Full Text of SB3743 96th General Assembly
SB3743sam001 96TH GENERAL ASSEMBLY
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Sen. Christine Radogno
Filed: 2/26/2010
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| AMENDMENT TO SENATE BILL 3743
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| AMENDMENT NO. ______. Amend Senate Bill 3743 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 1. Short title. This Act may be cited as the Long | 5 |
| Term Acute Care Hospital Quality Improvement Transfer Program | 6 |
| Act. | 7 |
| Section 5. Purpose of Act. The General Assembly finds that | 8 |
| it is vital for the State of Illinois to find methods to | 9 |
| improve the health care outcomes of patients served by the | 10 |
| healthcare programs operated by the Department of Healthcare | 11 |
| and Family Services. Improving a patient's health not only | 12 |
| benefits the patient's quality of life but also results in a | 13 |
| more efficient use of the resources needed to provide care. | 14 |
| Estimates show that the Long Term Acute Care Hospital Quality | 15 |
| Improvement Transfer Program established under this Act could | 16 |
| save approximately $10,000,000 annually. The program focuses |
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| on some of the most severely injured and ill patients in the | 2 |
| State of Illinois. It is designed to better utilize the | 3 |
| specialized services available in the State to improve these | 4 |
| patients' health outcomes and to enhance the continuity and | 5 |
| coordination of care for these patients. This program serves as | 6 |
| one of the many pieces needed to reform the State of Illinois' | 7 |
| healthcare programs to better serve the people of the State of | 8 |
| Illinois. | 9 |
| Section 10. Definitions. As used in this Act: | 10 |
| (a) "CARE tool" means the Continuity and Record Evaluation | 11 |
| (CARE) tool. It is a patient assessment instrument that has | 12 |
| been developed to document the medical, cognitive, functional, | 13 |
| and discharge status of persons receiving health care services | 14 |
| in acute and post-acute care settings. The data collected is | 15 |
| able to document provider-level quality of care (patient | 16 |
| outcomes) and characterize the clinical complexity of | 17 |
| patients. | 18 |
| (b) "Department" means the Illinois Department of | 19 |
| Healthcare and Family Services. | 20 |
| (c) "Discharge" means the release of a patient from | 21 |
| hospital care for any discharge disposition other than a leave | 22 |
| of absence, even if for Medicare payment purposes the discharge | 23 |
| fits the definition of an interrupted stay.
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| (d) "FTE" means "full-time equivalent" or a person or | 25 |
| persons employed in one full-time position. |
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| (e) "Hospital" means an institution, place, building, or | 2 |
| agency located in this State that is licensed as a general | 3 |
| acute hospital by the Illinois Department of Public Health | 4 |
| under the Hospital Licensing Act, whether public or private and | 5 |
| whether organized for profit or not-for-profit. | 6 |
| (f) "ICU" means intensive care unit. | 7 |
| (g) "LTAC hospital" means a hospital that is designated by | 8 |
| Medicare as a long term acute care hospital as described in | 9 |
| Section 1886(d)(1)(B)(iv)(I) of the Social Security Act and has | 10 |
| an average length of Medicaid inpatient stay greater than 25 | 11 |
| days as reported on the hospital's 2008 Medicaid cost report on | 12 |
| file as of February 15, 2010. | 13 |
| (h) "LTAC hospital criteria" means nationally recognized | 14 |
| evidence-based evaluation criteria that have been publicly | 15 |
| tested and includes criteria specific to an LTAC hospital for | 16 |
| admission, continuing stay, and discharge. The criteria cannot | 17 |
| include criteria derived or developed by or for a specific | 18 |
| hospital or group of hospitals. Criteria and tools developed by | 19 |
| hospitals or hospital associations or hospital-owned | 20 |
| organizations are not acceptable and do not meet the | 21 |
| requirements of this subsection. | 22 |
| (i) "Patient" means an individual who is admitted to a | 23 |
| hospital for an inpatient stay. | 24 |
| (j) "Program" means the Long Term Acute Care Hospital | 25 |
| Quality Improvement Transfer Program established by this Act. | 26 |
| (k) "STAC hospital" means a hospital that is not an LTAC |
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| hospital as defined in this Act or a psychiatric hospital or a | 2 |
| rehabilitation hospital.
