Illinois General Assembly - Full Text of HB5579
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Full Text of HB5579  95th General Assembly

HB5579eng 95TH GENERAL ASSEMBLY



 


 
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1     AN ACT concerning aging.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Senior Citizens and Disabled Persons
5 Property Tax Relief and Pharmaceutical Assistance Act is
6 amended by changing Sections 3.15 and 4 as follows:
 
7     (320 ILCS 25/3.15)  (from Ch. 67 1/2, par. 403.15)
8     Sec. 3.15. "Covered prescription drug" means (1) any
9 cardiovascular agent or drug; (2) any insulin or other
10 prescription drug used in the treatment of diabetes, including
11 syringe and needles used to administer the insulin; (3) any
12 prescription drug used in the treatment of arthritis, (4)
13 beginning on January 1, 2001, any prescription drug used in the
14 treatment of cancer, (5) beginning on January 1, 2001, any
15 prescription drug used in the treatment of Alzheimer's disease,
16 (6) beginning on January 1, 2001, any prescription drug used in
17 the treatment of Parkinson's disease, (7) beginning on January
18 1, 2001, any prescription drug used in the treatment of
19 glaucoma, (8) beginning on January 1, 2001, any prescription
20 drug used in the treatment of lung disease and smoking related
21 illnesses, (9) beginning on July 1, 2001, any prescription drug
22 used in the treatment of osteoporosis, and (10) beginning on
23 January 1, 2009 2004, any prescription drug used in treating

 

 

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1 the effects the treatment of multiple sclerosis. The specific
2 agents or products to be included under such categories shall
3 be listed in a handbook to be prepared and distributed by the
4 Department. The general types of covered prescription drugs
5 shall be indicated by rule.
6     Notwithstanding any other rulemaking authority that may
7 exist, neither the Governor nor any agency or agency head under
8 the jurisdiction of the Governor has any authority to make or
9 promulgate rules to implement or enforce the provisions of this
10 amendatory Act of the 95th General Assembly. If, however, the
11 Governor believes that rules are necessary to implement or
12 enforce the provisions of this amendatory Act of the 95th
13 General Assembly, the Governor may suggest rules to the General
14 Assembly by filing them with the Clerk of the House and
15 Secretary of the Senate and by requesting that the General
16 Assembly authorize such rulemaking by law, enact those
17 suggested rules into law, or take any other appropriate action
18 in the General Assembly's discretion. Nothing contained in this
19 amendatory Act of the 95th General Assembly shall be
20 interpreted to grant rulemaking authority under any other
21 Illinois statute where such authority is not otherwise
22 explicitly given. For the purposes of this amendatory Act of
23 the 95th General Assembly, "rules" is given the meaning
24 contained in Section 1-70 of the Illinois Administrative
25 Procedure Act, and "agency" and "agency head" are given the
26 meanings contained in Sections 1-20 and 1-25 of the Illinois

 

 

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1 Administrative Procedure Act to the extent that such
2 definitions apply to agencies or agency heads under the
3 jurisdiction of the Governor.
4 (Source: P.A. 92-10, eff. 6-11-01; 92-790, eff. 8-6-02; 93-528,
5 eff. 1-1-04.)
 
6     (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
7     Sec. 4. Amount of Grant.
8     (a) In general. Any individual 65 years or older or any
9 individual who will become 65 years old during the calendar
10 year in which a claim is filed, and any surviving spouse of
11 such a claimant, who at the time of death received or was
12 entitled to receive a grant pursuant to this Section, which
13 surviving spouse will become 65 years of age within the 24
14 months immediately following the death of such claimant and
15 which surviving spouse but for his or her age is otherwise
16 qualified to receive a grant pursuant to this Section, and any
17 disabled person whose annual household income is less than the
18 income eligibility limitation, as defined in subsection (a-5)
19 and whose household is liable for payment of property taxes
20 accrued or has paid rent constituting property taxes accrued
21 and is domiciled in this State at the time he or she files his
22 or her claim is entitled to claim a grant under this Act. With
23 respect to claims filed by individuals who will become 65 years
24 old during the calendar year in which a claim is filed, the
25 amount of any grant to which that household is entitled shall

