2001-2002 Bill 4023: Health Care Plans, Procedures For Enrollees To Access Information On; Insurance, Medical And Health - South Carolina Legislature Online

1 BIL: 4023 2 TYP: General Bill GB 3 INB: House 4 IND: 20010425 5 PSP: Lloyd 6 SPO: Lloyd, McLeod, Bales, Breeland, Cobb-Hunter, Govan, J.H. Neal and Weeks 7 DDN: l:\council\bills\pt\1179sd01.doc 8 RBY: House 9 COM: Medical, Military, Public and Municipal Affairs Committee 27 H3M 10 SUB: Health care plans, procedures for enrollees to access information on; 11 Insurance, Medical and health 12 13 14 15 HST: 16 17 Body Date Action Description Com Leg Involved 18 ______19 House 20010425 Introduced, read first time, 27 H3M 20 referred to Committee 21 22 23 Versions of This Bill 24 25 26 27 28 TXT: 1 2 3 4 5 6 7 8 9 A BILL 10 11 TO AMEND TITLE 38, CODE OF LAWS OF SOUTH 12 CAROLINA, 1976, RELATING TO INSURANCE, BY ADDING 13 CHAPTER 34 SO AS TO PROVIDE FOR THE MANNER IN 14 WHICH AND PROCEDURES UNDER WHICH PERSONS 15 ENROLLED IN HEALTH CARE PLANS SHALL HAVE 16 ACCESS TO INFORMATION REGARDING THEIR PLAN, 17 ACCESS TO HEALTH CARE SERVICES AND PROVIDERS 18 INCLUDING CHOICES AMONG PROVIDERS UNDER THEIR 19 PLAN, STANDARDS ON WHICH HEALTH CARE 20 DECISIONS ARE MADE, A PROCESS FOR APPEALING 21 THESE DECISIONS, AND TO PROVIDE FOR THE 22 PROTECTION OF THE PRIVACY OF HEALTH CARE 23 INFORMATION. 24 25 Be it enacted by the General Assembly of the State of South 26 Carolina: 27 28 “CHAPTER 34 29 30 Health Care Plans, Providers, and Procedures 31 32 Section 38-34-10. It is the intent of the General Assembly in 33 enacting this chapter that enrollees covered by health plans receive 34 quality health care designed to maintain and improve their health. 35 The purpose of this chapter is to ensure that health plan enrollees: 36 (1) have improved access to information regarding their health 37 plans; 38 (2) have sufficient and timely access to appropriate health care 39 services and choice among health care providers; 40 (3) are assured that health care decisions are made by 41 appropriate medical personnel;

1 [4023] 1 1 (4) have access to a quick and impartial process for appealing 2 plan decisions; 3 (5) are protected from unnecessary invasions of health care 4 privacy; and 5 (6) are assured that personal health care information will be 6 used only as necessary to obtain and pay for health care or to 7 improve the quality of care. 8 9 Section 38-34-20. Third party payors shall not release health 10 care information disclosed under this chapter, except to the extent 11 that health care providers are authorized to do so by law. 12 13 Section 38-34-30. (A) In making a correction or amendment to 14 a patient’s health care record, the health care provider shall: 15 (1) add the amending information as a part of the health 16 record; and 17 (2) mark the challenged entries as corrected or amended 18 entries and indicate the place in the record where the corrected or 19 amended information is located, in a manner practicable under the 20 circumstances. 21 (B) If the health care provider maintaining the record of the 22 patient’s health care information refuses to make the patient’s 23 proposed correction or amendment, the provider shall: 24 (1) permit the patient to file as a part of the record of the 25 patient’s health care information a concise statement of the 26 correction or amendment requested and the reasons for the 27 correction or amendment; and 28 (2) mark the challenged entry to indicate that the patient 29 claims the entry is inaccurate or incomplete and indicate the place 30 in the record where the statement of disagreement is located, in a 31 manner practicable under the circumstances. 32 (C) A health care provider who receives a request from a 33 patient to amend or correct the patient’s health care information, 34 shall forward any changes made in the patient’s health care 35 information or health record, including any statement of 36 disagreement, to any third-party payor or insurer to which the 37 health care provider has disclosed the health care information that 38 is the subject of the request. 39 40 Section 38-34-40. This chapter does not restrict a health care 41 provider, third-party payor, or an insurer from complying with 42 obligations imposed by federal or state health care payment 43 programs or by federal or state law.

