HB1530 EnrolledLRB097 09356 RPM 49491 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 370c and by adding Section 370c.1 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
9Act of the 97th General Assembly Section, every insurer which
10amends, delivers, issues, or renews delivers, issues for
11delivery or renews or modifies group accident and health A&H
12policies providing coverage for hospital or medical treatment
13or services for illness on an expense-incurred basis shall
14offer to the applicant or group policyholder subject to the
15insurer's insurers standards of insurability, coverage for
16reasonable and necessary treatment and services for mental,
17emotional or nervous disorders or conditions, other than
18serious mental illnesses as defined in item (2) of subsection
19(b), consistent with the parity requirements of Section 370c.1
20of this Code up to the limits provided in the policy for other
21disorders or conditions, except (i) the insured may be required
22to pay up to 50% of expenses incurred as a result of the
23treatment or services, and (ii) the annual benefit limit may be

 

 

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1limited to the lesser of $10,000 or 25% of the lifetime policy
2limit.
3    (2) Each insured that is covered for mental, emotional, or
4nervous, or substance use disorders or conditions shall be free
5to select the physician licensed to practice medicine in all
6its branches, licensed clinical psychologist, licensed
7clinical social worker, licensed clinical professional
8counselor, or licensed marriage and family therapist, licensed
9speech-language pathologist, or other licensed or certified
10professional at a program licensed pursuant to the Illinois
11Alcoholism and Other Drug Abuse and Dependency Act of his
12choice to treat such disorders, and the insurer shall pay the
13covered charges of such physician licensed to practice medicine
14in all its branches, licensed clinical psychologist, licensed
15clinical social worker, licensed clinical professional
16counselor, or licensed marriage and family therapist, licensed
17speech-language pathologist, or other licensed or certified
18professional at a program licensed pursuant to the Illinois
19Alcoholism and Other Drug Abuse and Dependency Act up to the
20limits of coverage, provided (i) the disorder or condition
21treated is covered by the policy, and (ii) the physician,
22licensed psychologist, licensed clinical social worker,
23licensed clinical professional counselor, or licensed marriage
24and family therapist, licensed speech-language pathologist, or
25other licensed or certified professional at a program licensed
26pursuant to the Illinois Alcoholism and Other Drug Abuse and

 

 

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1Dependency Act is authorized to provide said services under the
2statutes of this State and in accordance with accepted
3principles of his profession.
4    (3) Insofar as this Section applies solely to licensed
5clinical social workers, licensed clinical professional
6counselors, and licensed marriage and family therapists,
7licensed speech-language pathologists, and other licensed or
8certified professionals at programs licensed pursuant to the
9Illinois Alcoholism and Other Drug Abuse and Dependency Act,
10those persons who may provide services to individuals shall do
11so after the licensed clinical social worker, licensed clinical
12professional counselor, or licensed marriage and family
13therapist, licensed speech-language pathologist, or other
14licensed or certified professional at a program licensed
15pursuant to the Illinois Alcoholism and Other Drug Abuse and
16Dependency Act has informed the patient of the desirability of
17the patient conferring with the patient's primary care
18physician and the licensed clinical social worker, licensed
19clinical professional counselor, or licensed marriage and
20family therapist, licensed speech-language pathologist, or
21other licensed or certified professional at a program licensed
22pursuant to the Illinois Alcoholism and Other Drug Abuse and
23Dependency Act has provided written notification to the
24patient's primary care physician, if any, that services are
25being provided to the patient. That notification may, however,
26be waived by the patient on a written form. Those forms shall

 

 

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1be retained by the licensed clinical social worker, licensed
2clinical professional counselor, or licensed marriage and
3family therapist, licensed speech-language pathologist, or
4other licensed or certified professional at a program licensed
5pursuant to the Illinois Alcoholism and Other Drug Abuse and
6Dependency Act for a period of not less than 5 years.
7    (b) (1) An insurer that provides coverage for hospital or
8medical expenses under a group policy of accident and health
9insurance or health care plan amended, delivered, issued, or
10renewed on or after the effective date of this amendatory Act
11of the 97th 92nd General Assembly shall provide coverage under
12the policy for treatment of serious mental illness and
13substance use disorders consistent with the parity
14requirements of Section 370c.1 of this Code under the same
15terms and conditions as coverage for hospital or medical
16expenses related to other illnesses and diseases. The coverage
17required under this Section must provide for same durational
18limits, amount limits, deductibles, and co-insurance
19requirements for serious mental illness as are provided for
20other illnesses and diseases. This subsection does not apply to
21any group policy of accident and health insurance or health
22care plan for any plan year of a small employer as defined in
23Section 5 of the Illinois Health Insurance Portability and
24Accountability Act coverage provided to employees by employers
25who have 50 or fewer employees.
26    (2) "Serious mental illness" means the following

