August 07, 2020
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       Florida Senate - 2010                                    SB 2082
       
       
       
       By Senator Rich
       
       
       
       
       34-00807C-10                                          20102082__
    1                        A bill to be entitled                      
    2         An act relating to the Florida Kidcare program;
    3         amending s. 409.8132, F.S.; providing that children
    4         under the age of 1 may participate in the Medikids
    5         program; conforming cross-references; amending s.
    6         409.814, F.S.; requiring that children who are
    7         eligible for Kidcare be offered the opportunity to be
    8         made presumptively eligible; providing that children
    9         who are eligible for a state-sponsored health benefit
   10         plan and the subsidized Kidcare program may enroll in
   11         the program; providing that an eligible child who is a
   12         lawful immigrant may enroll in the Florida Kidcare
   13         program regardless of the child’s date of entry;
   14         conforming provisions to changes made by the act;
   15         amending s. 409.815, F.S.; authorizing Kidcare
   16         coverage for temporomandibular joint disease; amending
   17         s. 409.816, F.S.; conforming cross-references;
   18         amending s. 409.818, F.S.; conforming provisions to
   19         changes made by the act; amending s. 409.904, F.S.;
   20         providing that Medicaid-eligible children are deemed
   21         eligible for 12 months of coverage regardless of any
   22         change in circumstances; requiring that such children
   23         be offered the opportunity to be made presumptively
   24         eligible; providing that a pregnant woman is eligible
   25         for Medicaid for the duration of her pregnancy and for
   26         the postpartum period; amending s. 624.91, F.S.,
   27         relating to the Florida Healthy Kids Corporation;
   28         conforming provisions to changes made by the act;
   29         expanding the membership of the board of directors of
   30         the Florida Healthy Kids Corporation; directing the
   31         Agency for Health Care Administration to implement the
   32         federal Family Opportunity Act; providing an effective
   33         date.
   34  
   35  Be It Enacted by the Legislature of the State of Florida:
   36  
   37         Section 1. Subsection (6) of section 409.8132, Florida
   38  Statutes, is amended to read:
   39         409.8132 Medikids program component.—
   40         (6) ELIGIBILITY.—
   41         (a) A child who has attained the age of 1 year but who is
   42  under the age of 5 years is eligible to enroll in the Medikids
   43  program component of the Florida Kidcare program, if the child
   44  is a member of a family that has a family income that which
   45  exceeds the Medicaid applicable income level as specified in s.
   46  409.903, but which is equal to or below 200 percent of the
   47  current federal poverty level. In determining the eligibility of
   48  such a child, an assets test is not required. A child who is
   49  eligible for Medikids may elect to enroll in Florida Healthy
   50  Kids coverage or employer-sponsored group coverage. However, a
   51  child who is eligible for Medikids may participate in the
   52  Florida Healthy Kids program only if the child has a sibling
   53  participating in the Florida Healthy Kids program and the
   54  child’s county of residence permits such enrollment.
   55         (b) The provisions of s. 409.814(3)-(8) are 409.814(3),
   56  (4), (5), and (6) shall be applicable to the Medikids program.
   57         Section 2. Section 409.814, Florida Statutes, is amended to
   58  read:
   59         409.814 Eligibility.—A child who has not reached 19 years
   60  of age whose family income is equal to or below 200 percent of
   61  the federal poverty level is eligible for the Florida Kidcare
   62  program as provided in this section. A child who is eligible
   63  under this section must be offered the opportunity to be made
   64  presumptively eligible. For enrollment in the Children’s Medical
   65  Services Network, a complete application includes the medical or
   66  behavioral health screening. If, subsequently, an enrolled
   67  individual is determined to be ineligible for coverage, he or
   68  she must be immediately be disenrolled from the respective
   69  Florida Kidcare program component.
   70         (1) A child who is eligible for Medicaid coverage under s.
   71  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   72  eligible to receive health benefits under any other health
   73  benefits coverage authorized under the Florida Kidcare program.
   74         (2) A child who is not eligible for Medicaid, but who is
   75  eligible for the Florida Kidcare program, may obtain health
   76  benefits coverage under any of the other components listed in s.
   77  409.813 if such coverage is approved and available in the county
   78  in which the child resides.
