Full Text of HB4475 103rd General Assembly
HB4475eng 103RD GENERAL ASSEMBLY | | | HB4475 Engrossed | | LRB103 36234 RPS 66329 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 1. This Act may be referred to as the | 5 | | Strengthening Mental Health and Substance Use Parity Act. | 6 | | Section 2. Purpose. The purpose of this Act is to improve | 7 | | mental health and substance use parity, specifically | 8 | | addressing network adequacy and nonquantitative treatment | 9 | | limitations that restrict access to care. | 10 | | Section 3. Findings. The General Assembly finds that: | 11 | | (1) A 2021 U.S. Surgeon General Advisory, Protecting Youth | 12 | | Mental Health, reported the COVID-19 pandemic's devastating | 13 | | impact on youth and family mental health: | 14 | | (A) One in 3 high school students reported persistent | 15 | | feelings of hopelessness and sadness in 2019. | 16 | | (B) Rates of depression and anxiety for youth doubled | 17 | | during the pandemic. | 18 | | (C) Black children under 13 are nearly twice as likely | 19 | | to die by suicide than white children. | 20 | | (2) According to a bipartisan U.S. Senate Finance | 21 | | Committee report on Mental Health Care in the United States, | 22 | | symptoms for depression and anxiety in adults increased nearly |
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| 1 | | four-fold during the pandemic. | 2 | | (3) In 2020, 2,944 Illinoisans lost their lives to an | 3 | | opioid overdose according to the Illinois Department of Public | 4 | | Health. | 5 | | (4) Discriminatory commercial insurance practices that do | 6 | | not live up to the federal Mental Health Parity and Addiction | 7 | | Equity Act (MHPAEA) and Illinois' parity laws, specifically | 8 | | regarding insurance network adequacy, severely limit access to | 9 | | care. | 10 | | (5) Commercial insurance practices disincentivize mental | 11 | | health and substance use treatment providers from | 12 | | participating in insurance networks by erecting significant | 13 | | administrative barriers and by reimbursing providers far below | 14 | | the reimbursement of other health care providers despite a | 15 | | behavioral health workforce crisis. | 16 | | (A) Such practices lead to restrictive, narrow | 17 | | insurance networks that restrict access care. | 18 | | (B) 26% of psychiatrists do not participate in | 19 | | insurance networks, according to a report in JAMA | 20 | | Psychiatry. | 21 | | (C) 21% of psychologists do not participate in | 22 | | insurance networks, according to a 2015 American | 23 | | Psychological Association Survey. | 24 | | (D) A significant percentage of behavioral health | 25 | | providers do not contract with insurers, leaving patients | 26 | | to see out-of-network providers. |
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| 1 | | (E) Out-of-network treatment is far more expensive for | 2 | | the patient than in-network care. | 3 | | (F) Mental health and substance use treatment is | 4 | | inaccessible and unaffordable for millions of Illinoisans | 5 | | for these reasons. | 6 | | (6) A recent Milliman report analyzing insurance claims | 7 | | for 37,000,000 Americans, including Illinois residents, found | 8 | | major disparities in out-of-network utilization for behavioral | 9 | | health compared to other health care. The report's findings | 10 | | include: | 11 | | (A) Illinois out-of-network behavioral health | 12 | | utilization was 18.2% for outpatient services in 2017 | 13 | | compared to just 3.9% for medical/surgical services. | 14 | | (B) Illinois out-of-network behavioral health | 15 | | utilization was 12.1% in 2017 for inpatient care compared | 16 | | to just 2.8% for medical/surgical. | 17 | | (C) The disparity between out-of-network usage for | 18 | | behavioral health compared to medical/surgical services | 19 | | grew significantly between 2013 and 2017: Out-of-network | 20 | | behavioral health utilization for outpatient visits grew | 21 | | by 44%, while out-of-network utilization for | 22 | | medical/surgical services decreased by 42% over the same | 23 | | period in Illinois. | 24 | | (D) Nearly 14% of behavioral health office visits for | 25 | | individuals with a preferred provider organization plan | 26 | | were out-of-network in Illinois. |
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| 1 | | (7) Mental health and substance use care, which represents | 2 | | just 5.2% of all health care spending, does not drive up | 3 | | premiums. | 4 | | (8) Improved access to behavioral health care is expected | 5 | | to reduce overall health care spending because: | 6 | | (A) spending on physical health care is 2 to 3 times | 7 | | higher for patients with ongoing mental health and | 8 | | substance use diagnoses, according to a 2018 Milliman | 9 | | research report; and | 10 | | (B) improved utilization of mental health services has | 11 | | been demonstrated empirically to reduce overall health | 12 | | care spending (Biu, Yoon, & Hines, 2021). | 13 | | (9) Illinois must strengthen its parity laws to prevent | 14 | | insurance practices that restrict access to mental health and | 15 | | substance use care. | 16 | | Section 10. The Illinois Insurance Code is amended by | 17 | | adding Section 370c.3 as follows: | 18 | | (215 ILCS 5/370c.3 new) | 19 | | Sec. 370c.3. Mental health and substance use parity. | 20 | | (a) In this Section: | 21 | | "Application" means a person's or facility's application | 22 | | to become a participating provider with an insurer in at least | 23 | | one of the insurer's provider networks. | 24 | | "Applying provider" means a provider or facility that has |