 

 

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1psychiatric illnesses as defined in the most current edition of
2the Diagnostic and Statistical Manual (DSM) published by the
3American Psychiatric Association:
4        (A) schizophrenia;
5        (B) paranoid and other psychotic disorders;
6        (C) bipolar disorders (hypomanic, manic, depressive,
7    and mixed);
8        (D) major depressive disorders (single episode or
9    recurrent);
10        (E) schizoaffective disorders (bipolar or depressive);
11        (F) pervasive developmental disorders;
12        (G) obsessive-compulsive disorders;
13        (H) depression in childhood and adolescence;
14        (I) panic disorder;
15        (J) post-traumatic stress disorders (acute, chronic,
16    or with delayed onset); and
17        (K) anorexia nervosa and bulimia nervosa.
18    (2.5) "Substance use disorder" means the following mental
19disorders as defined in the most current edition of the
20Diagnostic and Statistical Manual (DSM) published by the
21American Psychiatric Association:
22        (A) substance abuse disorders;
23        (B) substance dependence disorders; and
24        (C) substance induced disorders.
25    (3) Unless otherwise prohibited by federal law and
26consistent with the parity requirements of Section 370c.1 of

 

 

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1this Code, Upon request of the reimbursing insurer, a provider
2of treatment of serious mental illness or substance use
3disorder shall furnish medical records or other necessary data
4that substantiate that initial or continued treatment is at all
5times medically necessary. An insurer shall provide a mechanism
6for the timely review by a provider holding the same license
7and practicing in the same specialty as the patient's provider,
8who is unaffiliated with the insurer, jointly selected by the
9patient (or the patient's next of kin or legal representative
10if the patient is unable to act for himself or herself), the
11patient's provider, and the insurer in the event of a dispute
12between the insurer and patient's provider regarding the
13medical necessity of a treatment proposed by a patient's
14provider. If the reviewing provider determines the treatment to
15be medically necessary, the insurer shall provide
16reimbursement for the treatment. Future contractual or
17employment actions by the insurer regarding the patient's
18provider may not be based on the provider's participation in
19this procedure. Nothing prevents the insured from agreeing in
20writing to continue treatment at his or her expense. When
21making a determination of the medical necessity for a treatment
22modality for serious serous mental illness or substance use
23disorder, an insurer must make the determination in a manner
24that is consistent with the manner used to make that
25determination with respect to other diseases or illnesses
26covered under the policy, including an appeals process. Medical

 

 

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1necessity determinations for substance use disorders shall be
2made in accordance with appropriate patient placement criteria
3established by the American Society of Addiction Medicine.
4    (4) A group health benefit plan amended, delivered, issued,
5or renewed on or after the effective date of this amendatory
6Act of the 97th General Assembly:
7        (A) shall provide coverage based upon medical
8    necessity for the following treatment of mental illness and
9    substance use disorders consistent with the parity
10    requirements of Section 370c.1 of this Code; provided,
11    however, that in each calendar year coverage shall not be
12    less than the following:
13            (i) 45 days of inpatient treatment; and
14            (ii) beginning on June 26, 2006 (the effective date
15        of Public Act 94-921), 60 visits for outpatient
16        treatment including group and individual outpatient
17        treatment; and
18            (iii) for plans or policies delivered, issued for
19        delivery, renewed, or modified after January 1, 2007
20        (the effective date of Public Act 94-906), 20
21        additional outpatient visits for speech therapy for
22        treatment of pervasive developmental disorders that
23        will be in addition to speech therapy provided pursuant
24        to item (ii) of this subparagraph (A); and
25        (B) may not include a lifetime limit on the number of
26    days of inpatient treatment or the number of outpatient

 

 