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| Section 15. Qualifying Hospitals. | 4 |
| (a) Beginning on the effective date of this Act, the | 5 |
| Department shall establish the Long Term Acute Care Hospital | 6 |
| Quality Improvement Transfer Program. Any hospital may | 7 |
| participate in the program if it meets the requirements of this | 8 |
| Section as determined by the Department. | 9 |
| (b) To participate in the program a hospital must do the | 10 |
| following: | 11 |
| (1) Operate as an LTAC hospital. | 12 |
| (2) Employ one-half of an FTE (designated for case | 13 |
| management) for every 15 patients admitted to the hospital. | 14 |
| (3) Maintain on-site physician coverage 24 hours a day, | 15 |
| 7 days a week. | 16 |
| (4) Maintain on-site respiratory therapy coverage 24 | 17 |
| hours a day, 7 days a week. | 18 |
| (c) A hospital must also execute a program participation | 19 |
| agreement with the Department. The agreement must include: | 20 |
| (1) An attestation that the hospital complies with the | 21 |
| criteria in subsection (b) of this Section. | 22 |
| (2) A process for the hospital to report its continuing | 23 |
| compliance with subsection (b) of this Section. The | 24 |
| hospital must submit a compliance report at least annually. | 25 |
| (3) A requirement that the hospital complete and submit |
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| the CARE tool (the most currently available version or an | 2 |
| equivalent tool designated and approved for use by the | 3 |
| Department) for each patient no later than 7 calendar days | 4 |
| after discharge. | 5 |
| (4) A requirement that the hospital use a patient | 6 |
| satisfaction survey specifically designed for LTAC | 7 |
| hospital settings. The hospital must submit survey results | 8 |
| data to the Department at least annually.
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| (5) A requirement that the hospital accept all | 10 |
| clinically-approved patients for admission or transfer | 11 |
| from a STAC hospital. The patient must be evaluated using | 12 |
| LTAC hospital criteria approved by the Department for use | 13 |
| in this program and meet the appropriate criteria. | 14 |
| (6) A requirement that the hospital report quality and | 15 |
| outcome measurement data, as described in Section 20 of | 16 |
| this Act, to the Department at least annually. | 17 |
| (7) A requirement that the hospital provide the | 18 |
| Department full access to patient data and other data | 19 |
| maintained by the hospital. Access must be in compliance | 20 |
| with State and federal law. | 21 |
| (8) A requirement that the hospital use LTAC hospital | 22 |
| criteria to evaluate patients that are admitted to the | 23 |
| hospital to determine that the patient is in the most | 24 |
| appropriate setting.
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| Section 20. Quality and outcome measurement data.
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| (a) For proper evaluation and monitoring of the program, | 2 |
| each LTAC hospital must provide quality and outcome measurement | 3 |
| data ("measures") as specified in subsections (c) through (h) | 4 |
| of this Section to the Department for patients treated under | 5 |
| this program. The Department may develop measures in addition | 6 |
| to the minimum measures required under this Section. | 7 |
| (b) Two sets of measures must be calculated. The first set | 8 |
| should only use data for medical assistance patients, and the | 9 |
| second set should include all patients of the LTAC hospital | 10 |
| regardless of payer. | 11 |
| (c) Average LTAC hospital length of stay for patients | 12 |
| discharged during the reporting period. The quotient of: | 13 |
| (1) Numerator: all patient days for discharged | 14 |
| patients during the reporting period. | 15 |
| (2) Denominator: number of patient discharges | 16 |
| associated with the days included in the numerator. | 17 |
| (d) Adverse outcomes rates: Percent of patients who expired | 18 |
| or whose condition worsens and requires treatment in a STAC | 19 |
| hospital. The quotient of: | 20 |
| (1) Numerator: sum of expirations plus discharges to a | 21 |
| STAC Hospital. | 22 |
| (2) Denominator: total discharges. | 23 |
| (e) Ventilator weaning rate: Percent of patients | 24 |
| discharged during the reporting period who have been | 25 |
| successfully weaned off invasive mechanical ventilation. The | 26 |
| quotient of: |
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| (1) Numerator: | 2 |
| (A) Includes all patients who were admitted on | 3 |
| invasive mechanical ventilation (per endotracheal or | 4 |
| tracheostomy tube) and were completely weaned from | 5 |
| invasive mechanical ventilation at discharge from the | 6 |
