SB2158 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB2158

 

Introduced 2/26/2021, by Sen. Jil Tracy

 

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.43 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. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act that provides coverage to an Illinois resident shall provide coverage for the treatment, removal, elimination, or maximum feasible treatment of nevus flammeus, also known as port-wine stains, including, but not limited to, port-wine stains caused by Sturge-Weber Syndrome. Provides that no health carrier may reduce or eliminate coverage due to coverage for port-wine stain treatment. Provides that the Director of Insurance shall not approve any rate increases due to coverage for port-wine stain treatment. Provides that no health maintenance organization shall increase rates due to coverage for port-wine stain treatment. Makes conforming changes in 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.


LRB102 14125 BMS 19477 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

SB2158LRB102 14125 BMS 19477 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    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

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1by the Department of Central Management 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

SB2158- 5 -LRB102 14125 BMS 19477 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB2158- 6 -LRB102 14125 BMS 19477 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Coverage for port-wine stain treatment.
15    (a) A group or individual policy of accident and health
16insurance or managed care plan amended, delivered, issued, or
17renewed on or after the effective date of this amendatory Act
18of the 102nd General Assembly that provides coverage to an
19Illinois resident shall provide coverage for the treatment,
20removal, elimination, or maximum feasible treatment of nevus
21flammeus, also known as port-wine stains, including, but not
22limited to, port-wine stains caused by Sturge-Weber Syndrome.
23    (b) No health carrier may reduce or eliminate coverage due
24to the coverage required under subsection (a).

 

 

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1    (c) The Director shall not approve any rate increases due
2to the coverage required under subsection (a).
3    (d) No health maintenance organization shall increase
4rates due to the coverage required under subsection (a).
 
5    Section 30. The Health Maintenance Organization Act is
6amended by changing Section 5-3 as follows:
 
7    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
8    Sec. 5-3. Insurance Code provisions.
9    (a) Health Maintenance Organizations shall be subject to
10the provisions of Sections 133, 134, 136, 137, 139, 140,
11141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
12154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
13355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
14356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
16356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
17356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
18356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
19368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
20408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
21(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
22XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
23Insurance Code.
24    (b) For purposes of the Illinois Insurance Code, except

 

 

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1for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
2Health Maintenance Organizations in the following categories
3are deemed to be "domestic companies":
4        (1) a corporation authorized under the Dental Service
5    Plan Act or the Voluntary Health Services Plans Act;
6        (2) a corporation organized under the laws of this
7    State; or
8        (3) a corporation organized under the laws of another
9    state, 30% or more of the enrollees of which are residents
10    of this State, except a corporation subject to
11    substantially the same requirements in its state of
12    organization as is a "domestic company" under Article VIII
13    1/2 of the Illinois Insurance Code.
14    (c) In considering the merger, consolidation, or other
15acquisition of control of a Health Maintenance Organization
16pursuant to Article VIII 1/2 of the Illinois Insurance Code,
17        (1) the Director shall give primary consideration to
18    the continuation of benefits to enrollees and the
19    financial conditions of the acquired Health Maintenance
20    Organization after the merger, consolidation, or other
21    acquisition of control takes effect;
22        (2)(i) the criteria specified in subsection (1)(b) of
23    Section 131.8 of the Illinois Insurance Code shall not
24    apply and (ii) the Director, in making his determination
25    with respect to the merger, consolidation, or other
26    acquisition of control, need not take into account the

 

 

SB2158- 9 -LRB102 14125 BMS 19477 b

1    effect on competition of the merger, consolidation, or
2    other acquisition of control;
3        (3) the Director shall have the power to require the
4    following information:
5            (A) certification by an independent actuary of the
6        adequacy of the reserves of the Health Maintenance
7        Organization sought to be acquired;
8            (B) pro forma financial statements reflecting the
9        combined balance sheets of the acquiring company and
10        the Health Maintenance Organization sought to be
11        acquired as of the end of the preceding year and as of
12        a date 90 days prior to the acquisition, as well as pro
13        forma financial statements reflecting projected
14        combined operation for a period of 2 years;
15            (C) a pro forma business plan detailing an
16        acquiring party's plans with respect to the operation
17        of the Health Maintenance Organization sought to be
18        acquired for a period of not less than 3 years; and
19            (D) such other information as the Director shall
20        require.
21    (d) The provisions of Article VIII 1/2 of the Illinois
22Insurance Code and this Section 5-3 shall apply to the sale by
23any health maintenance organization of greater than 10% of its
24enrollee population (including without limitation the health
25maintenance organization's right, title, and interest in and
26to its health care certificates).

