Full Text of HB4112 103rd General Assembly
HB4112eng 103RD GENERAL ASSEMBLY | | | HB4112 Engrossed | | LRB103 33223 LNS 63031 b |
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| 1 | | AN ACT concerning regulation. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11B as follows: | 6 | | (5 ILCS 375/6.11B) | 7 | | Sec. 6.11B. Infertility coverage. | 8 | | (a) Beginning on January 1, 2024, the State Employees | 9 | | Group Insurance Program shall provide coverage for the | 10 | | diagnosis and treatment of infertility, including, but not | 11 | | limited to, in vitro fertilization, uterine embryo lavage, | 12 | | embryo transfer, artificial insemination, gamete | 13 | | intrafallopian tube transfer, zygote intrafallopian tube | 14 | | transfer, and low tubal ovum transfer. The coverage required | 15 | | shall include procedures necessary to screen or diagnose a | 16 | | fertilized egg before implantation, including, but not limited | 17 | | to, preimplantation genetic diagnosis, preimplantation genetic | 18 | | screening, and prenatal genetic diagnosis. | 19 | | (b) Beginning on January 1, 2024, coverage under this | 20 | | Section for procedures for in vitro fertilization, gamete | 21 | | intrafallopian tube transfer, or zygote intrafallopian tube | 22 | | transfer shall be required only if the procedures: | 23 | | (1) are considered medically appropriate based on |
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| 1 | | clinical guidelines or standards developed by the American | 2 | | Society for Reproductive Medicine, the American College of | 3 | | Obstetricians and Gynecologists, or the Society for | 4 | | Assisted Reproductive Technology; and | 5 | | (2) are performed at medical facilities or clinics | 6 | | that conform to the American College of Obstetricians and | 7 | | Gynecologists guidelines for in vitro fertilization or the | 8 | | American Society for Reproductive Medicine minimum | 9 | | standards for practices offering assisted reproductive | 10 | | technologies. | 11 | | (c) As used in this Section, "infertility" means a | 12 | | disease, condition, or status characterized by: | 13 | | (1) a failure to establish a pregnancy or to carry a | 14 | | pregnancy to live birth after 12 months of regular, | 15 | | unprotected sexual intercourse if the woman is 35 years of | 16 | | age or younger, or after 6 months of regular, unprotected | 17 | | sexual intercourse if the woman is over 35 years of age; | 18 | | conceiving but having a miscarriage does not restart the | 19 | | 12-month or 6-month term for determining infertility; | 20 | | (2) a person's inability to reproduce either as a | 21 | | single individual or with a partner without medical | 22 | | intervention; or | 23 | | (3) a licensed physician's findings based on a | 24 | | patient's medical, sexual, and reproductive history, age, | 25 | | physical findings, or diagnostic testing. | 26 | | (d) The State Employees Group Insurance Program may not |
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| 1 | | impose any exclusions, limitations, or other restrictions on | 2 | | coverage of fertility medications that are different from | 3 | | those imposed on any other prescription medications, nor may | 4 | | it impose any exclusions, limitations, or other restrictions | 5 | | on coverage of any fertility services based on a covered | 6 | | individual's participation in fertility services provided by | 7 | | or to a third party, nor may it impose deductibles, | 8 | | copayments, coinsurance, benefit maximums, waiting periods, or | 9 | | any other limitations on coverage for the diagnosis of | 10 | | infertility, treatment for infertility, and standard fertility | 11 | | preservation services, except as provided in this Section, | 12 | | that are different from those imposed upon benefits for | 13 | | services not related to infertility. | 14 | | (e) This Section applies only to coverage provided on or | 15 | | after January 1, 2024 and before July 1, 2026. | 16 | | (f) This Section is repealed on July 1, 2026. | 17 | | (Source: P.A. 103-8, eff. 1-1-24 .) | 18 | | Section 10. The Counties Code is amended by changing | 19 | | Section 5-1069.3 as follows: | 20 | | (55 ILCS 5/5-1069.3) | 21 | | Sec. 5-1069.3. Required health benefits. If a county, | 22 | | including a home rule county, is a self-insurer for purposes | 23 | | of providing health insurance coverage for its employees, the | 24 | | coverage shall include coverage for the post-mastectomy care |
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| 1 | | benefits required to be covered by a policy of accident and | 2 | | health insurance under Section 356t and the coverage required | 3 | | under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, | 4 | | 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 5 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | 6 | | 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, | 7 | | 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, | 8 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | 9 | | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | 10 | | of the Illinois Insurance Code. The coverage shall comply with | 11 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | 12 | | Insurance Code. The Department of Insurance shall enforce the | 13 | | requirements of this Section. The requirement that health | 14 | | benefits be covered as provided in this Section is an | 15 | | exclusive power and function of the State and is a denial and | 16 | | limitation under Article VII, Section 6, subsection (h) of the | 17 | | Illinois Constitution. A home rule county to which this | 18 | | Section applies must comply with every provision of this | 19 | | Section. | 20 | | Rulemaking authority to implement Public Act 95-1045, if | 21 | | any, is conditioned on the rules being adopted in accordance | 22 | | with all provisions of the Illinois Administrative Procedure | 23 | | Act and all rules and procedures of the Joint Committee on | 24 | | Administrative Rules; any purported rule not so adopted, for | 25 | | whatever reason, is unauthorized. | 26 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