| LTAC hospital, patients admitted receiving part-time | 7 |
| or nocturnal invasive mechanical ventilation, patients | 8 |
| admitted on invasive mechanical and transitioned to | 9 |
| noninvasive ventilation at time of discharge. | 10 |
| (B) Excludes patients who have not yet been | 11 |
| discharged, patients who were not completely weaned | 12 |
| from invasive mechanical ventilation, patients that | 13 |
| were weaned for a period of time but returned to | 14 |
| ventilator support and were ventilator-dependent at | 15 |
| time of discharge, and patients who expired. | 16 |
| (2) Denominator: includes all ventilator dependent | 17 |
| patients. | 18 |
| (f) Central Line Infection Rate per 1000 central line days: | 19 |
| Number of patients discharged from an LTAC hospital during the | 20 |
| reporting period that had a central line in place and developed | 21 |
| a bloodstream infection 48 hours or more after admission to the | 22 |
| LTAC hospital. The quotient of: | 23 |
| (1) Numerator: | 24 |
| (A) Includes all discharged patients that had a | 25 |
| central line and developed a bloodstream infection as | 26 |
| defined by the Centers for Disease Control and |
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| Prevention. The definition of central line includes | 2 |
| any device that is not peripheral, including Single, | 3 |
| Double, and Triple Lumen vascular catheters, | 4 |
| percutaneously inserted central catheter lines, and | 5 |
| Tunneled catheters such as Mediports and Groshongs. | 6 |
| Number of primary bloodstream infections in patients | 7 |
| with a central line catheter, including patients whose | 8 |
| primary blood stream infection was identified at least | 9 |
| 48 hours after admission. | 10 |
| (B) Excludes patients that: | 11 |
| (i) Were admitted to the LTAC hospital with a | 12 |
| bloodstream infection;
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| (ii) Had a bloodstream infection identified by | 14 |
| the LTAC hospital within 48 hours of the LTAC | 15 |
| hospital admission; | 16 |
| (iii) Were not discharged; or | 17 |
| (iv) Did not have a central line. | 18 |
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(2) Denominator: Number of central line catheter days | 19 |
| for the reporting period. | 20 |
| (A) Includes central line catheter patient days | 21 |
| for all discharges from the LTAC hospital. | 22 |
| (B) Excludes patients that did not have a central | 23 |
| line and exclude patient days for patients that left | 24 |
| the facility for a leave of absence and subsequently | 25 |
| returned to the LTAC hospital and therefore were not | 26 |
| discharged. |
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| (g) Acquired pressure ulcers per 1000 patient days. The | 2 |
| quotient of: | 3 |
| (1) Numerator: Number of pressure ulcers that | 4 |
| developed during the LTAC hospital hospitalization in | 5 |
| patients discharged from an LTAC hospital during the | 6 |
| reporting period. | 7 |
| (A) Includes total number of stage 2-4 ulcers | 8 |
| identified more than 48 hours after admission to the LTAC | 9 |
| hospital. | 10 |
| (B) Excludes
the following: | 11 |
| (i) Ulcers in patients that have not yet been | 12 |
| discharged. | 13 |
| (ii) Pressure ulcers Stage 2 and greater | 14 |
| present at admission to the LTAC hospital. | 15 |
| (iii) Stage 1 pressure ulcers. | 16 |
| (iv) Pressure ulcers that were identified | 17 |
| within the first 48 hours of admission to the LTAC | 18 |
| hospital. | 19 |
| (2) Denominator: total patient days for the reporting | 20 |
| period. | 21 |
| (h) Falls with injury per 1000 patient days: Number of | 22 |
| falls among discharged LTAC hospital patients discharged | 23 |
| during the reporting period, who fell during the LTAC hospital | 24 |
| stay, regardless of distance fallen, that required an ancillary | 25 |
| or surgical procedure (i.e. x-ray, MRI, sutures, surgery, etc.) | 26 |
| The quotient of: |
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| (1) Numerator: | 2 |
| (A) Includes the following: | 3 |
| (i) Falls with injury levels of minor, | 4 |
| moderate, major, and death in accordance with the | 5 |
| guidelines for falls with injury Fall Prevention | 6 |
| Protocol of the National Database of Nursing | 7 |
| Quality Indicators (NDNQI). | 8 |
| (ii) Assisted falls among discharged LTAC | 9 |
| hospital patients (patient caught themselves, | 10 |
| staff or witness assisted falls, falls caught to | 11 |
| prevent further falling). | 12 |
| (B) Excludes the following: | 13 |
| (i) Assisted falls (patient caught themselves, | 14 |
| staff or witness assisted falls, falls caught to | 15 |
| prevent further falling) among discharged LTAC | 16 |
| hospital patients that required physician exam or | 17 |
| bandage but no ancillary test or procedure.
