Illinois 2023-2024 Regular Session

Illinois House Bill HB3920 Compare Versions

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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3920 Introduced 2/17/2023, by Rep. Debbie Meyers-Martin SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 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 Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for cranial prostheses when prescribed as part of a course of rehabilitative treatment by a physician licensed to practice medicine in all of its branches. Makes conforming changes in the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. LRB103 26433 BMS 52796 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3920 Introduced 2/17/2023, by Rep. Debbie Meyers-Martin SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 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 5/5-16.8 215 ILCS 5/356z.61 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 Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for cranial prostheses when prescribed as part of a course of rehabilitative treatment by a physician licensed to practice medicine in all of its branches. Makes conforming changes in the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. LRB103 26433 BMS 52796 b LRB103 26433 BMS 52796 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3920 Introduced 2/17/2023, by Rep. Debbie Meyers-Martin SYNOPSIS AS INTRODUCED:
33 215 ILCS 5/356z.61 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 5/5-16.8 215 ILCS 5/356z.61 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
44 215 ILCS 5/356z.61 new
55 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
66 215 ILCS 130/4003 from Ch. 73, par. 1504-3
77 215 ILCS 165/10 from Ch. 32, par. 604
88 305 ILCS 5/5-16.8
99 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for cranial prostheses when prescribed as part of a course of rehabilitative treatment by a physician licensed to practice medicine in all of its branches. Makes conforming changes in the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.
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1515 1 AN ACT concerning regulation.
1616 2 Be it enacted by the People of the State of Illinois,
1717 3 represented in the General Assembly:
1818 4 Section 5. The Illinois Insurance Code is amended by
1919 5 adding Section 356z.61 as follows:
2020 6 (215 ILCS 5/356z.61 new)
2121 7 Sec. 356z.61. Coverage for cranial prostheses. A group or
2222 8 individual policy of accident and health insurance or a
2323 9 managed care plan that is amended, delivered, issued, or
2424 10 renewed on or after the effective date of this amendatory Act
2525 11 of the 103rd General Assembly shall provide coverage for
2626 12 cranial prostheses when prescribed as part of a course of
2727 13 rehabilitative treatment by a physician licensed to practice
2828 14 medicine in all of its branches.
2929 15 Section 10. The Health Maintenance Organization Act is
3030 16 amended by changing Section 5-3 as follows:
3131 17 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
3232 18 Sec. 5-3. Insurance Code provisions.
3333 19 (a) Health Maintenance Organizations shall be subject to
3434 20 the provisions of Sections 133, 134, 136, 137, 139, 140,
3535 21 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
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3939 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3920 Introduced 2/17/2023, by Rep. Debbie Meyers-Martin SYNOPSIS AS INTRODUCED:
4040 215 ILCS 5/356z.61 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 5/5-16.8 215 ILCS 5/356z.61 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
4141 215 ILCS 5/356z.61 new
4242 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
4343 215 ILCS 130/4003 from Ch. 73, par. 1504-3
4444 215 ILCS 165/10 from Ch. 32, par. 604
4545 305 ILCS 5/5-16.8
4646 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for cranial prostheses when prescribed as part of a course of rehabilitative treatment by a physician licensed to practice medicine in all of its branches. Makes conforming changes in the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.
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5555 215 ILCS 5/356z.61 new
5656 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
5757 215 ILCS 130/4003 from Ch. 73, par. 1504-3
5858 215 ILCS 165/10 from Ch. 32, par. 604
5959 305 ILCS 5/5-16.8
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7878 1 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
7979 2 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
8080 3 356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
8181 4 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
8282 5 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
8383 6 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
8484 7 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
8585 8 356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
8686 9 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
8787 10 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
8888 11 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
8989 12 paragraph (c) of subsection (2) of Section 367, and Articles
9090 13 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
9191 14 XXXIIB of the Illinois Insurance Code.
9292 15 (b) For purposes of the Illinois Insurance Code, except
9393 16 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9494 17 Health Maintenance Organizations in the following categories
9595 18 are deemed to be "domestic companies":
9696 19 (1) a corporation authorized under the Dental Service
9797 20 Plan Act or the Voluntary Health Services Plans Act;
9898 21 (2) a corporation organized under the laws of this
9999 22 State; or
100100 23 (3) a corporation organized under the laws of another
101101 24 state, 30% or more of the enrollees of which are residents
102102 25 of this State, except a corporation subject to
103103 26 substantially the same requirements in its state of
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114114 1 organization as is a "domestic company" under Article VIII
115115 2 1/2 of the Illinois Insurance Code.