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| 1 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 2 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 3 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 4 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 5 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 6 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 7 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 8 | | 8-29-23.) | 9 | | Section 15. The Illinois Municipal Code is amended by | 10 | | changing Section 10-4-2.3 as follows: | 11 | | (65 ILCS 5/10-4-2.3) | 12 | | Sec. 10-4-2.3. Required health benefits. If a | 13 | | municipality, including a home rule municipality, is a | 14 | | self-insurer for purposes of providing health insurance | 15 | | coverage for its employees, the coverage shall include | 16 | | coverage for the post-mastectomy care benefits required to be | 17 | | covered by a policy of accident and health insurance under | 18 | | Section 356t and the coverage required under Sections 356g, | 19 | | 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4, | 20 | | 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 21 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 22 | | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | 23 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | 24 | | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , |
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| 1 | | 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois | 2 | | Insurance Code. The coverage shall comply with Sections | 3 | | 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | 4 | | Code. The Department of Insurance shall enforce the | 5 | | requirements of this Section. The requirement that health | 6 | | benefits be covered as provided in this is an exclusive power | 7 | | and function of the State and is a denial and limitation under | 8 | | Article VII, Section 6, subsection (h) of the Illinois | 9 | | Constitution. A home rule municipality to which this Section | 10 | | applies must comply with every provision of this Section. | 11 | | Rulemaking authority to implement Public Act 95-1045, if | 12 | | any, is conditioned on the rules being adopted in accordance | 13 | | with all provisions of the Illinois Administrative Procedure | 14 | | Act and all rules and procedures of the Joint Committee on | 15 | | Administrative Rules; any purported rule not so adopted, for | 16 | | whatever reason, is unauthorized. | 17 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 18 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 19 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 20 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 21 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 22 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 23 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 24 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 25 | | 8-29-23.) |
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| 1 | | Section 20. The School Code is amended by changing Section | 2 | | 10-22.3f as follows: | 3 | | (105 ILCS 5/10-22.3f) | 4 | | Sec. 10-22.3f. Required health benefits. Insurance | 5 | | protection and benefits for employees shall provide the | 6 | | post-mastectomy care benefits required to be covered by a | 7 | | policy of accident and health insurance under Section 356t and | 8 | | the coverage required under Sections 356g, 356g.5, 356g.5-1, | 9 | | 356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | 10 | | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 11 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 12 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 13 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | 14 | | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | 15 | | of the Illinois Insurance Code. Insurance policies shall | 16 | | comply with Section 356z.19 of the Illinois Insurance Code. | 17 | | The coverage shall comply with Sections 155.22a, 355b, and | 18 | | 370c of the Illinois Insurance Code. The Department of | 19 | | Insurance shall enforce the requirements of this Section. | 20 | | Rulemaking authority to implement Public Act 95-1045, if | 21 | | any, is conditioned on the rules being adopted in accordance | 22 | | with all provisions of the Illinois Administrative Procedure | 23 | | Act and all rules and procedures of the Joint Committee on | 24 | | Administrative Rules; any purported rule not so adopted, for | 25 | | whatever reason, is unauthorized. |