1 [4023] 2 1 2 Section 38-34-50. (A) Health care insurers shall adopt policies 3 and procedures that conform administrative, business, and 4 operational practices to protect an enrollee’s right to privacy or 5 right to confidential health care services granted under state or 6 federal laws. 7 (B) The Director of the Department of Insurance may 8 promulgate regulations to implement this chapter after considering 9 relevant standards adopted by national managed care accreditation 10 organizations and the national association of insurance 11 commissioners, and after considering the affect of those standards 12 on the ability of carriers to undertake enrollee care management 13 and disease management programs. 14 15 Section 38-34-60. (A) A carrier that offers a health plan may 16 not offer to sell a health plan to an enrollee or to any group 17 representative, agent, employer, or enrollee representative without 18 first offering to provide, and providing upon request, the following 19 information before purchase or selection: 20 (1) a listing of covered benefits, including prescription drug 21 benefits, if any, a copy of the current formulary, if any is used, 22 definitions of terms such as generic versus brand name, and 23 policies regarding coverage of drugs, such as how they become 24 approved or taken off the formulary, and how consumers may be 25 involved in decisions about benefits; 26 (2) a listing of exclusions, reductions, and limitations to 27 covered benefits, and any definition of medical necessity or other 28 coverage criteria upon which they may be based; 29 (3) a statement of the carrier’s policies for protecting the 30 confidentiality of health information; 31 (4) a statement of the cost of premiums and any enrollee 32 cost-sharing requirements; 33 (5) a summary explanation of the carrier’s grievance 34 process; 35 (6) a statement regarding the availability of a 36 point-of-service option, if any, and how the option operates; and 37 (7) a convenient means of obtaining lists of participating 38 primary care and specialty care providers, including disclosure of 39 network arrangements that restrict access to providers within any 40 plan network. 41 The offer to provide the information referenced in this 42 subsection must be clearly and prominently displayed on any 43 information provided to any prospective enrollee or to any

1 [4023] 3 1 prospective group representative, agent, employer, or enrollee 2 representative. 3 (B) Upon the request of any person, including a current 4 enrollee, prospective enrollee, or the Director of the Department of 5 Insurance, a carrier must provide written information regarding 6 any health care plan it offers, that includes the following written 7 information: 8 (1) any documents, instruments, or other information 9 referred to in the medical coverage agreement; 10 (2) a full description of the procedures to be followed by an 11 enrollee for consulting a provider other than the primary care 12 provider and whether the enrollee’s primary care provider, the 13 carrier’s medical director, or another entity must authorize the 14 referral; 15 (3) procedures, if any, that an enrollee must first follow for 16 obtaining prior authorization for health care services; 17 (4) a written description of any reimbursement or payment 18 arrangements, including, but not limited to, capitation provisions, 19 fee-for-service provisions, and health care delivery efficiency 20 provisions, between a carrier and a provider or network; 21 (5) descriptions and justifications for provider compensation 22 programs, including any incentives or penalties that are intended to 23 encourage providers to withhold services or minimize or avoid 24 referrals to specialists; 25 (6) an annual accounting of all payments made by the carrier 26 which have been counted against any payment limitations, visit 27 limitations, or other overall limitations on a person’s coverage 28 under his plan; 29 (7) a copy of the carrier’s grievance process for claim or 30 service denial and for dissatisfaction with care; and 31 (8) accreditation status with one or more national 32 accreditation organizations, and whether the carrier tracks its 33 health care effectiveness performance using the health employer 34 data information set, whether it publicly reports this data, and how 35 interested persons can access this data. 36 (C) Each carrier shall provide to all enrollees and prospective 37 enrollees a list of available disclosure items. 38 (D) Nothing in this chapter requires a carrier or a health care 39 provider to divulge proprietary information to an enrollee, 40 including the specific contractual terms and conditions between a 41 carrier and a provider.