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1    visits covered under the plan. ; and
2        (C) (Blank). shall include the same amount limits,
3    deductibles, copayments, and coinsurance factors for
4    serious mental illness as for physical illness.
5    (5) An issuer of a group health benefit plan may not count
6toward the number of outpatient visits required to be covered
7under this Section an outpatient visit for the purpose of
8medication management and shall cover the outpatient visits
9under the same terms and conditions as it covers outpatient
10visits for the treatment of physical illness.
11    (6) An issuer of a group health benefit plan may provide or
12offer coverage required under this Section through a managed
13care plan.
14    (7) (Blank). This Section shall not be interpreted to
15require a group health benefit plan to provide coverage for
16treatment of:
17        (A) an addiction to a controlled substance or cannabis
18    that is used in violation of law; or
19        (B) mental illness resulting from the use of a
20    controlled substance or cannabis in violation of law.
21    (8) (Blank).
22    (9) With respect to substance use disorders, coverage for
23inpatient treatment shall include coverage for treatment in a
24residential treatment center licensed by the Department of
25Public Health or the Department of Human Services, Division of
26Alcoholism and Substance Abuse.

 

 

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1    (c) This Section shall not be interpreted to require
2coverage for speech therapy or other habilitative services for
3those individuals covered under Section 356z.15 of this Code.
4(Source: P.A. 95-331, eff. 8-21-07; 95-972, eff. 9-22-08;
595-973, eff. 1-1-09; 95-1049, eff. 1-1-10; 96-328, eff.
68-11-09; 96-1000, eff. 7-2-10.)
 
7    (215 ILCS 5/370c.1 new)
8    Sec. 370c.1. Mental health parity.
9    (a) On and after the effective date of this amendatory Act
10of the 97th General Assembly, every insurer that amends,
11delivers, issues, or renews a group policy of accident and
12health insurance in this State providing coverage for hospital
13or medical treatment and for the treatment of mental,
14emotional, nervous, or substance use disorders or conditions
15shall ensure that:
16        (1) the financial requirements applicable to such
17    mental, emotional, nervous, or substance use disorder or
18    condition benefits are no more restrictive than the
19    predominant financial requirements applied to
20    substantially all hospital and medical benefits covered by
21    the policy and that there are no separate cost-sharing
22    requirements that are applicable only with respect to
23    mental, emotional, nervous, or substance use disorder or
24    condition benefits; and
25        (2) the treatment limitations applicable to such

 

 

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1    mental, emotional, nervous, or substance use disorder or
2    condition benefits are no more restrictive than the
3    predominant treatment limitations applied to substantially
4    all hospital and medical benefits covered by the policy and
5    that there are no separate treatment limitations that are
6    applicable only with respect to mental, emotional,
7    nervous, or substance use disorder or condition benefits.
8    (b) The following provisions shall apply concerning
9aggregate lifetime limits:
10        (1) In the case of a group policy of accident and
11    health insurance amended, delivered, issued, or renewed in
12    this State on or after the effective date of this
13    amendatory Act of the 97th General Assembly that provides
14    coverage for hospital or medical treatment and for the
15    treatment of mental, emotional, nervous, or substance use
16    disorders or conditions the following provisions shall
17    apply:
18            (A) if the policy does not include an aggregate
19        lifetime limit on substantially all hospital and
20        medical benefits, then the policy may not impose any
21        aggregate lifetime limit on mental, emotional,
22        nervous, or substance use disorder or condition
23        benefits; or
24            (B) if the policy includes an aggregate lifetime
25        limit on substantially all hospital and medical
26        benefits (in this subsection referred to as the

 

 

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1        "applicable lifetime limit"), then the policy shall
2        either:
3                (i) apply the applicable lifetime limit both
4            to the hospital and medical benefits to which it
5            otherwise would apply and to mental, emotional,
6            nervous, or substance use disorder or condition
7            benefits and not distinguish in the application of
8            the limit between the hospital and medical
9            benefits and mental, emotional, nervous, or
10            substance use disorder or condition benefits; or
11                (ii) not include any aggregate lifetime limit
12            on mental, emotional, nervous, or substance use
13            disorder or condition benefits that is less than
14            the applicable lifetime limit.
15        (2) In the case of a policy that is not described in
16    paragraph (1) of subsection (b) of this Section and that
17    includes no or different aggregate lifetime limits on
18    different categories of hospital and medical benefits, the
19    Director shall establish rules under which subparagraph
20    (B) of paragraph (1) of subsection (b) of this Section is
21    applied to such policy with respect to mental, emotional,
22    nervous, or substance use disorder or condition benefits by
23    substituting for the applicable lifetime limit an average
24    aggregate lifetime limit that is computed taking into
25    account the weighted average of the aggregate lifetime
26    limits applicable to such categories.

