0001| HOUSE BILL 979
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0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997
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0003| INTRODUCED BY
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0004| JEANNETTE WALLACE
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0005|
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0006|
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0007|
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0008|
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0009|
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0010| AN ACT
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0011| RELATING TO INSURANCE; REQUIRING COVERAGE FOR CHILDHOOD
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0012| IMMUNIZATIONS; AMENDING AND ENACTING SECTIONS OF THE NMSA 1978.
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0013|
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0014| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0015| Section 1. A new Section 59A-22-34.3 NMSA 1978 is enacted
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0016| to read:
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0017| "59A-22-34.3. [NEW MATERIAL] CHILDHOOD IMMUNIZATION
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0018| COVERAGE REQUIRED.--
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0019| A. Each individual and group health insurance
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0020| policy, health care plan and certificate of health insurance
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0021| delivered or issued for delivery in this state shall provide
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0022| coverage for childhood immunizations, as well as coverage for
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0023| medically necessary booster doses of all immunizing agents used
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0024| in child immunizations.
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0025| B. The provisions of this section shall not apply
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0001| to short-term travel, accident-only or limited or specified
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0002| disease policies.
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0003| C. Coverage for childhood immunizations and
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0004| necessary booster doses may be subject to deductibles and co-
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0005| insurance consistent with those imposed on other benefits under
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0006| the same policy, plan or certificate."
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0007| Section 2. Section 59A-23-4 NMSA 1978 (being Laws 1984,
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0008| Chapter 127, Section 463, as amended) is amended to read:
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0009| "59A-23-4. OTHER PROVISIONS APPLICABLE.--
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0010| A. No blanket or group health insurance policy or
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0011| contract shall contain any provision relative to notice or
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0012| proof of loss or the time for paying benefits or the time
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0013| within which suit may be brought upon the policy that in the
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0014| superintendent's opinion is less favorable to the insured than
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0015| would be permitted in the required or optional provisions for
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0016| individual health insurance policies as set forth in Chapter
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0017| 59A, Article 22 NMSA 1978.
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0018| B. The following provisions of Chapter 59A, Article
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0019| 22 NMSA 1978 shall also apply as to Chapter 59A, Article 23
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0020| NMSA 1978 and blanket and group health insurance contracts:
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0021| (1) Section 59A-22-1 NMSA 1978, except
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0022| Subsection C thereof; and
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0023| (2) Section 59A-22-32 NMSA 1978.
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0024| C. The following provisions of Chapter 59A, Article
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0025| 22 NMSA 1978 shall also apply as to group health insurance
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0001| contracts:
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0002| (1) Section 59A-22-33 NMSA 1978;
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0003| (2) Section 59A-22-34 NMSA 1978;
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0004| (3) Section 59A-22-34.1 NMSA 1978;
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0005| (4) Section 59A-22-35 NMSA 1978;
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0006| (5) Section 59A-22-36 NMSA 1978;
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0007| (6) Section 59A-22-39 NMSA 1978; [and]
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0008| (7) Section 59A-22-34.3 NMSA 1978; and
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0009| [(7)] (8) Section 59A-22-40 NMSA 1978."
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0010| Section 3. Section 59A-23B-3 NMSA 1978 (being Laws 1991,
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0011| Chapter 111, Section 3, as amended) is amended to read:
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0012| "59A-23B-3. POLICY OR PLAN--DEFINITION--CRITERIA.--
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0013| A. For purposes of the Minimum Healthcare
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0014| Protection Act, "policy or plan" means a healthcare benefit
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0015| policy or healthcare benefit plan that the insurer, fraternal
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0016| benefit society, health maintenance organization or nonprofit
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0017| healthcare plan chooses to offer to individuals, families or
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0018| groups of fewer than twenty members formed for purposes other
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0019| than obtaining insurance coverage and that meets the
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0020| requirements of Subsection B of this section. For purposes of
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0021| the Minimum Healthcare Protection Act, "policy or plan" shall
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0022| not mean a healthcare policy or healthcare benefit plan that an
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0023| insurer, health maintenance organization, fraternal benefit
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0024| society or nonprofit healthcare plan chooses to offer outside
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0025| the authority of the Minimum Healthcare Protection Act.