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| 1 | | submitted a completed application to become a participating | 2 | | provider or facility with an insurer. | 3 | | "Behavioral health trainee" means any person: (1) engaged | 4 | | in the provision of mental health or substance use disorder | 5 | | clinical services as part of that person's supervised course | 6 | | of study while enrolled in a master's or doctoral psychology, | 7 | | social work, counseling, or marriage or family therapy program | 8 | | or as a postdoctoral graduate working toward licensure; and | 9 | | (2) who is working toward clinical State licensure under the | 10 | | clinical supervision of a fully licensed mental health or | 11 | | substance use disorder treatment provider. | 12 | | "Completed application" means a person's or facility's | 13 | | application to become a participating provider that has been | 14 | | submitted to the insurer and includes all the required | 15 | | information for the application to be considered by the | 16 | | insurer according to the insurer's policies and procedures for | 17 | | verifying a provider's or facility's credentials. | 18 | | "Contracting process" means the process by which a mental | 19 | | health or substance use disorder treatment provider or | 20 | | facility makes a completed application with an insurer to | 21 | | become a participating provider with the insurer until the | 22 | | effective date of a final contract between the provider or | 23 | | facility and the insurer. "Contracting process" includes the | 24 | | process of verifying a provider's credentials. | 25 | | "Participating provider" means any mental health or | 26 | | substance use disorder treatment provider that has a contract |
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| 1 | | to provide mental health or substance use disorder services | 2 | | with an insurer. | 3 | | (b) For all group or individual policies of accident and | 4 | | health insurance or managed care plans that are amended, | 5 | | delivered, issued, or renewed on or after January 1, 2026, or | 6 | | any contracted third party administering the behavioral health | 7 | | benefits for the insurer, reimbursement for in-network mental | 8 | | health and substance use disorder treatment services delivered | 9 | | by Illinois providers and facilities must be equal to or | 10 | | greater than 141% of the Medicare rate for the mental health or | 11 | | substance use disorder service delivered. For services not | 12 | | covered by Medicare, the reimbursement rates must be, on | 13 | | average, equal to or greater than 144% of the insurer's | 14 | | in-network reimbursement rate for such service on the | 15 | | effective date of this amendatory Act of the 103rd General | 16 | | Assembly. This Section applies to all covered office, | 17 | | outpatient, inpatient, and residential mental health and | 18 | | substance use disorder services. | 19 | | (c) A group or individual policy of accident and health | 20 | | insurance or managed care plan that is amended, delivered, | 21 | | issued, or renewed on or after January 1, 2025, or contracted | 22 | | third party administering the behavioral health benefits for | 23 | | the insurer, shall cover all medically necessary mental health | 24 | | or substance use disorder services received by the same | 25 | | insured on the same day from the same or different mental | 26 | | health or substance use provider or facility for both |
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| 1 | | outpatient and inpatient care. | 2 | | (d) A group or individual policy of accident and health | 3 | | insurance or managed care plan that is amended, delivered, | 4 | | issued, or renewed on or after January 1, 2025, or any | 5 | | contracted third party administering the behavioral health | 6 | | benefits for the insurer, shall cover any medically necessary | 7 | | mental health or substance use disorder service provided by a | 8 | | behavioral health trainee when the trainee is working toward | 9 | | clinical State licensure and is under the supervision of a | 10 | | fully licensed mental health or substance use disorder | 11 | | treatment provider, which is a physician licensed to practice | 12 | | medicine in all its branches, licensed clinical psychologist, | 13 | | licensed clinical social worker, licensed clinical | 14 | | professional counselor, licensed marriage and family | 15 | | therapist, licensed speech-language pathologist, or other | 16 | | licensed or certified professional at a program licensed | 17 | | pursuant to the Substance Use Disorder Act who is engaged in | 18 | | treating mental, emotional, nervous, or substance use | 19 | | disorders or conditions. Services provided by the trainee must | 20 | | be billed under the supervising clinician's rendering National | 21 | | Provider Identifier. | 22 | | (e) A group or individual policy of accident and health | 23 | | insurance or managed care plan that is amended, delivered, | 24 | | issued, or renewed on or after January 1, 2025, or any | 25 | | contracted third party administering the behavioral health | 26 | | benefits for the insurer, shall: |