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| (ii) Falls that required a physician exam or | 19 |
| bandage or ancillary test that was negative such as | 20 |
| x-ray. | 21 |
| (iii) Falls with no injury according to NDNQI | 22 |
| definitions. | 23 |
| (iv) Falls among the patients who have not yet | 24 |
| been discharged. | 25 |
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(2) Denominator: Number of discharged LTAC hospital | 26 |
| patient days for the reporting period, with patient days |
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| calculated once per 24 hour period (usually at midnight | 2 |
| excluding patient days for the period of non-LTAC hospital | 3 |
| patients and LTAC hospital patients who are not yet | 4 |
| discharged).
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| Section 25. Quality improvement transfer program.
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| (a) The Department may exempt the following STAC hospitals | 7 |
| from the requirements in this Section: | 8 |
| (1) A hospital operated by a county with a population | 9 |
| of 3,000,000 or more. | 10 |
| (2) A hospital operated by a State agency or a State | 11 |
| university. | 12 |
| (b) STAC hospitals may transfer patients who meet criteria | 13 |
| in the LTAC hospital criteria and are medically stable for | 14 |
| discharge from the STAC hospital. | 15 |
| (c) A patient in a STAC hospital may be exempt from a | 16 |
| transfer if: | 17 |
| (1) The patients physician does not issue an order for | 18 |
| a transfer; | 19 |
| (2) The patient or the individual legally authorized to | 20 |
| make medical decisions for the patient refuses the | 21 |
| transfer; or | 22 |
| (3) The patient's care is primarily paid for by | 23 |
| Medicare or another third party. The exemption in this | 24 |
| paragraph (3) of subsection (c) does not apply to a patient | 25 |
| who has exhausted his or her Medicare benefits resulting in |
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| the Department becoming the primary payer.
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| Section 30. LTAC hospital duties. | 3 |
| (a) The LTAC hospital must notify the Department within 5 | 4 |
| calendar days if it no longer meets the requirements under | 5 |
| subsection (b) of Section 15. | 6 |
| (b) The LTAC hospital may terminate the agreement under | 7 |
| subsection (c) of Section 15 with a notice to the Department | 8 |
| within 15 calendar days if the State of Illinois fails to issue | 9 |
| payment within 50 days of submission of an appropriately | 10 |
| submitted claim. | 11 |
| (c) The LTAC hospital must assist the Department in | 12 |
| creating patient and family education material concerning the | 13 |
| program. | 14 |
| (d) The LTAC hospital must retain the patient's admission | 15 |
| evaluation to document that the patient meets the LTAC hospital | 16 |
| criteria and is eligible to receive the LTAC supplemental per | 17 |
| diem rate described in Section 35 of this Act.
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| Section 35. LTAC supplemental per diem rate. | 19 |
| (a) The Department must pay an LTAC supplemental per diem | 20 |
| rate calculated under this Section to LTAC hospitals that meet | 21 |
| the requirements of Section 15 of this Act for patients who | 22 |
| upon admission to the LTAC hospital meet LTAC hospital | 23 |
| criteria. | 24 |
| (b) The Department must not pay the LTAC supplemental per |
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| diem rate calculated under this Section if the LTAC hospital no | 2 |
| longer meets the requirements under Section 15 or terminates | 3 |
| the agreement specified under Section 15. The Department must | 4 |
| not pay the LTAC supplemental per diem rate calculated under | 5 |
| this Section if the patient does not meet the LTAC hospital | 6 |
| criteria upon admission. | 7 |
| (c) After the first year of operation of the program | 8 |
| established by this Act, the Department may reduce the LTAC | 9 |
| supplemental per diem rate calculated under this Section by no | 10 |
| more than 5% for an LTAC hospital that does not meet benchmarks | 11 |
| or targets set by the Department. The Department may also | 12 |
| increase the LTAC supplemental per diem rate calculated under | 13 |
| this Section by no more than 5% for an LTAC hospital that | 14 |
| exceeds the benchmarks or targets set by the Department. | 15 |
| (d) The LTAC supplemental per diem rate shall be calculated | 16 |
| using the LTAC hospital's inflated cost per diem, defined in | 17 |
| subsection (f) of this Section, and subtracting the following: | 18 |
| (1) The LTAC hospital's Medicaid per diem inpatient | 19 |
| rate as calculated under 89 Ill. Adm. Code 148.270(c)(4). | 20 |
| (2) The LTAC hospital's disproportionate share (DSH) | 21 |
| rate as calculated under 89 Ill. Adm. Code 148.120. | 22 |
| (3) The LTAC hospital's Medicaid Percentage Adjustment | 23 |
| (MPA) rate as calculated under 89 Ill. Adm. Code 148.122. | 24 |
| (4) The LTAC hospital's Medicaid High Volume | 25 |
| Adjustment (MHVA) rate as calculated under 89 Ill. Adm. | 26 |
| Code 148.290(d). |
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| (e) LTAC supplemental per diem rates are effective for 12 | 2 |
| months beginning on October 1 of each year and must be updated | 3 |
| every 12 months. | 4 |
| (f) For the purposes of this Section, "inflated cost per | 5 |
| diem" means the quotient resulting from dividing the hospital's | 6 |
| inpatient Medicaid costs by the hospital's Medicaid inpatient | 7 |
| days and inflating it to the most current period using | 8 |
| methodologies consistent with the calculation of the rates | 9 |
| described in paragraphs (2),(3), and (4) of subsection (d). The | 10 |
| data is obtained from the LTAC hospital's most recent cost | 11 |
| report submitted to the Department as mandated under 89 Ill. | 12 |
| Adm. Code 148.210.