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0001| B. A policy or plan shall meet the following
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0002| criteria:
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0003| (1) the individual, family or group obtaining
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0004| coverage under the policy or plan has been without healthcare
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0005| insurance, a health services plan or employer-sponsored
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0006| healthcare coverage for the six-month period immediately
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0007| preceding the effective date of its coverage under a policy or
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0008| plan, provided that the six-month period shall not apply to:
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0009| (a) a group that has been in existence
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0010| for less than six months and has been without healthcare
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0011| coverage since the formation of the group;
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0012| (b) an employee whose healthcare
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0013| coverage has been terminated by an employer;
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0014| (c) a dependent who no longer qualifies
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0015| as a dependent under the terms of the contract; or
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0016| (d) an individual and an individual's
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0017| dependents who no longer have healthcare coverage as a result
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0018| of termination or change in employment of the individual or by
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0019| reason of death of a spouse or dissolution of a marriage,
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0020| notwithstanding rights the individual or individual's
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0021| dependents may have to continue healthcare coverage on a self-
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0022| pay basis pursuant to the provisions of the federal
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0023| Consolidated Omnibus Budget Reconciliation Act of 1985;
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0024| (2) the policy or plan includes the following
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0025| managed care provisions to control costs:
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0001| (a) an exclusion for services that are
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0002| not medically necessary or are not covered by preventive health
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0003| services; and
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0004| (b) a procedure for preauthorization of
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0005| elective hospital admissions by the insurer, fraternal benefit
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0006| society, health maintenance organization or nonprofit
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0007| healthcare plan; and
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0008| (3) subject to a maximum limit on the cost of
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0009| healthcare services covered in any calendar year of not less
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0010| than fifty thousand dollars ($50,000), the policy or plan
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0011| provides the following minimum healthcare services to covered
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0012| individuals:
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0013| (a) inpatient hospitalization coverage
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0014| or home care coverage in lieu of hospitalization or a
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0015| combination of both, not to exceed twenty-five days of coverage
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0016| inclusive of any deductibles, co-payments or co-insurance,
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0017| provided that a period of inpatient hospitalization coverage
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0018| shall precede any home care coverage;
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0019| (b) prenatal care, including a minimum
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0020| of one prenatal office visit per month during the first two
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0021| trimesters of pregnancy, two office visits per month during the
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0022| seventh and eighth months of pregnancy and one office visit per
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0023| week during the ninth month and until term, provided that
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0024| coverage for each office visit shall also include prenatal
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0025| counseling and education and necessary and appropriate
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0001| screening, including history, physical examination and the
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0002| laboratory and diagnostic procedures deemed appropriate by the
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0003| physician based upon recognized medical criteria for the risk
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0004| group of which the patient is a member;
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0005| (c) obstetrical care, including
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0006| physicians' and certified nurse midwives' services, delivery
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0007| room and other medically necessary services directly associated
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0008| with delivery;
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0009| (d) well-baby and well-child care,
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0010| including periodic evaluation of a child's physical and
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0011| emotional status, a history, a complete physical examination, a
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0012| developmental assessment, anticipatory guidance, appropriate
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0013| immunizations and laboratory tests in keeping with prevailing
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0014| medical standards, provided that such evaluation and care shall
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0015| be covered when performed at approximately the age intervals of
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0016| birth, two weeks, two months, four months, six months, nine
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0017| months, twelve months, fifteen months, eighteen months, two
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0018| years, three years, four years, five years and six years;
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0019| (e) coverage for low-dose screening
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0020| mammograms for determining the presence of breast cancer,
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0021| provided that the mammogram coverage shall include one baseline
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0022| mammogram for persons age thirty-five through thirty-nine
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0023| years, one biennial mammogram for persons age forty through
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0024| forty-nine years and one annual mammogram for persons age fifty
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0025| years and over, and further provided that the mammogram
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0001| coverage shall only be subject to deductibles and co-insurance
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0002| requirements consistent with those imposed on other benefits
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0003| under the same policy or plan;
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0004| (f) coverage for cytologic screening, to
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0005| include a Papanicolaou test and pelvic exam for asymptomatic as
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0006| well as symptomatic women; [and]
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0007| (g) a basic level of primary and
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0008| preventive care, including, but not limited to, no less than
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0009| seven physician, nurse practitioner, nurse midwife or physician
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0010| assistant office visits per calendar year, including any
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0011| ancillary diagnostic or laboratory tests related to the office
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0012| visit; and
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0013| (h) coverage for childhood
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0014| immunizations, including coverage for all medically necessary
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0015| booster doses of all immunizing agents used in childhood
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0016| immunizations, provided that coverage for childhood
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0017| immunizations and necessary booster doses may be subject to
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0018| deductibles and co-insurance consistent with those imposed on
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0019| other benefits under the same policy or plan.