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| 1 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 2 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | 3 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | 4 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 5 | | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | 6 | | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | 7 | | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | 8 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 9 | | Section 25. The Illinois Insurance Code is amended by | 10 | | changing Section 356m as follows: | 11 | | (215 ILCS 5/356m) (from Ch. 73, par. 968m) | 12 | | Sec. 356m. Infertility coverage. | 13 | | (a) No group policy of accident and health insurance | 14 | | providing coverage for more than 25 employees that provides | 15 | | pregnancy related benefits may be issued, amended, delivered, | 16 | | or renewed in this State after January 1, 2016 through | 17 | | December 31, 2025 the effective date of this amendatory Act of | 18 | | the 99th General Assembly unless the policy contains coverage | 19 | | for the diagnosis and treatment of infertility including, but | 20 | | not limited to, in vitro fertilization, uterine embryo lavage, | 21 | | embryo transfer, artificial insemination, gamete | 22 | | intrafallopian tube transfer, zygote intrafallopian tube | 23 | | transfer, and low tubal ovum transfer. | 24 | | (b) The coverage required under subsection (a) for |
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| 1 | | procedures for in vitro fertilization, gamete intrafallopian | 2 | | tube transfer, or zygote intrafallopian tube transfer shall be | 3 | | required only if: is subject to the following conditions: | 4 | | (1) Coverage for procedures for in vitro | 5 | | fertilization, gamete intrafallopian tube transfer, or | 6 | | zygote intrafallopian tube transfer shall be required only | 7 | | if: | 8 | | (1) (A) the covered individual has been unable to | 9 | | attain a viable pregnancy, maintain a viable pregnancy, or | 10 | | sustain a successful pregnancy through reasonable, less | 11 | | costly medically appropriate infertility treatments for | 12 | | which coverage is available under the policy, plan, or | 13 | | contract; | 14 | | (2) (B) the covered individual has not undergone 4 | 15 | | completed oocyte retrievals, except that if a live birth | 16 | | follows a completed oocyte retrieval, then 2 more | 17 | | completed oocyte retrievals shall be covered; and | 18 | | (3) (C) the procedures are performed at medical | 19 | | facilities that conform to the American College of | 20 | | Obstetric and Gynecology guidelines for in vitro | 21 | | fertilization clinics or to the American Fertility Society | 22 | | minimal standards for programs of in vitro fertilization. | 23 | | (2) The procedures required to be covered under this | 24 | | Section are not required to be contained in any policy or | 25 | | plan issued to or by a religious institution or | 26 | | organization or to or by an entity sponsored by a |
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| 1 | | religious institution or organization that finds the | 2 | | procedures required to be covered under this Section to | 3 | | violate its religious and moral teachings and beliefs. | 4 | | (c) No group policy of accident and health insurance that | 5 | | provides pregnancy related benefits may be issued, amended, | 6 | | delivered, or renewed in this State on or after January 1, 2026 | 7 | | unless the policy contains coverage for the diagnosis and | 8 | | treatment of infertility, including, but not limited to, in | 9 | | vitro fertilization, uterine embryo lavage, embryo transfer, | 10 | | artificial insemination, gamete intrafallopian tube transfer, | 11 | | zygote intrafallopian tube transfer, and low tubal ovum | 12 | | transfer and procedures necessary to screen or diagnose a | 13 | | fertilized egg before implantation, including, but not limited | 14 | | to, preimplantation genetic diagnosis, preimplantation genetic | 15 | | screening, and prenatal genetic diagnosis. Coverage under this | 16 | | subsection for the diagnosis and treatment of infertility | 17 | | shall be required only if the procedures: | 18 | | (1) are considered medically appropriate by the | 19 | | patient's medical provider based on clinical guidelines or | 20 | | standards developed by the American Society for | 21 | | Reproductive Medicine, the American College of | 22 | | Obstetricians and Gynecologists, or the Society for | 23 | | Assisted Reproductive Technology; and | 24 | | (2) are performed at medical facilities or clinics | 25 | | that conform to the American College of Obstetricians and | 26 | | Gynecologists guidelines for in vitro fertilization or the |
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| 1 | | American Society for Reproductive Medicine minimum | 2 | | standards for practices offering assisted reproductive | 3 | | technologies. | 4 | | (d) (c) As used in this Section, "infertility" means a | 5 | | disease, condition, or status characterized by: | 6 | | (1) a failure to establish a pregnancy or to carry a | 7 | | pregnancy to live birth after 12 months of regular, | 8 | | unprotected sexual intercourse if the woman is 35 years of | 9 | | age or younger, or after 6 months of regular, unprotected | 10 | | sexual intercourse if the woman is over 35 years of age; | 11 | | conceiving but having a miscarriage does not restart the | 12 | | 12-month or 6-month term for determining infertility; | 13 | | (2) a person's inability to reproduce either as a | 14 | | single individual or with a partner without medical | 15 | | intervention; or | 16 | | (3) a licensed physician's findings based on a | 17 | | patient's medical, sexual, and reproductive history, age, | 18 | | physical findings, or diagnostic testing. | 19 | | (e) (d) A policy, contract, or certificate may not impose | 20 | | any exclusions, limitations, or other restrictions on coverage | 21 | | of fertility medications that are different from those imposed | 22 | | on any other prescription medications, nor may it impose any | 23 | | exclusions, limitations, or other restrictions on coverage of | 24 | | any fertility services based on a covered individual's | 25 | | participation in fertility services provided by or to a third | 26 | | party, nor may it impose deductibles, copayments, coinsurance, |