   79         (3) A Title XXI-funded child who is eligible for the
   80  Florida Kidcare program and who is a child with special health
   81  care needs, as determined through a medical or behavioral
   82  screening instrument, is eligible for health benefits coverage
   83  from and shall be assigned to and may opt out of the Children’s
   84  Medical Services Network.
   85         (4)A child who is eligible for a state-sponsored health
   86  benefit plan through a family member or guardian employed by the
   87  state and who meets the eligibility requirements for the
   88  subsidized Florida Kidcare program may enroll in the subsidized
   89  Florida Kidcare program, subject to an appropriation or the
   90  availability of local contributions collected pursuant to s.
   91  624.91.
   92         (5) A child who is an immigrant lawfully residing in the
   93  United States and who meets the eligibility requirements for the
   94  Florida Kidcare program may enroll in the program regardless of
   95  the child’s date of entry.
   96         (6)(4) The following children are not eligible to receive
   97  Title XXI-funded premium assistance for health benefits coverage
   98  under the Florida Kidcare program, except under Medicaid if the
   99  child would have been eligible for Medicaid under s. 409.903 or
  100  s. 409.904 as of June 1, 1997:
  101         (a)A child who is eligible for coverage under a state
  102  health benefit plan on the basis of a family member’s employment
  103  with a public agency in the state.
  104         (a)(b) A child who is covered under a family member’s group
  105  health benefit plan or under other private or employer health
  106  insurance coverage, if the cost of the child’s participation is
  107  not greater than 5 percent of the family’s income. If a child is
  108  otherwise eligible for a subsidy under the Florida Kidcare
  109  program and the cost of the child’s participation in the family
  110  member’s health insurance benefit plan is greater than 5 percent
  111  of the family’s income, the child may enroll in the appropriate
  112  subsidized Kidcare program.
  113         (b)(c) A child who is seeking premium assistance for the
  114  Florida Kidcare program through employer-sponsored group
  115  coverage, if the child has been covered by the same employer’s
  116  group coverage during the 60 days before the family submitted
  117  prior to the family’s submitting an application for
  118  determination of eligibility under the program.
  119         (d)A child who is an alien, but who does not meet the
  120  definition of qualified alien, in the United States.
  121         (c)(e) A child who is an inmate of a public institution or
  122  a patient in an institution for mental diseases.
  123         (d)(f) A child who is otherwise eligible for premium
  124  assistance for the Florida Kidcare program and has had his or
  125  her coverage in an employer-sponsored or private health benefit
  126  plan voluntarily canceled in the last 60 days, except those
  127  children whose coverage was voluntarily canceled for good cause,
  128  including, but not limited to, the following circumstances:
  129         1. The cost of participation in an employer-sponsored
  130  health benefit plan is greater than 5 percent of the family’s
  131  income;
  132         2. The parent lost a job that provided an employer
  133  sponsored health benefit plan for children;
  134         3. The parent who had health benefits coverage for the
  135  child is deceased;
  136         4. The child has a medical condition that, without medical
  137  care, would cause serious disability, loss of function, or
  138  death;
  139         5. The employer of the parent canceled health benefits
  140  coverage for children;
  141         6. The child’s health benefits coverage ended because the
  142  child reached the maximum lifetime coverage amount;
  143         7. The child has exhausted coverage under a COBRA
  144  continuation provision;
  145         8. The health benefits coverage does not cover the child’s
  146  health care needs; or
  147         9. Domestic violence led to loss of coverage.
  148         (7)(5) A child who is otherwise eligible for the Florida
  149  Kidcare program and who has a preexisting condition that
  150  prevents coverage under another insurance plan as described in
  151  paragraph (6)(a) (4)(b) which would have disqualified the child
  152  for the Florida Kidcare program if the child were able to enroll
  153  in the plan is shall be eligible for Florida Kidcare coverage
  154  when enrollment is possible.
  155         (8)(6) A child whose family income is above 200 percent of
  156  the federal poverty level or a child who is excluded under the
  157  provisions of subsection (6) (4) may participate in the Florida
  158  Kidcare program as provided in s. 409.8132 or, if the child is
  159  ineligible for Medikids by reason of age, in the Florida Healthy
  160  Kids program, subject to the following provisions:
  161         (a) The family is not eligible for premium assistance
  162  payments and must pay the full cost of the premium, including
  163  any administrative costs.
  164         (b) The board of directors of the Florida Healthy Kids
  165  Corporation may offer a reduced benefit package to these
  166  children in order to limit program costs for such families.