1 [4023] 4 1 (E) No carrier may advertise or market any health plan to the 2 public as a plan that covers services that help prevent illness or 3 promote the health of enrollees unless it: 4 (1) provides all clinical preventive health services provided 5 by the basic health plan, authorized by this chapter; 6 (2) monitors and reports annually to enrollees on 7 standardized measures of health care and satisfaction of all 8 enrollees in the health plan. The Department of Insurance shall 9 recommend appropriate standardized measures for this purpose, 10 after consideration of national standardized measurement systems 11 adopted by national accreditation organizations and state agencies 12 that purchase managed health care services; and 13 (3) makes available upon request to enrollees its integrated 14 plan to identify and manage the most prevalent diseases within its 15 enrolled population, including cancer, heart disease, and stroke. 16 (F) No carrier may preclude or discourage its providers from 17 informing an enrollee of the care he or she requires, including 18 various treatment options, and whether in the providers’ view the 19 care is consistent with the plan’s health coverage criteria, or 20 otherwise covered by the enrollee’s medical coverage agreement 21 with the carrier. 22 No carrier may prohibit, discourage, or penalize a provider 23 otherwise practicing in compliance with law from advocating on 24 behalf of an enrollee with a carrier. Nothing in this chapter shall 25 be construed to authorize a provider to bind a carrier to pay for any 26 service. 27 (G) No carrier may preclude or discourage enrollees or those 28 paying for their coverage from discussing the comparative merits 29 of different carriers with their providers. This prohibition 30 specifically includes prohibiting or limiting providers participating 31 in those discussions even if critical of a carrier. 32 (H) Each carrier must communicate enrollee information 33 required in this chapter by means that ensure that a substantial 34 portion of the enrollee population can make use of the information. 35 36 Section 38-34-70. (A) Each enrollee in a health plan must 37 have adequate choice among health care providers. 38 (B) Each carrier must allow an enrollee to choose a primary 39 care provider who is accepting new enrollees from a list of 40 participating providers. Enrollees also must be permitted to 41 change primary care providers at any time with the change 42 becoming effective no later than the beginning of the month 43 following the enrollee’s request for the change.

1 [4023] 5 1 (C) Each carrier must have a process whereby an enrollee with 2 a complex or serious medical or psychiatric condition may receive 3 a standing referral to a participating specialist for an extended 4 period of time. 5 (D) Each carrier must provide for appropriate and timely 6 referral of enrollees to a choice of specialists within the plan if 7 specialty care is warranted. If the type of medical specialist 8 needed for a specific condition is not represented on the specialty 9 panel, enrollees must have access to nonparticipating specialty 10 health care providers. 11 (E) Each carrier shall provide enrollees with direct access to 12 the participating chiropractor of the enrollee’s choice for covered 13 chiropractic health care without the necessity of prior referral. 14 Nothing in this chapter shall prevent carriers from restricting 15 enrollees to seeing only providers who have signed participating 16 provider agreements or from utilizing other managed care and cost 17 containment techniques and processes. For purposes of this 18 subsection, ‘covered chiropractic health care’ means covered 19 benefits and limitations related to chiropractic health services as 20 stated in the plan’s medical coverage agreement, with the 21 exception of any provisions related to prior referral for services. 22 (F) Each carrier must provide, upon the request of an enrollee, 23 access by the enrollee to a second opinion regarding any medical 24 diagnosis or treatment plan from a qualified participating provider 25 of the enrollee’s choice. 26 (G) Each carrier must cover services of a primary care provider 27 whose contract with the plan or whose contract with a 28 subcontractor is being terminated by the plan or subcontractor 29 without cause under the terms of that contract for at least sixty 30 days following notice of termination to the enrollees or, in group 31 coverage arrangements involving periods of open enrollment, only 32 until the end of the next open enrollment period. The provider’s 33 relationship with the carrier or subcontractor must be continued on 34 the same terms and conditions as those of the contract the plan or 35 subcontractor is terminating, except for any provision requiring 36 that the carrier assign new enrollees to the terminated provider. 37 (H) Every carrier shall meet the standards set forth in this 38 section and any regulations adopted by the director to implement 39 this chapter. 40 41 Section 38-34-80. (A) Carriers that offer a health plan shall 42 maintain a documented utilization review program description and 43 written utilization review criteria based on reasonable medical