 

 

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1    (c) The following provisions shall apply concerning annual
2limits:
3        (1) In the case of a group policy of accident and
4    health insurance amended, delivered, issued, or renewed in
5    this State on or after the effective date of this
6    amendatory Act of the 97th General Assembly that provides
7    coverage for hospital or medical treatment and for the
8    treatment of mental, emotional, nervous, or substance use
9    disorders or conditions the following provisions shall
10    apply:
11            (A) if the policy does not include an annual limit
12        on substantially all hospital and medical benefits,
13        then the policy may not impose any annual limits on
14        mental, emotional, nervous, or substance use disorder
15        or condition benefits; or
16            (B) if the policy includes an annual limit on
17        substantially all hospital and medical benefits (in
18        this subsection referred to as the "applicable annual
19        limit"), then the policy shall either:
20                (i) apply the applicable annual limit both to
21            the hospital and medical benefits to which it
22            otherwise would apply and to mental, emotional,
23            nervous, or substance use disorder or condition
24            benefits and not distinguish in the application of
25            the limit between the hospital and medical
26            benefits and mental, emotional, nervous, or

 

 

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1            substance use disorder or condition benefits; or
2                (ii) not include any annual limit on mental,
3            emotional, nervous, or substance use disorder or
4            condition benefits that is less than the
5            applicable annual limit.
6        (2) In the case of a policy that is not described in
7    paragraph (1) of subsection (c) of this Section and that
8    includes no or different annual limits on different
9    categories of hospital and medical benefits, the Director
10    shall establish rules under which subparagraph (B) of
11    paragraph (1) of subsection (c) of this Section is applied
12    to such policy with respect to mental, emotional, nervous,
13    or substance use disorder or condition benefits by
14    substituting for the applicable annual limit an average
15    annual limit that is computed taking into account the
16    weighted average of the annual limits applicable to such
17    categories.
18    (d) This Section shall be interpreted in a manner
19consistent with the interim final regulations promulgated by
20the U.S. Department of Health and Human Services at 75 FR 5410,
21including the prohibition against applying a cumulative
22financial requirement or cumulative quantitative treatment
23limitation for mental, emotional, nervous, or substance use
24disorder benefits that accumulates separately from any
25cumulative financial requirement or cumulative quantitative
26treatment limitation established for hospital and medical

 

 

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1benefits in the same classification.
2    (e) The provisions of subsections (b) and (c) of this
3Section shall not be interpreted to allow the use of lifetime
4or annual limits otherwise prohibited by State or federal law.
5    (f) This Section shall not apply to individual health
6insurance coverage as defined in Section 5 of the Illinois
7Health Insurance Portability and Accountability Act.
8    (g) As used in this Section:
9    "Financial requirement" includes deductibles, copayments,
10coinsurance, and out-of-pocket maximums, but does not include
11an aggregate lifetime limit or an annual limit subject to
12subsections (b) and (c).
13    "Treatment limitation" includes limits on benefits based
14on the frequency of treatment, number of visits, days of
15coverage, days in a waiting period, or other similar limits on
16the scope or duration of treatment. "Treatment limitation"
17includes both quantitative treatment limitations, which are
18expressed numerically (such as 50 outpatient visits per year),
19and nonquantitative treatment limitations, which otherwise
20limit the scope or duration of treatment. A permanent exclusion
21of all benefits for a particular condition or disorder shall
22not be considered a treatment limitation.
 
23    Section 10. The Health Maintenance Organization Act is
24amended by changing Section 5-3 as follows:
 

 

 

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1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
5141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
6154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
7356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
8356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
9356z.18, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
10368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
11409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
12Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
13XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
14    (b) For purposes of the Illinois Insurance Code, except for
15Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
16Maintenance Organizations in the following categories are
17deemed to be "domestic companies":
18        (1) a corporation authorized under the Dental Service
19    Plan Act or the Voluntary Health Services Plans Act;
20        (2) a corporation organized under the laws of this
21    State; or
22        (3) a corporation organized under the laws of another
23    state, 30% or more of the enrollees of which are residents
24    of this State, except a corporation subject to
25    substantially the same requirements in its state of
26    organization as is a "domestic company" under Article VIII

 

 