 

 

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1 be an amount equal to 1/12 of the amount to which the claimant
2 would otherwise be entitled as provided in this Section,
3 multiplied by the number of months in which the claimant was 65
4 in the calendar year in which the claim is filed.
5     (a-5) Income eligibility limitation. For purposes of this
6 Section, "income eligibility limitation" means an amount:
7         (i) for grant years before the 1998 grant year, less
8     than $14,000;
9         (ii) for the 1998 and 1999 grant year, less than
10     $16,000;
11         (iii) for grant years 2000 through 2007:
12             (A) less than $21,218 for a household containing
13         one person;
14             (B) less than $28,480 for a household containing 2
15         persons; or
16             (C) less than $35,740 for a household containing 3
17         or more persons; or
18         (iv) for grant years 2008 and thereafter:
19             (A) less than $22,218 for a household containing
20         one person;
21             (B) less than $29,480 for a household containing 2
22         persons; or
23             (C) less than $36,740 for a household containing 3
24         or more persons.
25     (b) Limitation. Except as otherwise provided in
26 subsections (a) and (f) of this Section, the maximum amount of

 

 

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1 grant which a claimant is entitled to claim is the amount by
2 which the property taxes accrued which were paid or payable
3 during the last preceding tax year or rent constituting
4 property taxes accrued upon the claimant's residence for the
5 last preceding taxable year exceeds 3 1/2% of the claimant's
6 household income for that year but in no event is the grant to
7 exceed (i) $700 less 4.5% of household income for that year for
8 those with a household income of $14,000 or less or (ii) $70 if
9 household income for that year is more than $14,000.
10     (c) Public aid recipients. If household income in one or
11 more months during a year includes cash assistance in excess of
12 $55 per month from the Department of Healthcare and Family
13 Services or the Department of Human Services (acting as
14 successor to the Department of Public Aid under the Department
15 of Human Services Act) which was determined under regulations
16 of that Department on a measure of need that included an
17 allowance for actual rent or property taxes paid by the
18 recipient of that assistance, the amount of grant to which that
19 household is entitled, except as otherwise provided in
20 subsection (a), shall be the product of (1) the maximum amount
21 computed as specified in subsection (b) of this Section and (2)
22 the ratio of the number of months in which household income did
23 not include such cash assistance over $55 to the number twelve.
24 If household income did not include such cash assistance over
25 $55 for any months during the year, the amount of the grant to
26 which the household is entitled shall be the maximum amount

 

 

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1 computed as specified in subsection (b) of this Section. For
2 purposes of this paragraph (c), "cash assistance" does not
3 include any amount received under the federal Supplemental
4 Security Income (SSI) program.
5     (d) Joint ownership. If title to the residence is held
6 jointly by the claimant with a person who is not a member of
7 his or her household, the amount of property taxes accrued used
8 in computing the amount of grant to which he or she is entitled
9 shall be the same percentage of property taxes accrued as is
10 the percentage of ownership held by the claimant in the
11 residence.
12     (e) More than one residence. If a claimant has occupied
13 more than one residence in the taxable year, he or she may
14 claim only one residence for any part of a month. In the case
15 of property taxes accrued, he or she shall prorate 1/12 of the
16 total property taxes accrued on his or her residence to each
17 month that he or she owned and occupied that residence; and, in
18 the case of rent constituting property taxes accrued, shall
19 prorate each month's rent payments to the residence actually
20 occupied during that month.
21     (f) There is hereby established a program of pharmaceutical
22 assistance to the aged and disabled which shall be administered
23 by the Department in accordance with this Act, to consist of
24 payments to authorized pharmacies, on behalf of beneficiaries
25 of the program, for the reasonable costs of covered
26 prescription drugs. Each beneficiary who pays $5 for an

 

 