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0020| C. A policy or plan may include the following
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0021| managed care and cost control features to control costs:
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0022| (1) a panel of providers who have entered into
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0023| written agreements with the insurer, fraternal benefit society,
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0024| health maintenance organization or nonprofit healthcare plan to
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0025| provide covered healthcare services at specified levels of
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0001| reimbursement, provided that any such written agreement shall
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0002| contain a provision relieving the individual, family or group
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0003| covered by the policy or plan from any obligation to pay for
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0004| any healthcare service performed by the provider that is
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0005| determined by the insurer, fraternal benefit society, health
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0006| maintenance organization or nonprofit healthcare plan not to be
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0007| medically necessary;
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0008| (2) a requirement for obtaining a second
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0009| opinion before elective surgery is performed;
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0010| (3) a procedure for utilization review by the
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0011| insurer, fraternal benefit society, health maintenance
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0012| organization or nonprofit healthcare plan; and
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0013| (4) a maximum limit on the cost of healthcare
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0014| services covered in any calendar year of not less than fifty
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0015| thousand dollars ($50,000).
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0016| D. Nothing contained in Subsection C of this
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0017| section shall prohibit an insurer, fraternal benefit society,
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0018| health maintenance organization or nonprofit healthcare plan
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0019| from including in the policy or plan additional managed care
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0020| and cost control provisions that the superintendent of
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0021| insurance determines to have the potential for controlling
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0022| costs in a manner that does not cause discriminatory treatment
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0023| of individuals, families or groups covered by the policy or
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0024| plan.
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0025| E. Notwithstanding any other provisions of law, a
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0001| policy or plan shall not exclude coverage for losses incurred
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0002| for a preexisting condition more than six months from the
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0003| effective date of coverage. The policy or plan shall not
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0004| define a preexisting condition more restrictively than a
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0005| condition for which medical advice was given or treatment
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0006| recommended by or received from a physician within six months
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0007| before the effective date of coverage.
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0008| F. No medical group, independent practice
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0009| association or health professional employed by or contracting
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0010| with an insurer, fraternal benefit society, health maintenance
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0011| organization or nonprofit healthcare plan shall maintain any
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0012| action against any insured person, family or group member for
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0013| sums owed by an insurer, fraternal benefit society, health
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0014| maintenance organization or nonprofit healthcare plan, for sums
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0015| higher than those agreed to pursuant to a policy or plan."
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0016| Section 4. A new Section 59A-46-38.2 NMSA 1978 is enacted
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0017| to read:
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0018| "59A-46-38.2. [NEW MATERIAL] CHILDHOOD IMMUNIZATION
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0019| COVERAGE REQUIRED.--
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0020| A. Each individual and group health maintenance
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0021| contract delivered or issued for delivery in this state shall
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0022| provide coverage for childhood immunizations, including
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0023| coverage for all medically necessary booster doses of all
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0024| immunizing agents used in childhood immunizations.
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0025| B. Coverage for childhood immunizations and
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0001| necessary booster doses may be subject to deductibles and co-
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0002| insurance consistent with those imposed on other benefits under
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0003| the same contract."
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0004| State of New Mexico
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0005| House of Representatives
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0006|
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0007| FORTY-THIRD LEGISLATURE
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0008| FIRST SESSION, 1997
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0009|
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0010|
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0011| February 27, 1997
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0012|
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0013|
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0014| Mr. Speaker:
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0015|
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0016| Your CONSUMER AND PUBLIC AFFAIRS COMMITTEE, to
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0017| whom has been referred
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0018|
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0019| HOUSE BILL 979
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0020|
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0021| has had it under consideration and reports same with
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0022| recommendation that it DO PASS, and thence referred to the
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0023| BUSINESS AND INDUSTRY COMMITTEE.
