0001|                            HOUSE BILL 274
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0002|     43RD LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 1998
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0003|                            INTRODUCED BY
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0004|                           NICK L. SALAZAR
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0005|     
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0006|                                   
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0007|     
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0008|             FOR THE HEALTH AND WELFARE REFORM COMMITTEE
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0009|     
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0010|                                AN ACT
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0011|     RELATING TO HEALTH CARE DATA; ESTABLISHING STANDARDS FOR
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0012|     HEALTH CARE DATA AND ELECTRONIC DATA EXCHANGE; MAKING AN
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0013|     APPROPRIATION.
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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|     "Health Data and Exchange Standards Act".
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0018|          Section 2.  PURPOSE.--The purpose of the Health Data and
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0019|     Exchange Standards Act is to improve the efficiency and
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0020|     effectiveness of the health care system and state government
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0021|     by establishing data and electronic exchange standards for
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0022|     health data and information, promote data sharing among state
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0023|     agencies, reduce redundant data entry and duplicate databases,
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0024|     streamline reporting to state agencies by the private sector,
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0025|     reduce health care administrative expenses and promote the
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0001|     appropriate exchange of information for improved care.
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0002|          Section 3.  DEFINITIONS.--As used in the Health Data and
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0003|     Exchange Standards Act:
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0004|               A.  "chief information officer" means the chief
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0005|     information officer of the office on information and
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0006|     communication management;
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0007|               B.  "commission" means the New Mexico health policy
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0008|     commission;
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0009|               C.  "electronic data interchange" means the
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0010|     computer-to-computer exchange of strictly formatted messages;
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0011|               D.  "health care clearinghouse" means a public or
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0012|     private entity that processes or facilitates the processing of
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0013|     nonstandard data elements of health information into standard
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0014|     data elements;
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0015|               E.  "health care facility" means a facility
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0016|     licensed by the department of health under its authority
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0017|     provided pursuant to Section 24-1-3 NMSA 1978;
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0018|               F.  "health data or information" means any data or
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0019|     information, regardless of its form or medium that:
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0020|                    (1)  is created or received by a health care
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0021|     provider, health care facility, health plan, state or
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0022|     political subdivision, employer, life insurer, school,
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0023|     university or health care clearinghouse; and
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0024|                    (2)  relates to the physical or mental health
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0025|     or condition of a person, the provision of health care or
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0001|     payment for health care to a person;
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0002|               G.  "person" means an individual or other legal
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0003|     entity, including the state or a department, agency,
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0004|     institution or political subdivision of the state; and
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0005|               H.  "standard-setting organization" means an
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0006|     organization accredited by the American national standards
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0007|     institute, including the national council for prescription
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0008|     drug programs, that develops standards for information
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0009|     transactions, data elements or any other standard used in the
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0010|     implementation of the Health Data and Exchange Standards Act.
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0011|          Section 4.  HEALTH DATA STANDARDS--APPLICABILITY.--
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0012|               A.  Standards adopted pursuant to the Health Data
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0013|     and Exchange Standards Act shall apply to the data and the
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0014|     exchange of data between the following:
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0015|                    (1)  licensed health care providers;
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0016|                    (2)  licensed health care facilities;
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0017|                    (3)  entities licensed as health insurance
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0018|     entities by the department of insurance;
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0019|                    (4)  a group health plan, if the plan has
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0020|     fifty or more participants or if it is administered by an
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0021|     entity other than the employer who established and maintains
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0022|     the plan;
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0023|                    (5)  state and political subdivisions paying
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0024|     for or providing health services or collecting health data and
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0025|     information; and
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0001|                    (6)  health care clearinghouses.
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0002|               B.  Data definition standards and data exchange
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0003|     standards adopted pursuant to the Health Data and Exchange
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0004|     Standards Act shall apply to the following data exchanges:
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0005|                    (1)  health claims or equivalent encounter
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0006|     information;
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0007|                    (2)  enrollment and disenrollment in a health
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0008|     plan;
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0009|                    (3)  eligibility for a health plan;
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0010|                    (4)  health care payment and remittance;
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0011|                    (5)  health plan premium payments;
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0012|                    (6)  first report of injury;
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0013|                    (7)  referral certification and authorization;
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0014|                    (8)  required reporting of health data and
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0015|     information to the state;
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0016|                    (9)  electronic transmission of medical
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0017|     records;
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0018|                    (10)  retrieval by the public or other
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0019|     nonstate government entity of health data maintained by
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0020|     government; and
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0021|                    (11)  other clinical, financial or
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0022|     administrative exchanges of health or health-related data
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0023|     established by the commission by regulation.