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1 identification card shall pay no additional prescription
2 costs. Each beneficiary who pays $25 for an identification card
3 shall pay $3 per prescription. In addition, after a beneficiary
4 receives $2,000 in benefits during a State fiscal year, that
5 beneficiary shall also be charged 20% of the cost of each
6 prescription for which payments are made by the program during
7 the remainder of the fiscal year. To become a beneficiary under
8 this program a person must: (1) be (i) 65 years of age or
9 older, or (ii) the surviving spouse of such a claimant, who at
10 the time of death received or was entitled to receive benefits
11 pursuant to this subsection, which surviving spouse will become
12 65 years of age within the 24 months immediately following the
13 death of such claimant and which surviving spouse but for his
14 or her age is otherwise qualified to receive benefits pursuant
15 to this subsection, or (iii) disabled, and (2) be domiciled in
16 this State at the time he or she files his or her claim, and (3)
17 have a maximum household income of less than the income
18 eligibility limitation, as defined in subsection (a-5). In
19 addition, each eligible person must (1) obtain an
20 identification card from the Department, (2) at the time the
21 card is obtained, sign a statement assigning to the State of
22 Illinois benefits which may be otherwise claimed under any
23 private insurance plans, and (3) present the identification
24 card to the dispensing pharmacist.
25     The Department may adopt rules specifying participation
26 requirements for the pharmaceutical assistance program,

 

 

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1 including copayment amounts, identification card fees,
2 expenditure limits, and the benefit threshold after which a 20%
3 charge is imposed on the cost of each prescription, to be in
4 effect on and after July 1, 2004. Notwithstanding any other
5 provision of this paragraph, however, the Department may not
6 increase the identification card fee above the amount in effect
7 on May 1, 2003 without the express consent of the General
8 Assembly. To the extent practicable, those requirements shall
9 be commensurate with the requirements provided in rules adopted
10 by the Department of Healthcare and Family Services to
11 implement the pharmacy assistance program under Section
12 5-5.12a of the Illinois Public Aid Code.
13     Whenever a generic equivalent for a covered prescription
14 drug is available, the Department shall reimburse only for the
15 reasonable costs of the generic equivalent, less the co-pay
16 established in this Section, unless (i) the covered
17 prescription drug contains one or more ingredients defined as a
18 narrow therapeutic index drug at 21 CFR 320.33, (ii) the
19 prescriber indicates on the face of the prescription "brand
20 medically necessary", and (iii) the prescriber specifies that a
21 substitution is not permitted. When issuing an oral
22 prescription for covered prescription medication described in
23 item (i) of this paragraph, the prescriber shall stipulate
24 "brand medically necessary" and that a substitution is not
25 permitted. If the covered prescription drug and its authorizing
26 prescription do not meet the criteria listed above, the

 

 

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1 beneficiary may purchase the non-generic equivalent of the
2 covered prescription drug by paying the difference between the
3 generic cost and the non-generic cost plus the beneficiary
4 co-pay.
5     Any person otherwise eligible for pharmaceutical
6 assistance under this Act whose covered drugs are covered by
7 any public program for assistance in purchasing any covered
8 prescription drugs shall be ineligible for assistance under
9 this Act to the extent such costs are covered by such other
10 plan.
11     The fee to be charged by the Department for the
12 identification card shall be equal to $5 per coverage year for
13 persons below the official poverty line as defined by the
14 United States Department of Health and Human Services and $25
15 per coverage year for all other persons.
16     In the event that 2 or more persons are eligible for any
17 benefit under this Act, and are members of the same household,
18 (1) each such person shall be entitled to participate in the
19 pharmaceutical assistance program, provided that he or she
20 meets all other requirements imposed by this subsection and (2)
21 each participating household member contributes the fee
22 required for that person by the preceding paragraph for the
23 purpose of obtaining an identification card.
24     The provisions of this subsection (f), other than this
25 paragraph, are inoperative after December 31, 2005.
26 Beneficiaries who received benefits under the program

 

 