1 [4023] 6 1 evidence. The program must include a method for reviewing and 2 updating criteria. Carriers shall make clinical protocols, medical 3 management standards, and other review criteria available upon 4 request to participating providers. 5 (B) A carrier shall not be required to use medical evidence or 6 standards in its utilization review of religious nonmedical 7 treatment or religious nonmedical nursing care. 8 9 Section 38-34-90. A health carrier that offers a health plan shall 10 not retrospectively deny coverage for emergency and 11 nonemergency care that had prior authorization under the plan’s 12 written policies at the time the care was rendered. 13 14 Section 38-34-100. (A) Each carrier that offers a health plan 15 must have a fully operational, comprehensive grievance process 16 that complies with the requirements of this section and any 17 regulations adopted by the director to implement this section. 18 (B) Each carrier must process as a complaint an enrollee’s 19 expression of dissatisfaction about customer service or the quality 20 or availability of a health service. Each carrier must implement 21 procedures for registering and responding to oral and written 22 complaints in a timely and thorough manner. 23 (C) Each carrier must provide written notice to an enrollee or 24 the enrollee’s designated representative, and the enrollee’s 25 provider, of its decision to deny, modify, reduce, or terminate 26 payment, coverage, authorization, or provision of health care 27 services or benefits, including the admission to or continued stay 28 in a health care facility. 29 (D) Each carrier must process as an appeal an enrollee’s written 30 or oral request that the carrier reconsider its resolution of a 31 complaint made by an enrollee; or its decision to deny, modify, 32 reduce, or terminate payment, coverage, authorization, or 33 provision of health care services or benefits, including the 34 admission to, or continued stay in, a health care facility. 35 (E) To process an appeal, each carrier must: 36 (1) provide written notice to the enrollee when the appeal is 37 received; 38 (2) assist the enrollee with the appeal process; 39 (3) make its decision regarding the appeal within thirty days 40 of the date the appeal is received. An appeal must be expedited if 41 the enrollee’s provider or the carrier’s medical director reasonably 42 determines that following the appeal process response timelines 43 could seriously jeopardize the enrollee’s life, health, or ability to

1 [4023] 7 1 regain maximum function. The decision regarding an expedited 2 appeal must be made within seventy-two hours of the date the 3 appeal is received; 4 (4) cooperate with a representative authorized in writing by 5 the enrollee; 6 (5) consider information submitted by the enrollee; 7 (6) investigate and resolve the appeal; and 8 (7) provide written notice of its resolution of the appeal to 9 the enrollee and, with the permission of the enrollee, to the 10 enrollee’s providers. The written notice must explain the carrier’s 11 decision and the supporting coverage or clinical reasons and the 12 enrollee’s right to request independent review of the carrier’s 13 decision as provided by this chapter. 14 (F) Written notice required by this section must explain: 15 (1) the carrier’s decision and the supporting coverage or 16 clinical reasons; and 17 (2) the carrier’s appeal process, including information, as 18 appropriate, about how to exercise the enrollee’s rights to obtain a 19 second opinion, and how to continue receiving services as 20 provided in this section. 21 (G) When an enrollee requests that the carrier reconsider its 22 decision to modify, reduce, or terminate an otherwise covered 23 health service that an enrollee is receiving through the health plan 24 and the carrier’s decision is based upon a finding that the health 25 service, or level of health service, is no longer medically necessary 26 or appropriate, the carrier must continue to provide that health 27 service until the appeal is resolved. If the resolution of the appeal 28 or any review sought by the enrollee under this chapter affirms the 29 carrier’s decision, the enrollee may be responsible for the cost of 30 this continued health service. 31 (H) Each carrier must provide a clear explanation of the 32 grievance process upon request, upon enrollment to new enrollees, 33 and annually to enrollees and subcontractors. 34 (I) Each carrier must ensure that the grievance process is 35 accessible to enrollees who are limited English speakers, who have 36 literacy problems, or who have physical or mental disabilities that 37 impede their ability to file a grievance. 38 (J) Each carrier must track each appeal until final resolution, 39 maintain, and make accessible to the Director of the Department of 40 Insurance for a period of three years, a log of all appeals, and 41 identify and evaluate trends in appeals. 42