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0024|               C.  A person shall submit nonstandard data elements
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0025|     to a health care clearinghouse for processing into standard
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0001|     data elements and transmission by the health care
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0002|     clearinghouse.
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0003|               D.  Standards adopted pursuant to the Health Data
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0004|     and Exchange Standards Act are applicable to data and the
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0005|     exchange and retrieval of information between entities,
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0006|     including state departments and agencies, but shall not
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0007|     supersede department or agency standards and policies for
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0008|     data, exchange and retrieval within departments or agencies.
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0009|          Section 5.  DATA STANDARDS--ESTABLISHMENT.--
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0010|               A.  No later than January 1, 2000, the commission
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0011|     shall adopt standard health care data definitions and
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0012|     establish a health data dictionary and electronic data
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0013|     exchange standards for health data.
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0014|               B.  In adopting the standard health care data
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0015|     definitions and electronic data interchange standard for
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0016|     health data, the commission shall:
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0017|                    (1)  incorporate those standards required and
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0018|     established pursuant to the federal Health Insurance
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0019|     Portability and Accountability Act of 1996;
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0020|                    (2)  review and take into consideration public
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0021|     and private functional data dictionaries and electronic data
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0022|     interchange standards currently in use;
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0023|                    (3)  consult with the health information
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0024|     alliance and the health information system advisory committee
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0025|     memberships;
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0001|                    (4)  except as provided for in Subsection C of
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0002|     this section, use standards that have been developed or
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0003|     adopted by a standard-setting organization; and
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0004|                    (5)  seek advice from the chief information
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0005|     officer and others with technical and health care industry
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0006|     expertise.
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0007|               C.  The commission may adopt a standard that is
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0008|     different from any standard developed or adopted by a
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0009|     standard-setting organization if:
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0010|                    (1)  the different standard will substantially
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0011|     reduce costs to health care providers, health insurers or the
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0012|     government compared to the alternative;
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0013|                    (2)  the different standard will minimize the
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0014|     need for redundant data reporting to state government by the
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0015|     private sector or redundant data maintenance by government or
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0016|     substantially improve the appropriate exchange of data to
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0017|     enhance information as an asset;
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0018|                    (3)  no standard-setting organization has
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0019|     developed, adopted or modified any standard relating to a
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0020|     standard that the commission is authorized or required to
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0021|     adopt under the Health Data and Exchange Standards Act; or
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0022|                    (4)  the different standard is required to
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0023|     comply with the purpose of the Health Data and Exchange
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0024|     Standards Act; and
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0025|                    (5)  the standard is promulgated in accordance
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0001|     with the commission's procedures for promulgating regulations.
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0002|          Section 6.  IMPLEMENTATION.--
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0003|               A.  Except as provided in Subsection B of this
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0004|     section, standards adopted by the commission shall be
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0005|     implemented by January 1, 2002.
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0006|               B.  The commission, after consultation with the
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0007|     chief information officer and the department of insurance, may
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0008|     grant a temporary waiver of compliance with provisions of the
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0009|     Health Data and Exchange Standards Act if the requestor can
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0010|     demonstrate proof of inability to comply due to no fault of
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0011|     its own or if compliance would impose a substantial burden
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0012|     that outweighs the benefit to the health care system in New
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0013|     Mexico.
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0014|          Section 7.  STANDARD MODIFICATIONS.--The commission shall
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0015|     establish procedures for the routine review, modification,
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0016|     enhancement and expansion of the standards.
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0017|          Section 8.  APPROPRIATION.--One hundred thirty thousand
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0018|     dollars ($130,000) is appropriated from the general fund to
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0019|     the New Mexico health policy commission for expenditure in
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0020|     fiscal year 1999 for professional services contracts necessary
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0021|     to carry out the provisions of the Health Data and Exchange
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0022|     Standards Act.  Any unexpended or unencumbered balance
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0023|     remaining at the end of the fiscal year 1999 shall revert to
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0024|     the general fund.
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0025|          Section 9.  EFFECTIVE DATE.--The effective date of the
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0001|     provisions of this act is July 1, 1998.  
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0002|                              
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