0001|                           SENATE BILL 1152
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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|                           MANNY M. ARAGON
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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 EDUCATION; ENACTING A SECTION OF THE PUBLIC
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0012|     ASSISTANCE ACT TO PROVIDE FOR MEDICAID REIMBURSEMENTS TO SCHOOL
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0013|     DISTRICTS PURSUANT TO THE FEDERAL INDIVIDUALS WITH DISABILITIES
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0014|     EDUCATION ACT.
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0015|     
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0016|     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0017|          Section 1.  A new section of the Public Assistance Act is
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0018|     enacted to read:
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0019|          "[<u>NEW MATERIAL</u>]  MEDICAID IN THE SCHOOLS PROGRAM--HUMAN
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0020|     SERVICES DEPARTMENT--PUBLIC SCHOOL DISTRICTS--POWERS AND
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0021|     DUTIES--COVERED SERVICES--PROCESSING OF CLAIMS.--
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0022|               A.  School districts may enroll in the medicaid in
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0023|     the schools program to receive federal funds under the medicaid
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0024|     program pursuant to Title 19 of the federal Social Security Act
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0025|     and the federal Individuals with Disabilities Education Act.
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0001|               B.  In order to maximize receipt of federal funds,
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0002|     the medical assistance division of the department shall furnish
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0003|     services and promptly reimburse school districts and recipients
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0004|     within sixty days of receipt of a claim for reimbursement.  No
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0005|     state regulation or procedure affecting the medicaid in the
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0006|     schools program shall be more restrictive than those
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0007|     established by federal law or regulation.
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0008|               C.  The department may deduct an amount equal to
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0009|     five percent of the total federal reimbursement available from
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0010|     each medicaid claim filed under the program and shall convey
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0011|     the remaining ninety-five percent to the school districts.  The 
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0012|     department shall maintain a mechanized claims processing and
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0013|     information retrieval system for processing reimbursable claims
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0014|     filed under the program.
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0015|               D.  The following services shall be eligible for
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0016|     reimbursement by the medicaid in the schools program and do not
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0017|     need prior authorization:
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0018|                    (1)  speech, language and hearing service and
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0019|     evaluation;
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0020|                    (2)  occupational therapy and evaluation;
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0021|                    (3)  physical therapy and evaluation;
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0022|                    (4)  nursing services;
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0023|                    (5)  psychological, counseling and social work
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0024|     services;
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0025|                    (6)  developmental testing;
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0001|                    (7)  Individuals with Disabilities Education
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0002|     Act assessment;
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0003|                    (8)  case management; and
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0004|                    (9)  transportation for individuals whose
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0005|     medical needs require accommodation for transport in order to
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0006|     receive covered services.
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0007|               E.  The services described in Subsection D of this
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0008|     section are medically necessary if the service:
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0009|                    (1)  addresses a medical or mental disability;
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0010|                    (2)  assists the person to benefit from special
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0011|     education; and
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0012|                    (3)  is provided to a student identified in an
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0013|     individualized education program or individual family service
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0014|     plan.
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0015|               F.  The department shall permit the submission of
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0016|     retroactive claims no later than twelve months from the date of
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0017|     service.  The department shall pay claims within thirty days of
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0018|     the date of receipt.
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0019|               G.  Administrative claims are allowed for
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0020|     reimbursement of costs incurred for persons under twenty-one
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0021|     years of age by school districts acting in compliance with the
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0022|     early and periodic screening, diagnosis and treatment services
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0023|     program pursuant to 42 CFR Part 441 (B).  The services include
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0024|     actions by the department or school districts to assure
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0025|     families are informed about the program and are assisted to
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0001|     seek the services from health care providers.  Health care
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0002|     administrative services include:
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0003|                    (1)  program management;
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0004|                    (2)  training and supervision of service
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0005|     providers;
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0006|                    (3)  directing recipients to preventative
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0007|     services;
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0008|                    (4)  informing eligible recipients under Title
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0009|     19 of early and periodic screening, diagnosis and treatment
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0010|     services;
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0011|                    (5)  assistance to children and their families
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0012|     in determining their eligibility;
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0013|                    (6)  assuring that screening, diagnosis and
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0014|     treatment are appropriate and timely; and
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0015|                    (7)  assuring that services are of sufficient
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0016|     amount, duration and scope to correct or ameliorate the
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0017|     conditions for which they were determined to be necessary.
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0018|               H.  The department shall adopt regulations to carry
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0019|     out the provisions of this section pursuant to the federal
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0020|     office of management and budget circular A-87, as amended, and
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0021|     shall include requirements that:
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0022|                    (1)  school districts submit claims quarterly
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0023|     to the department no later than the forty-fifth calendar day
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0024|     after the end of the calendar quarter;
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0025|                    (2)  the financial data used to calculate the
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0001|     claim shall be based on actual expenditure reports including
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0002|     other costs and obtained directly from school districts'
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0003|     financial accounting systems;
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0004|                    (3)  the use by school districts of generally
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0005|     acceptable governmental accounting standards certified by an
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0006|     independent professional service;
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0007|                    (4)  use of a time allocation methodology shall
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0008|     be applied to determine the appropriate distribution of time
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0009|     toward the medicaid services during each quarter; and
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0010|                    (5)  a statistically valid, stratified, random
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0011|     sample of the school districts' personnel who directly perform
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0012|     the services shall be selected to participate in the time study
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0013|     for a segment of time during each quarter for representation of
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0014|     all eligible participants."
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0015|                                  
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0016|       
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0017|   
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0018|                      FORTY-THIRD LEGISLATURE
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0019|                        FIRST SESSION, 1997
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0020|   
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0021|   
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0022|                                                  March 15, 1997
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0023|   
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0024|   Mr. President:
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0025|   
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0001|       Your FINANCE COMMITTEE, to whom has been referred
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0002|   
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0003|                          SENATE BILL 1152
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0004|   
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0005|   has had it under consideration and reports same with
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0006|   recommendation that it DO PASS.
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0007|   
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0008|                                Respectfully submitted,
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0009|   
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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|                                Ben D. Altamirano, Chairman 
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0015|   
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0016|   
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0017|   
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0018|   Adopted_______________________   Not
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0019|   Adopted_______________________
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0020|             (Chief Clerk)                          (Chief Clerk)
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0021|   
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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|   
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0002|   The roll call vote was <u> 7 </u> For <u> 1 </u> Against
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0003|           Yes:    7
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0004|           No:     Lyons
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0005|                Excused:     Aragon, Ingle, McKibben
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0006|           Absent: None
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0007|   
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0008|   
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0009|   S1152FC1
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0010|                        FORTY-THIRD LEGISLATURE
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0011|                           FIRST SESSION
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0012|   
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0013|   
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0014|                                                  March 16, 1997
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0015|   
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0016|   
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0017|   SENATE FLOOR AMENDMENT number _______ to SENATE BILL 1152
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0018|   
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0019|   Amendment sponsored by Senator Manny M. Aragon 
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0020|   
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0021|   
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0022|       1.  On page 2, line 25, strike "developmental" and insert in
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0023|   lieu thereof "diagnostic".
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0024|   
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0025|       2.  On page 3, line 9, after "medical" insert "need".
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0001|   
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0002|       3.  On page 3, line 17, strike "thirty" and insert in lieu
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0003|   thereof "sixty".
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0004|   
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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|                                       __________________________
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0011|                                       Manny M. Aragon
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0012|   
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0013|   
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0014|   
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0015|   Adopted ___________________   Not Adopted _______________________
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0016|            (Chief Clerk)                    (Chief Clerk)
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0017|   
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0018|   
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0019|                    Date _________________
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