1 [4023] 8 1 Section 38-34-110. (A) A process for the fair consideration of 2 disputes relating to decisions by carriers that offer a health plan to 3 deny, modify, reduce, or terminate coverage of or payment for 4 health care services for an enrollee is established by this section . 5 (B) An enrollee may seek review by a certified independent 6 review organization of a carrier’s decision to deny, modify, reduce, 7 or terminate coverage of or payment for a health care service, after 8 exhausting the carrier’s grievance process and receiving a decision 9 that is unfavorable to the enrollee, or after the carrier has exceeded 10 the timelines for grievances provided in Section 38-34-100, 11 without good cause and without reaching a decision. 12 (C) The Director of the Department of Insurance must establish 13 and use a rotational registry system for the assignment of a 14 certified independent review organization to each dispute. The 15 system shall be flexible enough to ensure that an independent 16 review organization has the expertise necessary to review the 17 particular medical condition or service at issue in the dispute. 18 (D) Carriers must provide to the appropriate certified 19 independent review organization, not later than the third business 20 day after the date the carrier receives a request for review, a copy 21 of: 22 (1) any medical records of the enrollee that relevant to the 23 review; 24 (2) any documents used by the carrier in making the 25 determination to be reviewed by the certified independent review 26 organization; 27 (3) any documentation and written information submitted to 28 the carrier in support of the appeal; and 29 (4) a list of each physician or health care provider who has 30 provided care to the enrollee and who may have medical records 31 relevant to the appeal. Health information or other confidential or 32 proprietary information in the custody of a carrier may be provided 33 to an independent review organization, subject to regulations 34 promulgated by the director. 35 (E) The medical reviewers from a certified independent review 36 organization shall make determinations regarding the medical 37 necessity or appropriateness of, and the application of health plan 38 coverage provisions to, health care services for an enrollee. The 39 medical reviewers’ determinations must be based upon their expert 40 medical judgment, after consideration of relevant medical, 41 scientific, and cost-effectiveness evidence, and medical standards 42 of practice in the State of South Carolina. Except as provided in 43 this subsection, the certified independent review organization must

1 [4023] 9 1 ensure that determinations are consistent with the scope of covered 2 benefits as outlined in the medical coverage agreement. Medical 3 reviewers may override the health plan’s medical necessity or 4 appropriateness standards if the standards are determined upon 5 review to be unreasonable or inconsistent with sound, 6 evidence-based medical practice. 7 (F) Once a request for an independent review determination 8 has been made, the independent review organization must proceed 9 to a final determination, unless requested otherwise by both the 10 carrier and the enrollee or the enrollee’s representative. 11 (G) Carriers must timely implement the certified independent 12 review organization’s determination, and must pay the certified 13 independent review organization’s charges. 14 (H) When an enrollee requests independent review of a dispute 15 under this section, and the dispute involves a carrier’s decision to 16 modify, reduce, or terminate an otherwise covered health service 17 that an enrollee is receiving at the time the request for review is 18 submitted and the carrier’s decision is based upon a finding that 19 the health service, or level of health service, is no longer medically 20 necessary or appropriate, the carrier must continue to provide the 21 health service if requested by the enrollee until a determination is 22 made under this section. If the determination affirms the carrier’s 23 decision, the enrollee may be responsible for the cost of the 24 continued health service. 25 (I) A certified independent review organization may notify the 26 office of the director if, based upon its review of disputes under 27 this section, it finds a pattern of substandard or egregious conduct 28 by a carrier. 29 (J) This section does not supplant any existing authority of the 30 office of the director to oversee and enforce carrier compliance 31 with applicable statutes and regulations. 32 33 Section 38-34-120. (A) The director shall promulgate 34 regulations providing a procedure and criteria for certifying one or 35 more organizations to perform independent review of health care 36 disputes described in Section 38-34-110. 37 (B) The regulations must require that the organization ensure: 38 (1) the confidentiality of medical records transmitted to an 39 independent review organization for use in independent reviews; 40 (2) that each health care provider, physician, or contract 41 specialist making review determinations for an independent review 42 organization is qualified. Physicians, other health care providers, 43 and, if applicable, contract specialists must be appropriately