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| 1 | | (1) cover medically necessary 60-minute psychotherapy | 2 | | billed using the CPT Code 90837 for Individual Therapy; | 3 | | (2) not impose more onerous documentation requirements | 4 | | on the provider than is required for other psychotherapy | 5 | | CPT Codes; and | 6 | | (3) not audit the use of CPT Code 90837 any more | 7 | | frequently than audits for the use of other psychotherapy | 8 | | CPT Codes. | 9 | | (f)(1) Any group or individual policy of accident and | 10 | | health insurance or managed care plan that is amended, | 11 | | delivered, issued, or renewed on or after January 1, 2026, or | 12 | | any contracted third party administering the behavioral health | 13 | | benefits for the insurer, shall complete the contracting | 14 | | process with a mental health or substance use disorder | 15 | | treatment provider or facility for becoming a participating | 16 | | provider in the insurer's network, including the verification | 17 | | of the provider's credentials, within 60 days from the date of | 18 | | a completed application to the insurer to become a | 19 | | participating provider. Nothing in this paragraph (1), | 20 | | however, presumes or establishes a contract between an insurer | 21 | | and a provider. | 22 | | (2) Any group or individual policy of accident and health | 23 | | insurance or managed care plan that is amended, delivered, | 24 | | issued, or renewed on or after January 1, 2025, or any | 25 | | contracted third party administering the behavioral health | 26 | | benefits for the insurer, shall reimburse a participating |
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| 1 | | mental health or substance use disorder treatment provider or | 2 | | facility at the contracted reimbursement rate for any | 3 | | medically necessary services provided to an insured from the | 4 | | date of submission of the provider's or facility's completed | 5 | | application to become a participating provider with the | 6 | | insurer up to the effective date of the provider's contract. | 7 | | The provider's claims for such services shall be reimbursed | 8 | | only when submitted after the effective date of the provider's | 9 | | contract with the insurer. This paragraph (2) does not apply | 10 | | to a provider that does not have a completed contract with an | 11 | | insurer. If a provider opts to submit claims for medically | 12 | | necessary mental health or substance use disorder services | 13 | | pursuant to this paragraph (2), the provider must notify the | 14 | | insured following submission of the claims to the insurer that | 15 | | the services provided to the insured may be treated as | 16 | | in-network services. | 17 | | (3) Any group or individual policy of accident and health | 18 | | insurance or managed care plan that is amended, delivered, | 19 | | issued, or renewed on or after January 1, 2025, or any | 20 | | contracted third party administering the behavioral health | 21 | | benefits for the insurer, shall cover any medically necessary | 22 | | mental health or substance use disorder service provided by a | 23 | | fully licensed mental health or substance use disorder | 24 | | treatment provider affiliated with a mental health or | 25 | | substance use disorder treatment group practice who has | 26 | | submitted a completed application to become a participating |
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| 1 | | provider with an insurer who is delivering services under the | 2 | | supervision of another fully licensed participating mental | 3 | | health or substance use disorder treatment provider within the | 4 | | same group practice up to the effective date of the applying | 5 | | provider's contract with the insurer as a participating | 6 | | provider. Services provided by the applying provider must be | 7 | | billed under the supervising licensed provider's rendering | 8 | | National Provider Identifier. | 9 | | (4) Upon request, an insurer, or any contracted third | 10 | | party administering the behavioral health benefits for the | 11 | | insurer, shall provide an applying provider with the insurer's | 12 | | credentialing policies and procedures. An insurer, or any | 13 | | contracted third party administering the behavioral health | 14 | | benefits for the insurer, shall post the following | 15 | | nonproprietary information on its website and make that | 16 | | information available to all applicants: | 17 | | (A) a list of the information required to be included | 18 | | in an application; | 19 | | (B) a checklist of the materials that must be | 20 | | submitted in the credentialing process; and | 21 | | (C) designated contact information of a network | 22 | | representative, including a designated point of contact, | 23 | | an email address, and a telephone number, to which an | 24 | | applicant may address any credentialing inquiries. | 25 | | (g) The Department has the same authority to enforce this | 26 | | Section as it has to enforce compliance with Sections 370c and |
