0001| SENATE BILL 898
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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| SUE F. WILSON
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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 PUBLIC ASSISTANCE; PROVIDING FOR REVIEW AND
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0012| REGULATION OF MEDICAID PROVIDERS; PROVIDING ADMINISTRATIVE
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0013| PENALTIES.
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0014|
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0015| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0016| Section 1. SHORT TITLE.--This act may be cited as the
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0017| "Medicaid Provider Act".
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0018| Section 2. DEFINITIONS.--As used in the Medicaid Provider
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0019| Act:
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0020| A. "department" means the human services
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0021| department;
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0022| B. "managed care organization" means a person
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0023| eligible to enter into risk-based prepaid capitation agreements
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0024| with the department to provide health care and related
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0025| services;
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0001| C. "medicaid" means the medical assistance program
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0002| established pursuant to Title 19 of the federal Social
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0003| Security, Act, as amended from time to time, and regulations
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0004| issued pursuant to that act;
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0005| D. "medicaid provider" means a person, including a
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0006| managed care organization, operating under contract with the
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0007| department to provide medicaid-related services to recipients;
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0008| E. "person" means an individual or other legal
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0009| entity;
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0010| F. "recipient" means a person whom the department
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0011| has determined to be eligible to receive medicaid-related
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0012| services;
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0013| G. "secretary" means the secretary of human
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0014| services; and
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0015| H. "subcontractor" means a person that contracts
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0016| with a medicaid provider to provide medicaid-related services
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0017| to recipients."
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0018| Section 3. REVIEW OF MEDICAID PROVIDERS--CONTRACT
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0019| REMEDIES--PENALTIES.--
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0020| A. The secretary may review the operations of a
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0021| medicaid provider, and shall have the right of and be afforded
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0022| full access to the medicaid provider's records, personnel and
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0023| facilities for that purpose at all times.
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0024| B. The secretary may, consistent with the
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0025| provisions of the Medicaid Provider Act and regulations issued
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0001| pursuant to that act, carry out an administrative investigation
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0002| or conduct administrative proceedings to determine whether a
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0003| medicaid provider has:
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0004| (1) operated in a manner that materially
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0005| violates its organizational documents;
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0006| (2) materially breached its obligation to
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0007| furnish medicaid-related services to recipients, or any other
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0008| duty specified in its contract with the department;
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0009| (3) violated any provision of the Public
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0010| Assistance Act or the Medicaid Provider Act or any regulations
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0011| issued pursuant to those acts;
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0012| (4) made any false statement with respect to
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0013| any report or statement required by the Public Assistance Act,
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0014| or the Medicaid Provider Act, regulations issued pursuant to
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0015| either of those acts or a contract with the department;
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0016| (5) advertised or marketed, or attempted to
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0017| advertise or market, its services to recipients in such a
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0018| manner as to misrepresent its services or capacity for
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0019| services, or engaged in any deceptive, misleading or unfair
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0020| practice with respect to advertising or marketing;
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0021| (6) hindered or prevented the secretary from
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0022| performing any duty imposed by the Public Assistance Act, the
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0023| Human Services Department Act or the Medicaid Provider Act or
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0024| any regulations issued pursuant to those acts; or
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0025| (7) fraudulently procured or attempted to
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0001| procure any benefit from medicaid.