 

 

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1    (e) In considering any management contract or service
2agreement subject to Section 141.1 of the Illinois Insurance
3Code, the Director (i) shall, in addition to the criteria
4specified in Section 141.2 of the Illinois Insurance Code,
5take into account the effect of the management contract or
6service agreement on the continuation of benefits to enrollees
7and the financial condition of the health maintenance
8organization to be managed or serviced, and (ii) need not take
9into account the effect of the management contract or service
10agreement on competition.
11    (f) Except for small employer groups as defined in the
12Small Employer Rating, Renewability and Portability Health
13Insurance Act and except for medicare supplement policies as
14defined in Section 363 of the Illinois Insurance Code, a
15Health Maintenance Organization may by contract agree with a
16group or other enrollment unit to effect refunds or charge
17additional premiums under the following terms and conditions:
18        (i) the amount of, and other terms and conditions with
19    respect to, the refund or additional premium are set forth
20    in the group or enrollment unit contract agreed in advance
21    of the period for which a refund is to be paid or
22    additional premium is to be charged (which period shall
23    not be less than one year); and
24        (ii) the amount of the refund or additional premium
25    shall not exceed 20% of the Health Maintenance
26    Organization's profitable or unprofitable experience with

 

 

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1    respect to the group or other enrollment unit for the
2    period (and, for purposes of a refund or additional
3    premium, the profitable or unprofitable experience shall
4    be calculated taking into account a pro rata share of the
5    Health Maintenance Organization's administrative and
6    marketing expenses, but shall not include any refund to be
7    made or additional premium to be paid pursuant to this
8    subsection (f)). The Health Maintenance Organization and
9    the group or enrollment unit may agree that the profitable
10    or unprofitable experience may be calculated taking into
11    account the refund period and the immediately preceding 2
12    plan years.
13    The Health Maintenance Organization shall include a
14statement in the evidence of coverage issued to each enrollee
15describing the possibility of a refund or additional premium,
16and upon request of any group or enrollment unit, provide to
17the group or enrollment unit a description of the method used
18to calculate (1) the Health Maintenance Organization's
19profitable experience with respect to the group or enrollment
20unit and the resulting refund to the group or enrollment unit
21or (2) the Health Maintenance Organization's unprofitable
22experience with respect to the group or enrollment unit and
23the resulting additional premium to be paid by the group or
24enrollment unit.
25    In no event shall the Illinois Health Maintenance
26Organization Guaranty Association be liable to pay any

 

 

SB2158- 12 -LRB102 14125 BMS 19477 b

1contractual obligation of an insolvent organization to pay any
2refund authorized under this Section.
3    (g) Rulemaking authority to implement Public Act 95-1045,
4if any, is conditioned on the rules being adopted in
5accordance with all provisions of the Illinois Administrative
6Procedure Act and all rules and procedures of the Joint
7Committee on Administrative Rules; any purported rule not so
8adopted, for whatever reason, is unauthorized.
9(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
10100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
111-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
12eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
141-1-20; 101-625, eff. 1-1-21.)
 
15    Section 35. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions 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, 155.37, 355.2, 355.3,
23355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
24356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,

 

 

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1401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
2444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
3XXV, and XXVI of the Illinois Insurance Code. For purposes of
4the Illinois Insurance Code, except for Sections 444 and 444.1
5and Articles XIII and XIII 1/2, limited health service
6organizations in the following categories are deemed to be
7domestic companies:
8        (1) a corporation under the laws of this State; or
9        (2) a corporation organized under the laws of another
10    state, 30% or more of the enrollees of which are residents
11    of this State, except a corporation subject to
12    substantially the same requirements in its state of
13    organization as is a domestic company under Article VIII
14    1/2 of the Illinois Insurance Code.
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
18eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
19    Section 40. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
 
21    (215 ILCS 165/10)  (from Ch. 32, par. 604)
22    Sec. 10. Application of Insurance Code provisions. Health
23services plan corporations and all persons interested therein
24or dealing therewith shall be subject to the provisions of

 

 

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1Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
2143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
3356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
4356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
5356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
6356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
8367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
9and paragraphs (7) and (15) of Section 367 of the Illinois
10Insurance Code.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
18100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
191-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
20eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
21101-625, eff. 1-1-21.)
 
22    Section 45. The Illinois Public Aid Code is amended by
23changing Section 5-16.8 as follows:
 
24    (305 ILCS 5/5-16.8)

 

 

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1    Sec. 5-16.8. Required health benefits. The medical
2assistance program shall (i) provide the post-mastectomy care
3benefits required to be covered by a policy of accident and
4health insurance under Section 356t and the coverage required
5under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
6356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
7of the Illinois Insurance Code and (ii) be subject to the
8provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
9the Illinois Insurance Code.
10    The Department, by rule, shall adopt a model similar to
11the requirements of Section 356z.39 of the Illinois Insurance
12Code.
13    On and after July 1, 2012, the Department shall reduce any
14rate of reimbursement for services or other payments or alter
15any methodologies authorized by this Code to reduce any rate
16of reimbursement for services or other payments in accordance
17with Section 5-5e.
18    To ensure full access to the benefits set forth in this
19Section, on and after January 1, 2016, the Department shall
20ensure that provider and hospital reimbursement for
21post-mastectomy care benefits required under this Section are
22no lower than the Medicare reimbursement rate.
23(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
24100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
257-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
26eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)