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| 1 | | 370c.1. Additionally, if the Department determines that an | 2 | | insurer or a contracted third party administering the | 3 | | behavioral health benefits for the insurer has violated this | 4 | | Section, the Department shall, after appropriate notice and | 5 | | opportunity for hearing in accordance with Section 402, by | 6 | | order assess a civil penalty of $1,000 for each violation. The | 7 | | Department shall establish any processes or procedures | 8 | | necessary to monitor compliance with this Section. | 9 | | (h) The Department shall adopt any rules necessary to | 10 | | implement this Section by no later than May 1, 2025. | 11 | | (i) This Section does not apply to a health care plan | 12 | | serving Medicaid populations that provides, arranges for, pays | 13 | | for, or reimburses the cost of any health care service for | 14 | | persons who are enrolled under the Illinois Public Aid Code or | 15 | | under the Children's Health Insurance Program Act. | 16 | | Section 15. The Health Maintenance Organization Act is | 17 | | amended by changing Section 5-3 as follows: | 18 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | 19 | | Sec. 5-3. Insurance Code provisions. | 20 | | (a) Health Maintenance Organizations shall be subject to | 21 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 22 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | 23 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | 24 | | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, |
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| 1 | | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 2 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 3 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | 4 | | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | 5 | | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | 6 | | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | 7 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | 8 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | 9 | | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | 10 | | 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 11 | | 368d, 368e, 370c, 370c.3, 370c.1, 401, 401.1, 402, 403, 403A, | 12 | | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | 13 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | 14 | | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | 15 | | Illinois Insurance Code. | 16 | | (b) For purposes of the Illinois Insurance Code, except | 17 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | 18 | | Health Maintenance Organizations in the following categories | 19 | | are deemed to be "domestic companies": | 20 | | (1) a corporation authorized under the Dental Service | 21 | | Plan Act or the Voluntary Health Services Plans Act; | 22 | | (2) a corporation organized under the laws of this | 23 | | State; or | 24 | | (3) a corporation organized under the laws of another | 25 | | state, 30% or more of the enrollees of which are residents | 26 | | of this State, except a corporation subject to |
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| 1 | | substantially the same requirements in its state of | 2 | | organization as is a "domestic company" under Article VIII | 3 | | 1/2 of the Illinois Insurance Code. | 4 | | (c) In considering the merger, consolidation, or other | 5 | | acquisition of control of a Health Maintenance Organization | 6 | | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | 7 | | (1) the Director shall give primary consideration to | 8 | | the continuation of benefits to enrollees and the | 9 | | financial conditions of the acquired Health Maintenance | 10 | | Organization after the merger, consolidation, or other | 11 | | acquisition of control takes effect; | 12 | | (2)(i) the criteria specified in subsection (1)(b) of | 13 | | Section 131.8 of the Illinois Insurance Code shall not | 14 | | apply and (ii) the Director, in making his determination | 15 | | with respect to the merger, consolidation, or other | 16 | | acquisition of control, need not take into account the | 17 | | effect on competition of the merger, consolidation, or | 18 | | other acquisition of control; | 19 | | (3) the Director shall have the power to require the | 20 | | following information: | 21 | | (A) certification by an independent actuary of the | 22 | | adequacy of the reserves of the Health Maintenance | 23 | | Organization sought to be acquired; | 24 | | (B) pro forma financial statements reflecting the | 25 | | combined balance sheets of the acquiring company and | 26 | | the Health Maintenance Organization sought to be |