116116 3 (c) In considering the merger, consolidation, or other
117117 4 acquisition of control of a Health Maintenance Organization
118118 5 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
119119 6 (1) the Director shall give primary consideration to
120120 7 the continuation of benefits to enrollees and the
121121 8 financial conditions of the acquired Health Maintenance
122122 9 Organization after the merger, consolidation, or other
123123 10 acquisition of control takes effect;
124124 11 (2)(i) the criteria specified in subsection (1)(b) of
125125 12 Section 131.8 of the Illinois Insurance Code shall not
126126 13 apply and (ii) the Director, in making his determination
127127 14 with respect to the merger, consolidation, or other
128128 15 acquisition of control, need not take into account the
129129 16 effect on competition of the merger, consolidation, or
130130 17 other acquisition of control;
131131 18 (3) the Director shall have the power to require the
132132 19 following information:
133133 20 (A) certification by an independent actuary of the
134134 21 adequacy of the reserves of the Health Maintenance
135135 22 Organization sought to be acquired;
136136 23 (B) pro forma financial statements reflecting the
137137 24 combined balance sheets of the acquiring company and
138138 25 the Health Maintenance Organization sought to be
139139 26 acquired as of the end of the preceding year and as of
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150150 1 a date 90 days prior to the acquisition, as well as pro
151151 2 forma financial statements reflecting projected
152152 3 combined operation for a period of 2 years;
153153 4 (C) a pro forma business plan detailing an
154154 5 acquiring party's plans with respect to the operation
155155 6 of the Health Maintenance Organization sought to be
156156 7 acquired for a period of not less than 3 years; and
157157 8 (D) such other information as the Director shall
158158 9 require.
159159 10 (d) The provisions of Article VIII 1/2 of the Illinois
160160 11 Insurance Code and this Section 5-3 shall apply to the sale by
161161 12 any health maintenance organization of greater than 10% of its
162162 13 enrollee population (including without limitation the health
163163 14 maintenance organization's right, title, and interest in and
164164 15 to its health care certificates).
165165 16 (e) In considering any management contract or service
166166 17 agreement subject to Section 141.1 of the Illinois Insurance
167167 18 Code, the Director (i) shall, in addition to the criteria
168168 19 specified in Section 141.2 of the Illinois Insurance Code,
169169 20 take into account the effect of the management contract or
170170 21 service agreement on the continuation of benefits to enrollees
171171 22 and the financial condition of the health maintenance
172172 23 organization to be managed or serviced, and (ii) need not take
173173 24 into account the effect of the management contract or service
174174 25 agreement on competition.
175175 26 (f) Except for small employer groups as defined in the
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186186 1 Small Employer Rating, Renewability and Portability Health
187187 2 Insurance Act and except for medicare supplement policies as
188188 3 defined in Section 363 of the Illinois Insurance Code, a
189189 4 Health Maintenance Organization may by contract agree with a
190190 5 group or other enrollment unit to effect refunds or charge
191191 6 additional premiums under the following terms and conditions:
192192 7 (i) the amount of, and other terms and conditions with
193193 8 respect to, the refund or additional premium are set forth
194194 9 in the group or enrollment unit contract agreed in advance
195195 10 of the period for which a refund is to be paid or
196196 11 additional premium is to be charged (which period shall
197197 12 not be less than one year); and
198198 13 (ii) the amount of the refund or additional premium
199199 14 shall not exceed 20% of the Health Maintenance
200200 15 Organization's profitable or unprofitable experience with
201201 16 respect to the group or other enrollment unit for the
202202 17 period (and, for purposes of a refund or additional
203203 18 premium, the profitable or unprofitable experience shall
204204 19 be calculated taking into account a pro rata share of the
205205 20 Health Maintenance Organization's administrative and
206206 21 marketing expenses, but shall not include any refund to be
207207 22 made or additional premium to be paid pursuant to this
208208 23 subsection (f)). The Health Maintenance Organization and
209209 24 the group or enrollment unit may agree that the profitable
210210 25 or unprofitable experience may be calculated taking into
211211 26 account the refund period and the immediately preceding 2
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222222 1 plan years.
223223 2 The Health Maintenance Organization shall include a
224224 3 statement in the evidence of coverage issued to each enrollee
225225 4 describing the possibility of a refund or additional premium,
226226 5 and upon request of any group or enrollment unit, provide to
227227 6 the group or enrollment unit a description of the method used
228228 7 to calculate (1) the Health Maintenance Organization's
229229 8 profitable experience with respect to the group or enrollment
230230 9 unit and the resulting refund to the group or enrollment unit
231231 10 or (2) the Health Maintenance Organization's unprofitable
232232 11 experience with respect to the group or enrollment unit and
233233 12 the resulting additional premium to be paid by the group or
234234 13 enrollment unit.
235235 14 In no event shall the Illinois Health Maintenance
236236 15 Organization Guaranty Association be liable to pay any
237237 16 contractual obligation of an insolvent organization to pay any
238238 17 refund authorized under this Section.