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0002| C. After affording a medicaid provider written
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0003| notice of hearing not less than ten days before the hearing
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0004| date and an opportunity to be heard, and upon making
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0005| appropriate administrative findings, the secretary may take any
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0006| or any combination of the following actions against the
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0007| provider:
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0008| (1) impose an administrative penalty of not
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0009| more than ten thousand dollars ($10,000) for engaging in any
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0010| practice described in Paragraphs (1) through (7) of Subsection
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0011| B of this section; provided, that each occurrence of each
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0012| practice shall constitute a separate offense;
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0013| (2) issue an administrative order requiring
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0014| the provider to:
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0015| (a) cease or modify any specified
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0016| conduct or practices engaged in by it, its employees,
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0017| subcontractors or agents;
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0018| (b) fulfill its contractual obligations
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0019| in the manner specified in the order;
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0020| (c) provide any service that has been
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0021| denied;
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0022| (d) take steps to provide or arrange for
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0023| any service that it has agreed or is otherwise obligated to
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0024| make available; or
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0025| (e) enter into and abide by the terms of
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0001| a binding or non-binding arbitration proceeding, if agreed to
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0002| by any opposing party, including the secretary; or
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0003| (3) suspend or revoke the contract between the
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0004| provider and the department, in which case the provider:
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0005| (a) during the period of any suspension,
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0006| shall not enroll or treat additional recipients, except newborn
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0007| children or other newly acquired dependents of existing
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0008| enrolled recipients, and shall not engage in any advertising,
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0009| marketing or solicitation for enrollment or treatment of
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0010| additional recipients; and
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0011| (b) immediately following the effective
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0012| date of any revocation, shall proceed expeditiously to wind up
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0013| its affairs under its contract with the department, and shall
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0014| not conduct further business except as may be essential to the
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0015| orderly conclusion of its medicaid-related affairs and transfer
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0016| to other medicaid providers of its recipients and their
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0017| records; provided, that the secretary may, by written order,
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0018| permit such further operation of the medicaid provider's
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0019| medicaid-related services as the secretary finds to be in the
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0020| best interest of recipients, to the end that they will be
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0021| afforded the greatest practical opportunity to obtain
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0022| continuous medicaid-related coverage."
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0023| Section 4. RETENTION AND PRODUCTION OF RECORDS.--
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0024| A. Medicaid providers and their subcontractors
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0025| shall retain, for a period of at least five years from the date
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0001| of creation, all medical and business records relating to:
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0002| (1) treatment or care of any recipient;
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0003| (2) services or goods provided to any
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0004| recipient;
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0005| (3) amounts paid by medicaid or the medicaid
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0006| provider on behalf of any recipient; and
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0007| (4) records required by medicaid or used for
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0008| its administration.
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0009| B. Upon written request by medicaid or the
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0010| department to a medicaid provider or any subcontractor for
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0011| copies or inspection of records pursuant to the Public
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0012| Assistance Act, the medicaid provider or subcontractor shall
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0013| provide the copies or permit the inspection, as applicable,
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0014| within five business days after the date of the request.
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0015| C. Failure to provide copies or to permit
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0016| inspection of records requested pursuant to this section shall
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0017| constitute a violation of the Medicaid Provider Act within the
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0018| meaning of Paragraph (3) of Subsection B of Section 3 of that
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0019| act."
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0020| Section 5. REGULATIONS.--The secretary shall adopt and
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0021| promulgate regulations appropriate to administer, carry out and
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0022| enforce the provisions of the Medicaid Provider Act.
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0023|
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0024|
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0025| FORTY-THIRD LEGISLATURE
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0001| FIRST SESSION, 1997
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0002|
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0003|
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0004| March 21, 1997
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0005|
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0006| Mr. President:
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0007|
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0008| Your PUBLIC AFFAIRS COMMITTEE, to whom has been
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0009| referred
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0010|
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0011| SENATE BILL 898
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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, and thence referred to the
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0015| CORPORATIONS & TRANSPORTATION COMMITTEE.
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0016|
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0017| Respectfully submitted,
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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| __________________________________
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0023| Shannon Robinson, Chairman
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0024|
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0025|
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0001|
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0002| Adopted_______________________ Not
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0003| Adopted_______________________
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0004| (Chief Clerk) (Chief Clerk)
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0005|
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0006|
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0007| Date ________________________
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0008|
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0009|
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0010| The roll call vote was 7 For 0 Against
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0011| Yes: 7
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0012| No: 0
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0013| Excused: Ingle, Robinson
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0014| Absent: None
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0015|
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0016|
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0017|
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0018|
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0019| S0898PA1
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