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| Section 40. Duties of the Department. | 14 |
| (a) The Department is responsible for implementing, | 15 |
| monitoring, and evaluating the program. This includes but is | 16 |
| not limited to: | 17 |
| (1) Collecting data required under Section 15 and data | 18 |
| necessary to calculate the measures under Section 20 of | 19 |
| this Act. | 20 |
| (2) Setting annual benchmarks or targets for the | 21 |
| measures in Section 20 of this Act or other measures beyond | 22 |
| the minimum required under Section 20. The Department must | 23 |
| consult participating LTAC hospitals when setting these | 24 |
| benchmarks and targets. | 25 |
| (3) Monitoring compliance with all requirements of |
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| this Act. | 2 |
| (4) Creating patient and family education material | 3 |
| about the program for STAC hospitals to use.
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| (b) The Department must issue an annual report by posting | 5 |
| it to the Department's website. The annual report must include | 6 |
| at least the following information: | 7 |
| (1) Information on the LTAC hospitals that are | 8 |
| qualified and participating in the program. | 9 |
| (2) Quality and outcome measures, as described in | 10 |
| Section 20 of this Act, for each LTAC hospital. | 11 |
| (3) A calculation of the savings generated by the | 12 |
| program. | 13 |
| (4) Observations on how the program is working and any | 14 |
| suggestions to improve the program in the future. | 15 |
| (c) The Department must establish monitoring procedures | 16 |
| that ensure the LTAC supplemental payment is only paid for | 17 |
| patients who upon admission meet the LTAC hospital criteria. | 18 |
| The Department must notify qualified LTAC hospitals of the | 19 |
| procedures and establish an appeals process as part of those | 20 |
| procedures. The Department must recoup any LTAC supplemental | 21 |
| payments that are identified as being paid for patients who do | 22 |
| not meet the LTAC hospital criteria. | 23 |
| (d) The Department must implement the program by October 1, | 24 |
| 2010. | 25 |
| (e) The Department must execute an agreement as required | 26 |
| under subsection (c) of Section 15 no later than 45 days after |
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| the effective date of this Act. | 2 |
| (f) The Department must notify Illinois hospitals which | 3 |
| LTAC hospital criteria are approved for use under the program.
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| The Department may limit LTAC hospital criteria to the most | 5 |
| strict criteria that meet the definitions of this Act. | 6 |
| (g) The Department must identify discharge tools that are | 7 |
| considered equivalent to the CARE tool and approved for use | 8 |
| under the program. The Department must notify LTAC hospitals | 9 |
| which tools are approved for use under the program. | 10 |
| (h) The Department must notify Illinois LTAC hospitals of | 11 |
| the program and inform them how to apply for qualification and | 12 |
| what the qualification requirements are as described under | 13 |
| Section 15 of this Act. | 14 |
| (i) The Department must notify Illinois STAC hospitals | 15 |
| about the operation and implementation of the program | 16 |
| established by this Act. | 17 |
| (j) The Department must work with the Comptroller to ensure | 18 |
| a process to issue payments to LTAC hospitals qualified and | 19 |
| participating in the program within 50 days of submission of an | 20 |
| appropriate claim. | 21 |
| (k) The Department may use up to $500,000 of funds | 22 |
| contained in the Public Aid Recoveries Trust Fund per State | 23 |
| fiscal year to operate the program under this Act. The | 24 |
| Department may expand existing contracts, issue new contracts, | 25 |
| issue personal service contracts, or purchase other services, | 26 |
| supplies, or equipment.
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| Section 99. Effective date. This Act takes effect upon | 2 |
| becoming law.".
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