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1 established by this subsection (f) are not entitled, at the
2 termination of the program, to any refund of the identification
3 card fee paid under this subsection.
4     (g) Effective January 1, 2006, there is hereby established
5 a program of pharmaceutical assistance to the aged and
6 disabled, entitled the Illinois Seniors and Disabled Drug
7 Coverage Program, which shall be administered by the Department
8 of Healthcare and Family Services and the Department on Aging
9 in accordance with this subsection, to consist of coverage of
10 specified prescription drugs on behalf of beneficiaries of the
11 program as set forth in this subsection. The program under this
12 subsection replaces and supersedes the program established
13 under subsection (f), which shall end at midnight on December
14 31, 2005.
15     To become a beneficiary under the program established under
16 this subsection, a person must:
17         (1) be (i) 65 years of age or older or (ii) disabled;
18     and
19         (2) be domiciled in this State; and
20         (3) enroll with a qualified Medicare Part D
21     Prescription Drug Plan if eligible and apply for all
22     available subsidies under Medicare Part D; and
23         (4) have a maximum household income of (i) less than
24     $21,218 for a household containing one person, (ii) less
25     than $28,480 for a household containing 2 persons, or (iii)
26     less than $35,740 for a household containing 3 or more

 

 

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1     persons. If any income eligibility limit set forth in items
2     (i) through (iii) is less than 200% of the Federal Poverty
3     Level for any year, the income eligibility limit for that
4     year for households of that size shall be income equal to
5     or less than 200% of the Federal Poverty Level.
6     All individuals enrolled as of December 31, 2005, in the
7 pharmaceutical assistance program operated pursuant to
8 subsection (f) of this Section and all individuals enrolled as
9 of December 31, 2005, in the SeniorCare Medicaid waiver program
10 operated pursuant to Section 5-5.12a of the Illinois Public Aid
11 Code shall be automatically enrolled in the program established
12 by this subsection for the first year of operation without the
13 need for further application, except that they must apply for
14 Medicare Part D and the Low Income Subsidy under Medicare Part
15 D. A person enrolled in the pharmaceutical assistance program
16 operated pursuant to subsection (f) of this Section as of
17 December 31, 2005, shall not lose eligibility in future years
18 due only to the fact that they have not reached the age of 65.
19     To the extent permitted by federal law, the Department may
20 act as an authorized representative of a beneficiary in order
21 to enroll the beneficiary in a Medicare Part D Prescription
22 Drug Plan if the beneficiary has failed to choose a plan and,
23 where possible, to enroll beneficiaries in the low-income
24 subsidy program under Medicare Part D or assist them in
25 enrolling in that program.
26     Beneficiaries under the program established under this

 

 

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1 subsection shall be divided into the following 5 eligibility
2 groups:
3         (A) Eligibility Group 1 shall consist of beneficiaries
4     who are not eligible for Medicare Part D coverage and who
5     are:
6             (i) disabled and under age 65; or
7             (ii) age 65 or older, with incomes over 200% of the
8         Federal Poverty Level; or
9             (iii) age 65 or older, with incomes at or below
10         200% of the Federal Poverty Level and not eligible for
11         federally funded means-tested benefits due to
12         immigration status.
13         (B) Eligibility Group 2 shall consist of beneficiaries
14     otherwise described in Eligibility Group 1 but who are
15     eligible for Medicare Part D coverage.
16         (C) Eligibility Group 3 shall consist of beneficiaries
17     age 65 or older, with incomes at or below 200% of the
18     Federal Poverty Level, who are not barred from receiving
19     federally funded means-tested benefits due to immigration
20     status and are eligible for Medicare Part D coverage.
21         (D) Eligibility Group 4 shall consist of beneficiaries
22     age 65 or older, with incomes at or below 200% of the
23     Federal Poverty Level, who are not barred from receiving
24     federally funded means-tested benefits due to immigration
25     status and are not eligible for Medicare Part D coverage.
26         If the State applies and receives federal approval for

 

 