239239 18 (g) Rulemaking authority to implement Public Act 95-1045,
240240 19 if any, is conditioned on the rules being adopted in
241241 20 accordance with all provisions of the Illinois Administrative
242242 21 Procedure Act and all rules and procedures of the Joint
243243 22 Committee on Administrative Rules; any purported rule not so
244244 23 adopted, for whatever reason, is unauthorized.
245245 24 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
246246 25 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
247247 26 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
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258258 1 eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
259259 2 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
260260 3 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
261261 4 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
262262 5 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
263263 6 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
264264 7 eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
265265 8 Section 15. The Limited Health Service Organization Act is
266266 9 amended by changing Section 4003 as follows:
267267 10 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
268268 11 Sec. 4003. Illinois Insurance Code provisions. Limited
269269 12 health service organizations shall be subject to the
270270 13 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
271271 14 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
272272 15 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
273273 16 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
274274 17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
275275 18 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
276276 19 356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
277277 20 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
278278 21 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
279279 22 Illinois Insurance Code. Nothing in this Section shall require
280280 23 a limited health care plan to cover any service that is not a
281281 24 limited health service. For purposes of the Illinois Insurance
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292292 1 Code, except for Sections 444 and 444.1 and Articles XIII and
293293 2 XIII 1/2, limited health service organizations in the
294294 3 following categories are deemed to be domestic companies:
295295 4 (1) a corporation under the laws of this State; or
296296 5 (2) a corporation organized under the laws of another
297297 6 state, 30% or more of the enrollees of which are residents
298298 7 of this State, except a corporation subject to
299299 8 substantially the same requirements in its state of
300300 9 organization as is a domestic company under Article VIII
301301 10 1/2 of the Illinois Insurance Code.
302302 11 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
303303 12 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
304304 13 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
305305 14 eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
306306 15 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
307307 16 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
308308 17 Section 20. The Voluntary Health Services Plans Act is
309309 18 amended by changing Section 10 as follows:
310310 19 (215 ILCS 165/10) (from Ch. 32, par. 604)
311311 20 Sec. 10. Application of Insurance Code provisions. Health
312312 21 services plan corporations and all persons interested therein
313313 22 or dealing therewith shall be subject to the provisions of
314314 23 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
315315 24 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
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326326 1 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
327327 2 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
328328 3 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
329329 4 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
330330 5 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
331331 6 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
332332 7 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
333333 8 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
334334 9 and paragraphs (7) and (15) of Section 367 of the Illinois
335335 10 Insurance Code.
336336 11 Rulemaking authority to implement Public Act 95-1045, if
337337 12 any, is conditioned on the rules being adopted in accordance
338338 13 with all provisions of the Illinois Administrative Procedure
339339 14 Act and all rules and procedures of the Joint Committee on
340340 15 Administrative Rules; any purported rule not so adopted, for
341341 16 whatever reason, is unauthorized.
342342 17 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
343343 18 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
344344 19 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
345345 20 eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
346346 21 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
347347 22 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
348348 23 eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
349349 24 102-1117, eff. 1-13-23.)
350350 25 Section 25. The Illinois Public Aid Code is amended by
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361361 1 changing Section 5-16.8 as follows:
362362 2 (305 ILCS 5/5-16.8)
363363 3 Sec. 5-16.8. Required health benefits. The medical
364364 4 assistance program shall (i) provide the post-mastectomy care
365365 5 benefits required to be covered by a policy of accident and
366366 6 health insurance under Section 356t and the coverage required
367367 7 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
368368 8 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
369369 9 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
370370 10 356z.61 of the Illinois Insurance Code, (ii) be subject to the
371371 11 provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
372372 12 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
373373 13 subject to the provisions of subsection (d-5) of Section 10 of
374374 14 the Network Adequacy and Transparency Act.
375375 15 The Department, by rule, shall adopt a model similar to
376376 16 the requirements of Section 356z.39 of the Illinois Insurance
377377 17 Code.
378378 18 On and after July 1, 2012, the Department shall reduce any
379379 19 rate of reimbursement for services or other payments or alter
380380 20 any methodologies authorized by this Code to reduce any rate
381381 21 of reimbursement for services or other payments in accordance
382382 22 with Section 5-5e.
383383 23 To ensure full access to the benefits set forth in this
384384 24 Section, on and after January 1, 2016, the Department shall
385385 25 ensure that provider and hospital reimbursement for
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396396 1 post-mastectomy care benefits required under this Section are
397397 2 no lower than the Medicare reimbursement rate.
398398 3 (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
399399 4 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
400400 5 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
401401 6 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
402402 7 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
403403 8 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
404404 9 eff. 1-1-23; 102-1117, eff. 1-13-23.)
405405
406406
407407
408408
409409
410410 HB3920 - 11 - LRB103 26433 BMS 52796 b