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0024|
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0025| Respectfully submitted,
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0001|
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0002|
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0003|
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0004|
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0005|
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0006| Gary King, Chairman
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0007|
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0008|
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0009| Adopted Not Adopted
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0010|
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0011| (Chief Clerk) (Chief Clerk)
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0012|
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0013| Date
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0014|
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0015| The roll call vote was 8 For 0 Against
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0016| Yes: 8
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0017| Excused: Rios, Sandel
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0018| Absent: None
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0019|
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0020|
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0021| G:\BILLTEXT\BILLW_97\H0979 State of New Mexico
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0022| House of Representatives
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0023|
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0024| FORTY-THIRD LEGISLATURE
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0025| FIRST SESSION, 1997
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0001|
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0002|
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0003| March 6, 1997
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0004|
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0005|
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0006| Mr. Speaker:
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0007|
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0008| Your BUSINESS AND INDUSTRY COMMITTEE, to whom
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0009| has been referred
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0010|
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0011| HOUSE BILL 979
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0012|
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0013| has had it under consideration and reports same with
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0014| recommendation that it DO PASS.
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0015|
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0016| Respectfully submitted,
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0017|
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0018|
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0019|
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0020|
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0021|
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0022| Fred Luna, Chairman
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0023|
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0024|
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0025| Adopted Not Adopted
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0001|
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0002| (Chief Clerk) (Chief Clerk)
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0003|
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0004| Date
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0005|
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0006| The roll call vote was 10 For 0 Against
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0007| Yes: 10
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0008| Excused: Getty, Gubbels, Kissner
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0009| Absent: None
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0010|
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0011|
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0012| G:\BILLTEXT\BILLW_97\H0979 FORTY-THIRD LEGISLATURE
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0013| FIRST SESSION
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0014|
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0015|
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0016| March 7, 1997
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0017|
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0018|
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0019| HOUSE FLOOR AMENDMENT number ___1___ to HOUSE BILL 979
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0020|
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0021| Amendment sponsored by Representative Jeannette Wallace
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0022|
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0023|
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0024| 1. On page 1, line 24, after "immunizations" insert ", in
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0025| accordance with the current schedule of immunizations recommended by
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0001| the American academy of pediatrics".
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0002|
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0003| 2. On page 7, line 13, after "immunizations" insert ", in
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0004| accordance with the current schedule of immunizations recommended by
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0005| the American academy of pediatrics".
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0006|
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0007| 3. On page 9, line 21, after "immunizations" insert ", in
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0008| accordance with the current schedule of immunizations recommended by
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0009| the American academy of pediatrics".
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0010|
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0011|
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0012|
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0013|
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0014|
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0015| ___________________________
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0016| Jeannette Wallace
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0017|
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0018|
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0019|
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0020| Adopted ___________________ Not Adopted ___________________________
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0021| (Chief Clerk) (Chief Clerk)
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0022|
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0023|
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0024| Date ________________
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0025|
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0001| FORTY-THIRD LEGISLATURE
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0002| FIRST SESSION, 1997
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0003|
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0004|
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0005| March 15, 1997
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0006|
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0007| Mr. President:
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0008|
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0009| Your PUBLIC AFFAIRS COMMITTEE, to whom has been referred
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0010|
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0011| HOUSE BILL 979, as amended
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0012|
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0013| has had it under consideration and reports same with recommendation
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0014| that it DO PASS.
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0015|
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0016| Respectfully submitted,
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0017|
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0018|
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0019|
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0020| __________________________________
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0021| Shannon Robinson, Chairman
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0022|
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0023|
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0024|
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0025| Adopted_______________________ Not Adopted_______________________
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0001| (Chief Clerk) (Chief Clerk)
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0002|
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0003|
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0004| Date ________________________
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0005|
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0006|
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0007| The roll call vote was 5 For 0 Against
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0008| Yes: 5
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0009| No: 0
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0010| Excused: Adair, Ingle, Vernon, Smith
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0011| Absent: None
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0012|
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0013|
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0014|
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0015|
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0016| H0979PA1
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