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| 1 | | benefit maximums, waiting periods, or any other limitations on | 2 | | coverage for the diagnosis of infertility, treatment for | 3 | | infertility, and standard fertility preservation services, | 4 | | except as provided in this Section, that are different from | 5 | | those imposed upon benefits for services not related to | 6 | | infertility. | 7 | | (f) The procedures required to be covered under this | 8 | | Section are not required to be contained in any policy or plan | 9 | | issued to or by a religious institution or organization or to | 10 | | or by an entity sponsored by a religious institution or | 11 | | organization that finds the procedures required to be covered | 12 | | under this Section to violate its religious and moral | 13 | | teachings and beliefs. | 14 | | (Source: P.A. 102-170, eff. 1-1-22 .) | 15 | | Section 30. The Limited Health Service Organization Act is | 16 | | amended 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 | 19 | | health service organizations shall be subject to the | 20 | | provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, | 21 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 22 | | 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, | 23 | | 355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, | 24 | | 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, |
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| 1 | | 356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | 2 | | 356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, | 3 | | 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, | 4 | | 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, | 5 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. | 6 | | Nothing in this Section shall require a limited health care | 7 | | plan to cover any service that is not a limited health service. | 8 | | For purposes of the Illinois Insurance Code, except for | 9 | | Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited | 10 | | health service organizations in the following categories are | 11 | | deemed to be domestic companies: | 12 | | (1) a corporation under the laws of this State; or | 13 | | (2) a corporation organized under the laws of another | 14 | | state, 30% or more of the enrollees of which are residents | 15 | | of this State, except a corporation subject to | 16 | | substantially the same requirements in its state of | 17 | | organization as is a domestic company under Article VIII | 18 | | 1/2 of the Illinois Insurance Code. | 19 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | 20 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. | 21 | | 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, | 22 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 23 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 24 | | 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 25 | | eff. 1-1-24; revised 8-29-23.) |
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| 1 | | Section 35. The Voluntary Health Services Plans Act is | 2 | | amended by changing Section 10 as follows: | 3 | | (215 ILCS 165/10) (from Ch. 32, par. 604) | 4 | | Sec. 10. Application of Insurance Code provisions. Health | 5 | | services plan corporations and all persons interested therein | 6 | | or dealing therewith shall be subject to the provisions of | 7 | | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | 8 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 9 | | 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v, | 10 | | 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, | 11 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 12 | | 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, | 13 | | 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, | 14 | | 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | 15 | | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, | 16 | | 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, | 17 | | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) | 18 | | and (15) of Section 367 of the Illinois Insurance Code. | 19 | | Rulemaking authority to implement Public Act 95-1045, if | 20 | | any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for | 24 | | whatever reason, is unauthorized. | 25 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
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| 1 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | 2 | | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | 3 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 4 | | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | 5 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 6 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 7 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 8 | | Section 99. Effective date. This Act takes effect December | 9 | | 31, 2025. |
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