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1    1/2 of the Illinois Insurance Code.
2    (c) In considering the merger, consolidation, or other
3acquisition of control of a Health Maintenance Organization
4pursuant to Article VIII 1/2 of the Illinois Insurance Code,
5        (1) the Director shall give primary consideration to
6    the continuation of benefits to enrollees and the financial
7    conditions of the acquired Health Maintenance Organization
8    after the merger, consolidation, or other acquisition of
9    control takes effect;
10        (2)(i) the criteria specified in subsection (1)(b) of
11    Section 131.8 of the Illinois Insurance Code shall not
12    apply and (ii) the Director, in making his determination
13    with respect to the merger, consolidation, or other
14    acquisition of control, need not take into account the
15    effect on competition of the merger, consolidation, or
16    other acquisition of control;
17        (3) the Director shall have the power to require the
18    following information:
19            (A) certification by an independent actuary of the
20        adequacy of the reserves of the Health Maintenance
21        Organization sought to be acquired;
22            (B) pro forma financial statements reflecting the
23        combined balance sheets of the acquiring company and
24        the Health Maintenance Organization sought to be
25        acquired as of the end of the preceding year and as of
26        a date 90 days prior to the acquisition, as well as pro

 

 

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1        forma financial statements reflecting projected
2        combined operation for a period of 2 years;
3            (C) a pro forma business plan detailing an
4        acquiring party's plans with respect to the operation
5        of the Health Maintenance Organization sought to be
6        acquired for a period of not less than 3 years; and
7            (D) such other information as the Director shall
8        require.
9    (d) The provisions of Article VIII 1/2 of the Illinois
10Insurance Code and this Section 5-3 shall apply to the sale by
11any health maintenance organization of greater than 10% of its
12enrollee population (including without limitation the health
13maintenance organization's right, title, and interest in and to
14its health care certificates).
15    (e) In considering any management contract or service
16agreement subject to Section 141.1 of the Illinois Insurance
17Code, the Director (i) shall, in addition to the criteria
18specified in Section 141.2 of the Illinois Insurance Code, take
19into account the effect of the management contract or service
20agreement on the continuation of benefits to enrollees and the
21financial condition of the health maintenance organization to
22be managed or serviced, and (ii) need not take into account the
23effect of the management contract or service agreement on
24competition.
25    (f) Except for small employer groups as defined in the
26Small Employer Rating, Renewability and Portability Health

 

 

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1Insurance Act and except for medicare supplement policies as
2defined in Section 363 of the Illinois Insurance Code, a Health
3Maintenance Organization may by contract agree with a group or
4other enrollment unit to effect refunds or charge additional
5premiums under the following terms and conditions:
6        (i) the amount of, and other terms and conditions with
7    respect to, the refund or additional premium are set forth
8    in the group or enrollment unit contract agreed in advance
9    of the period for which a refund is to be paid or
10    additional premium is to be charged (which period shall not
11    be less than one year); and
12        (ii) the amount of the refund or additional premium
13    shall not exceed 20% of the Health Maintenance
14    Organization's profitable or unprofitable experience with
15    respect to the group or other enrollment unit for the
16    period (and, for purposes of a refund or additional
17    premium, the profitable or unprofitable experience shall
18    be calculated taking into account a pro rata share of the
19    Health Maintenance Organization's administrative and
20    marketing expenses, but shall not include any refund to be
21    made or additional premium to be paid pursuant to this
22    subsection (f)). The Health Maintenance Organization and
23    the group or enrollment unit may agree that the profitable
24    or unprofitable experience may be calculated taking into
25    account the refund period and the immediately preceding 2
26    plan years.

 

 

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1    The Health Maintenance Organization shall include a
2statement in the evidence of coverage issued to each enrollee
3describing the possibility of a refund or additional premium,
4and upon request of any group or enrollment unit, provide to
5the group or enrollment unit a description of the method used
6to calculate (1) the Health Maintenance Organization's
7profitable experience with respect to the group or enrollment
8unit and the resulting refund to the group or enrollment unit
9or (2) the Health Maintenance Organization's unprofitable
10experience with respect to the group or enrollment unit and the
11resulting additional premium to be paid by the group or
12enrollment unit.
13    In no event shall the Illinois Health Maintenance
14Organization Guaranty Association be liable to pay any
15contractual obligation of an insolvent organization to pay any
16refund authorized under this Section.
17    (g) Rulemaking authority to implement Public Act 95-1045,
18if any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
2495-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
2595-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
261-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.

 

 

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16-1-10; 96-1000, eff. 7-2-10.)
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.