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1     a waiver under Title XIX of the Social Security Act,
2     persons in Eligibility Group 4 shall continue to receive
3     benefits through the approved waiver, and Eligibility
4     Group 4 may be expanded to include disabled persons under
5     age 65 with incomes under 200% of the Federal Poverty Level
6     who are not eligible for Medicare and who are not barred
7     from receiving federally funded means-tested benefits due
8     to immigration status.
9         (E) On and after January 1, 2007, Eligibility Group 5
10     shall consist of beneficiaries who are otherwise described
11     in Eligibility Groups 2 and 3 who have a diagnosis of HIV
12     or AIDS.
13     The program established under this subsection shall cover
14 the cost of covered prescription drugs in excess of the
15 beneficiary cost-sharing amounts set forth in this paragraph
16 that are not covered by Medicare. In 2006, beneficiaries shall
17 pay a co-payment of $2 for each prescription of a generic drug
18 and $5 for each prescription of a brand-name drug. In future
19 years, beneficiaries shall pay co-payments equal to the
20 co-payments required under Medicare Part D for "other
21 low-income subsidy eligible individuals" pursuant to 42 CFR
22 423.782(b). For individuals in Eligibility Groups 1, 2, 3, and
23 4, once the program established under this subsection and
24 Medicare combined have paid $1,750 in a year for covered
25 prescription drugs, the beneficiary shall pay 20% of the cost
26 of each prescription in addition to the co-payments set forth

 

 

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1 in this paragraph. For individuals in Eligibility Group 5, once
2 the program established under this subsection and Medicare
3 combined have paid $1,750 in a year for covered prescription
4 drugs, the beneficiary shall pay 20% of the cost of each
5 prescription in addition to the co-payments set forth in this
6 paragraph unless the drug is included in the formulary of the
7 Illinois AIDS Drug Assistance Program operated by the Illinois
8 Department of Public Health. If the drug is included in the
9 formulary of the Illinois AIDS Drug Assistance Program,
10 individuals in Eligibility Group 5 shall continue to pay the
11 co-payments set forth in this paragraph after the program
12 established under this subsection and Medicare combined have
13 paid $1,750 in a year for covered prescription drugs.
14     For beneficiaries eligible for Medicare Part D coverage,
15 the program established under this subsection shall pay 100% of
16 the premiums charged by a qualified Medicare Part D
17 Prescription Drug Plan for Medicare Part D basic prescription
18 drug coverage, not including any late enrollment penalties.
19 Qualified Medicare Part D Prescription Drug Plans may be
20 limited by the Department of Healthcare and Family Services to
21 those plans that sign a coordination agreement with the
22 Department.
23     Notwithstanding Section 3.15, for purposes of the program
24 established under this subsection, the term "covered
25 prescription drug" has the following meanings:
26         For Eligibility Group 1, "covered prescription drug"

 

 

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1     means: (1) any cardiovascular agent or drug; (2) any
2     insulin or other prescription drug used in the treatment of
3     diabetes, including syringe and needles used to administer
4     the insulin; (3) any prescription drug used in the
5     treatment of arthritis; (4) any prescription drug used in
6     the treatment of cancer; (5) any prescription drug used in
7     the treatment of Alzheimer's disease; (6) any prescription
8     drug used in the treatment of Parkinson's disease; (7) any
9     prescription drug used in the treatment of glaucoma; (8)
10     any prescription drug used in the treatment of lung disease
11     and smoking-related illnesses; (9) any prescription drug
12     used in the treatment of osteoporosis; and (10) beginning
13     January 1, 2009, any prescription drug used in treating the
14     effects the treatment of multiple sclerosis. The
15     Department may add additional therapeutic classes by rule.
16     The Department may adopt a preferred drug list within any
17     of the classes of drugs described in items (1) through (10)
18     of this paragraph. The specific drugs or therapeutic
19     classes of covered prescription drugs shall be indicated by
20     rule.
21         For Eligibility Group 2, "covered prescription drug"
22     means those drugs covered for Eligibility Group 1 that are
23     also covered by the Medicare Part D Prescription Drug Plan
24     in which the beneficiary is enrolled.
25         For Eligibility Group 3, "covered prescription drug"
26     means those drugs covered by the Medicare Part D

 

 