  167         (9)(7) Once a child is enrolled in the Florida Kidcare
  168  program, the child is eligible for coverage under the program
  169  for 12 months without a redetermination or reverification of
  170  eligibility, if the family continues to pay the applicable
  171  premium. Eligibility for program components funded through Title
  172  XXI of the Social Security Act shall terminate when a child
  173  attains the age of 19. A child who has not attained the age of 5
  174  and who has been determined eligible for the Medicaid program is
  175  eligible for coverage for 12 months without a redetermination or
  176  reverification of eligibility.
  177         (10)(8) When determining or reviewing a child’s eligibility
  178  under the Florida Kidcare program, the applicant shall be
  179  provided with reasonable notice of changes in eligibility which
  180  may affect enrollment in one or more of the program components.
  181  If When a transition from one program component to another is
  182  authorized, there shall be cooperation between the program
  183  components and the affected family which promotes continuity of
  184  health care coverage. Any authorized transfers must be managed
  185  within the program’s overall appropriated or authorized levels
  186  of funding. Each component of the program shall establish a
  187  reserve to ensure that transfers between components will be
  188  accomplished within current year appropriations. These reserves
  189  shall be reviewed by each convening of the Social Services
  190  Estimating Conference to determine the adequacy of such reserves
  191  to meet actual experience.
  192         (11)(9) In determining the eligibility of a child, an
  193  assets test is not required. Each applicant shall provide
  194  documentation during the application process and the
  195  redetermination process, including, but not limited to, the
  196  following:
  197         (a) Each applicant’s Proof of family income, which must
  198  shall be verified electronically to determine financial
  199  eligibility for the Florida Kidcare program. Written
  200  documentation, which may include wages and earnings statements
  201  or pay stubs, W-2 forms, or a copy of the applicant’s most
  202  recent federal income tax return, are shall be required only if
  203  the electronic verification is not available or does not
  204  substantiate the applicant’s income.
  205         (b) Each applicant shall provide A statement from all
  206  applicable, employed family members that:
  207         1.Their employers do not sponsor health benefit plans for
  208  employees;
  209         2. the potential enrollee is not covered by an employer
  210  sponsored health benefit plan; or
  211         3.The potential enrollee is covered by an employer
  212  sponsored health benefit plan and the cost of the employer
  213  sponsored health benefit plan is more than 5 percent of the
  214  family’s income.
  215         (12)(10) Subject to paragraph (6)(a) (4)(b), the Florida
  216  Kidcare program shall withhold benefits from an enrollee if the
  217  program obtains evidence that the enrollee is no longer
  218  eligible, submitted incorrect or fraudulent information in order
  219  to establish eligibility, or failed to provide verification of
  220  eligibility. The applicant or enrollee shall be notified that
  221  because of such evidence program benefits will be withheld
  222  unless the applicant or enrollee contacts a designated
  223  representative of the program by a specified date, which must be
  224  within 10 working days after the date of notice, to discuss and
  225  resolve the matter. The program shall make every effort to
  226  resolve the matter within a timeframe that will not cause
  227  benefits to be withheld from an eligible enrollee.
  228         (13)(11) The following individuals may be subject to
  229  prosecution in accordance with s. 414.39:
  230         (a) An applicant obtaining or attempting to obtain benefits
  231  for a potential enrollee under the Florida Kidcare program if
  232  when the applicant knows or should have known that the potential
  233  enrollee does not qualify for the Florida Kidcare program.
  234         (b) An individual who assists an applicant in obtaining or
  235  attempting to obtain benefits for a potential enrollee under the
  236  Florida Kidcare program if when the individual knows or should
  237  have known that the potential enrollee does not qualify for the
  238  Florida Kidcare program.
  239         Section 3. Paragraph (f) of subsection (2) of section
  240  409.815, Florida Statutes, is amended to read:
  241         409.815 Health benefits coverage; limitations.—
  242         (2) BENCHMARK BENEFITS.—In order for health benefits
  243  coverage to qualify for premium assistance payments for an
  244  eligible child under ss. 409.810-409.821, the health benefits
  245  coverage, except for coverage under Medicaid and Medikids, must
  246  include the following minimum benefits, as medically necessary.
  247         (f) Outpatient services.—Covered services include
  248  preventive, diagnostic, therapeutic, palliative care, and other
  249  services authorized by the enrollee’s health benefits coverage
  250  provider and provided to an enrollee in the outpatient portion
  251  of a health facility licensed under chapter 395, except for the
  252  following limitations:
  253         1.Services must be authorized by the enrollee’s health
  254  benefits coverage provider; and
  255         2.Treatment for temporomandibular joint disease (TMJ) is
  256  specifically excluded.