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| 1 | | acquired as of the end of the preceding year and as of | 2 | | a date 90 days prior to the acquisition, as well as pro | 3 | | forma financial statements reflecting projected | 4 | | combined operation for a period of 2 years; | 5 | | (C) a pro forma business plan detailing an | 6 | | acquiring party's plans with respect to the operation | 7 | | of the Health Maintenance Organization sought to be | 8 | | acquired for a period of not less than 3 years; and | 9 | | (D) such other information as the Director shall | 10 | | require. | 11 | | (d) The provisions of Article VIII 1/2 of the Illinois | 12 | | Insurance Code and this Section 5-3 shall apply to the sale by | 13 | | any health maintenance organization of greater than 10% of its | 14 | | enrollee population (including , without limitation , the health | 15 | | maintenance organization's right, title, and interest in and | 16 | | to its health care certificates). | 17 | | (e) In considering any management contract or service | 18 | | agreement subject to Section 141.1 of the Illinois Insurance | 19 | | Code, the Director (i) shall, in addition to the criteria | 20 | | specified in Section 141.2 of the Illinois Insurance Code, | 21 | | take into account the effect of the management contract or | 22 | | service agreement on the continuation of benefits to enrollees | 23 | | and the financial condition of the health maintenance | 24 | | organization to be managed or serviced, and (ii) need not take | 25 | | into account the effect of the management contract or service | 26 | | agreement on competition. |
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| 1 | | (f) Except for small employer groups as defined in the | 2 | | Small Employer Rating, Renewability and Portability Health | 3 | | Insurance Act and except for medicare supplement policies as | 4 | | defined in Section 363 of the Illinois Insurance Code, a | 5 | | Health Maintenance Organization may by contract agree with a | 6 | | group or other enrollment unit to effect refunds or charge | 7 | | additional premiums under the following terms and conditions: | 8 | | (i) the amount of, and other terms and conditions with | 9 | | respect to, the refund or additional premium are set forth | 10 | | in the group or enrollment unit contract agreed in advance | 11 | | of the period for which a refund is to be paid or | 12 | | additional premium is to be charged (which period shall | 13 | | not be less than one year); and | 14 | | (ii) the amount of the refund or additional premium | 15 | | shall not exceed 20% of the Health Maintenance | 16 | | Organization's profitable or unprofitable experience with | 17 | | respect to the group or other enrollment unit for the | 18 | | period (and, for purposes of a refund or additional | 19 | | premium, the profitable or unprofitable experience shall | 20 | | be calculated taking into account a pro rata share of the | 21 | | Health Maintenance Organization's administrative and | 22 | | marketing expenses, but shall not include any refund to be | 23 | | made or additional premium to be paid pursuant to this | 24 | | subsection (f)). The Health Maintenance Organization and | 25 | | the group or enrollment unit may agree that the profitable | 26 | | or unprofitable experience may be calculated taking into |
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| 1 | | account the refund period and the immediately preceding 2 | 2 | | plan years. | 3 | | The Health Maintenance Organization shall include a | 4 | | statement in the evidence of coverage issued to each enrollee | 5 | | describing the possibility of a refund or additional premium, | 6 | | and upon request of any group or enrollment unit, provide to | 7 | | the group or enrollment unit a description of the method used | 8 | | to calculate (1) the Health Maintenance Organization's | 9 | | profitable experience with respect to the group or enrollment | 10 | | unit and the resulting refund to the group or enrollment unit | 11 | | or (2) the Health Maintenance Organization's unprofitable | 12 | | experience with respect to the group or enrollment unit and | 13 | | the resulting additional premium to be paid by the group or | 14 | | enrollment unit. | 15 | | In no event shall the Illinois Health Maintenance | 16 | | Organization Guaranty Association be liable to pay any | 17 | | contractual obligation of an insolvent organization to pay any | 18 | | refund authorized under this Section. | 19 | | (g) Rulemaking authority to implement Public Act 95-1045, | 20 | | if any, is conditioned on the rules being adopted in | 21 | | accordance with all provisions of the Illinois Administrative | 22 | | Procedure Act and all rules and procedures of the Joint | 23 | | Committee on Administrative Rules; any purported rule not so | 24 | | adopted, for whatever reason, is unauthorized. | 25 | | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | 26 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
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| 1 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 2 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 3 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 4 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 5 | | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | 6 | | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | 7 | | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 8 | | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) | 9 | | Section 99. Effective date. This Act takes effect upon | 10 | | becoming law. |
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