits set forth in this
16Section, on and after January 1, 2016, the Department shall
17ensure that provider and hospital reimbursement for
18post-mastectomy care benefits required under this Section are
19no lower than the Medicare reimbursement rate.
20(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
2199-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
228-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2310-4-18.)
 
24    Section 95. No acceleration or delay. Where this Act makes
25changes in a statute that is represented in this Act by text

 

 

HB3503- 17 -LRB101 09822 AMC 54924 b

1that is not yet or no longer in effect (for example, a Section
2represented by multiple versions), the use of that text does
3not accelerate or delay the taking effect of (i) the changes
4made by this Act or (ii) provisions derived from any other
5Public Act.