1 [4023] 10 1 licensed, certified, or registered as required in this State or in at 2 least one state with standards substantially comparable to this 3 State. Reviewers may be drawn from nationally recognized 4 centers of excellence, academic institutions, and recognized 5 leading practice sites. Expert medical reviewers shall have 6 substantial, recent clinical experience dealing with the same or 7 similar health conditions. The organization must have 8 demonstrated expertise and a history of reviewing health care in 9 terms of medical necessity, appropriateness, and the application of 10 other health plan coverage provisions; 11 (3) that any physician, health care provider, or contract 12 specialist making a review determination in a specific review is 13 free of any actual or potential conflict of interest or bias. Neither 14 the expert reviewer, nor the independent review organization, nor 15 any officer, director, or management employee of the independent 16 review organization may have any material professional, familial, 17 or financial affiliation with any of the following: the health 18 carrier; professional associations of carriers and providers; the 19 provider; the provider’s medical or practice group; the health 20 facility at which the service would be provided; the developer or 21 manufacturer of a drug or device under review; or the enrollee; 22 (4) the fairness of the procedures used by the independent 23 review organization in making the determinations; 24 (5) that each independent review organization make its 25 determination: 26 (a) not later than the earlier of: the fifteenth day after the 27 date the independent review organization receives the information 28 necessary to make the determination or the twentieth day after the 29 date the independent review organization receives the request that 30 the determination be made. In exceptional circumstances, when 31 the independent review organization has not obtained information 32 necessary to make a determination, a determination may be made 33 by the twenty-fifth day after the date the organization received the 34 request for the determination; and 35 (b) in cases of a condition that could seriously jeopardize 36 the enrollee’s health or ability to regain maximum function, not 37 later than the earlier of seventy-two hours after the date the 38 independent review organization receives the information 39 necessary to make the determination; or the eighth day after the 40 date the independent review organization receives the request that 41 the determination be made;

1 [4023] 11 1 (6) that timely notice is provided to enrollees of the results 2 of the independent review, including the clinical basis for the 3 determination; 4 (7) that the independent review organization has a quality 5 assurance mechanism in place that ensures the timeliness and 6 quality of review and communication of determinations to 7 enrollees and carriers, and the qualifications, impartiality, and 8 freedom from conflict of interest of the organization, its staff, and 9 expert reviewers; and 10 (8) that the independent review organization meets any other 11 reasonable requirements of the department directly related to the 12 functions the organization is to perform under this section and 13 Section 38-34-110. 14 (C) To be certified as an independent review organization 15 under this chapter, an organization must submit to the department 16 an application in the form required by the department. The 17 application must include: 18 (1) for an applicant that is publicly held, the name of each 19 stockholder or owner of more than five percent of any stock or 20 options; 21 (2) the name of any holder of bonds or notes of the applicant 22 that exceed one hundred thousand dollars; 23 (3) the name and type of business of each corporation or 24 other organization that the applicant controls or is affiliated with 25 and the nature and extent of the affiliation or control; 26 (4) the name and a biographical sketch of each director, 27 officer, and executive of the applicant and any entity listed under 28 item (3) of this subsection and a description of any relationship the 29 named individual has with: 30 (a) a carrier; 31 (b) a utilization review agent; 32 (c) a nonprofit or for-profit health corporation; 33 (d) a health care provider; 34 (e) a drug or device manufacturer; or 35 (f) a group representing any of the entities described by 36 (4)(a) through (e) of this subsection; 37 (5) the percentage of the applicant’s revenues that are 38 anticipated to be derived from reviews conducted under Section 39 38-34-110; 40 (6) a description of the areas of expertise of the health care 41 professionals and contract specialists making review 42 determinations for the applicant; and

1 [4023] 12 1 (7) the procedures to be used by the independent review 2 organization in making review determinations regarding reviews 3 conducted under Section 38-34-110. 4 (D) If at any time there is a material change in the information 5 included in the application under this section, the independent 6 review organization shall submit updated information to the 7 department. 8 (E) An independent review organization may not be a 9 subsidiary of, or in any way owned or controlled by, a carrier or a 10 trade or professional association of health care providers or 11 carriers. 12 (F) An independent review organization, and individuals acting 13 on its behalf, are immune from suit in a civil action when 14 performing functions under this chapter. However, this immunity 15 does not apply to an act or omission made in bad faith or that 16 involves gross negligence or recklessness. 17 18 Section 38-34-130. Any carrier that offers a health plan and any 19 self-insured health plan subject to the jurisdiction of this State shall 20 designate a medical director who is licensed by South Carolina. 21 22 Section 38-34-140. The provisions of this chapter are 23 supplemental to all other provisions of law relating to health care 24 insurance and providers, except that to the extent the provisions of 25 this chapter and any other provision of law conflict, the provisions 26 of this chapter shall control.” 27 28 SECTION 2. This act takes effect upon approval by the 29 Governor. 30 ----XX----

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