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1     Prescription Drug Plan in which the beneficiary is
2     enrolled.
3         For Eligibility Group 4, "covered prescription drug"
4     means those drugs covered by the Medical Assistance Program
5     under Article V of the Illinois Public Aid Code.
6         For Eligibility Group 5, for individuals otherwise
7     described in Eligibility Group 2, "covered prescription
8     drug" means: (1) those drugs covered for Eligibility Group
9     2 that are also covered by the Medicare Part D Prescription
10     Drug Plan in which the beneficiary is enrolled; and (2)
11     those drugs included in the formulary of the Illinois AIDS
12     Drug Assistance Program operated by the Illinois
13     Department of Public Health that are also covered by the
14     Medicare Part D Prescription Drug Plan in which the
15     beneficiary is enrolled. For Eligibility Group 5, for
16     individuals otherwise described in Eligibility Group 3,
17     "covered prescription drug" means those drugs covered by
18     the Medicare Part D Prescription Drug Plan in which the
19     beneficiary is enrolled.
20     An individual in Eligibility Group 1, 2, 3, 4, or 5 may opt
21 to receive a $25 monthly payment in lieu of the direct coverage
22 described in this subsection.
23     Any person otherwise eligible for pharmaceutical
24 assistance under this subsection whose covered drugs are
25 covered by any public program is ineligible for assistance
26 under this subsection to the extent that the cost of those

 

 

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1 drugs is covered by the other program.
2     The Department of Healthcare and Family Services shall
3 establish by rule the methods by which it will provide for the
4 coverage called for in this subsection. Those methods may
5 include direct reimbursement to pharmacies or the payment of a
6 capitated amount to Medicare Part D Prescription Drug Plans.
7     For a pharmacy to be reimbursed under the program
8 established under this subsection, it must comply with rules
9 adopted by the Department of Healthcare and Family Services
10 regarding coordination of benefits with Medicare Part D
11 Prescription Drug Plans. A pharmacy may not charge a
12 Medicare-enrolled beneficiary of the program established under
13 this subsection more for a covered prescription drug than the
14 appropriate Medicare cost-sharing less any payment from or on
15 behalf of the Department of Healthcare and Family Services.
16     The Department of Healthcare and Family Services or the
17 Department on Aging, as appropriate, may adopt rules regarding
18 applications, counting of income, proof of Medicare status,
19 mandatory generic policies, and pharmacy reimbursement rates
20 and any other rules necessary for the cost-efficient operation
21 of the program established under this subsection.
22     (h) Notwithstanding any other rulemaking authority that
23 may exist, neither the Governor nor any agency or agency head
24 under the jurisdiction of the Governor has any authority to
25 make or promulgate rules to implement or enforce the provisions
26 of this amendatory Act of the 95th General Assembly. If,

 

 

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1 however, the Governor believes that rules are necessary to
2 implement or enforce the provisions of this amendatory Act of
3 the 95th General Assembly, the Governor may suggest rules to
4 the General Assembly by filing them with the Clerk of the House
5 and Secretary of the Senate and by requesting that the General
6 Assembly authorize such rulemaking by law, enact those
7 suggested rules into law, or take any other appropriate action
8 in the General Assembly's discretion. Nothing contained in this
9 amendatory Act of the 95th General Assembly shall be
10 interpreted to grant rulemaking authority under any other
11 Illinois statute where such authority is not otherwise
12 explicitly given. For the purposes of this amendatory Act of
13 the 95th General Assembly, "rules" is given the meaning
14 contained in Section 1-70 of the Illinois Administrative
15 Procedure Act, and "agency" and "agency head" are given the
16 meanings contained in Sections 1-20 and 1-25 of the Illinois
17 Administrative Procedure Act to the extent that such
18 definitions apply to agencies or agency heads under the
19 jurisdiction of the Governor.
20 (Source: P.A. 94-86, eff. 1-1-06; 94-909, eff. 6-23-06; 95-208,
21 eff. 8-16-07; 95-644, eff. 10-12-07; revised 10-25-07.)
 
22     Section 99. Effective date. This Act takes effect upon
23 becoming law.