  257         Section 4. Subsection (3) of section 409.816, Florida
  258  Statutes, is amended to read:
  259         409.816 Limitations on premiums and cost-sharing.—The
  260  following limitations on premiums and cost-sharing are
  261  established for the program.
  262         (3) Enrollees in families with a family income above 150
  263  percent of the federal poverty level who are not receiving
  264  coverage under the Medicaid program or who are not eligible
  265  under s. 409.814(8) 409.814(7) may be required to pay enrollment
  266  fees, premiums, copayments, deductibles, coinsurance, or similar
  267  charges on a sliding scale related to income, except that the
  268  total annual aggregate cost-sharing with respect to all children
  269  in a family may not exceed 5 percent of the family’s income.
  270  However, copayments, deductibles, coinsurance, or similar
  271  charges may not be imposed for preventive services, including
  272  well-baby and well-child care, age-appropriate immunizations,
  273  and routine hearing and vision screenings.
  274         Section 5. Paragraph (b) of subsection (1) of section
  275  409.818, Florida Statutes, is amended to read:
  276         409.818 Administration.—In order to implement ss. 409.810
  277  409.821, the following agencies shall have the following duties:
  278         (1) The Department of Children and Family Services shall:
  279         (b) Establish and maintain the eligibility determination
  280  process under the program except as specified in subsection (5).
  281  The department shall directly, or through the services of a
  282  contracted third-party administrator, establish and maintain a
  283  process for determining eligibility of children for coverage
  284  under the program. The eligibility determination process must be
  285  used solely for determining eligibility of applicants for health
  286  benefits coverage under the program. The eligibility
  287  determination process must include an initial determination of
  288  eligibility for any coverage offered under the program, as well
  289  as a redetermination or reverification of eligibility each
  290  subsequent 6 months. Effective January 1, 1999, a child who has
  291  not attained the age of 5 and who has been determined eligible
  292  for the Medicaid program is eligible for coverage for 12 months
  293  without a redetermination or reverification of eligibility. In
  294  conducting an eligibility determination, the department shall
  295  determine if the child has special health care needs. The
  296  department, in consultation with the Agency for Health Care
  297  Administration and the Florida Healthy Kids Corporation, shall
  298  develop procedures for redetermining eligibility which enable a
  299  family to easily update any change in circumstances which could
  300  affect eligibility. The department may accept changes in a
  301  family’s status as reported to the department by the Florida
  302  Healthy Kids Corporation without requiring a new application
  303  from the family. Redetermination of a child’s eligibility for
  304  Medicaid may not be linked to a child’s eligibility
  305  determination for other programs.
  306         Section 6. Subsections (6) and (7) of section 409.904,
  307  Florida Statutes, are amended to read:
  308         409.904 Optional payments for eligible persons.—The agency
  309  may make payments for medical assistance and related services on
  310  behalf of the following persons who are determined to be
  311  eligible subject to the income, assets, and categorical
  312  eligibility tests set forth in federal and state law. Payment on
  313  behalf of these Medicaid eligible persons is subject to the
  314  availability of moneys and any limitations established by the
  315  General Appropriations Act or chapter 216.
  316         (6) A child who has not attained the age of 19 who has been
  317  determined eligible for the Medicaid program is deemed to be
  318  eligible for a total of 6 months, regardless of changes in
  319  circumstances other than attainment of the maximum age.
  320  Effective January 1, 1999, a child who has not attained the age
  321  of 5 and who has been determined eligible for the Medicaid
  322  program is deemed to be eligible for a total of 12 months
  323  regardless of changes in circumstances other than attainment of
  324  the maximum age. Subject to federal regulations, a child who is
  325  eligible under this subsection must be offered the opportunity
  326  to be made presumptively eligible.
  327         (7) A pregnant woman for the duration of her pregnancy and
  328  for the postpartum period as defined in federal law and rule, or
  329  a child under 1 year of age who lives in a family that has an
  330  income above 185 percent of the most recently published federal
  331  poverty level, but which is at or below 200 percent of such
  332  poverty level. In determining the eligibility of such child, an
  333  assets test is not required. An individual A child who is
  334  eligible for Medicaid under this subsection must be offered the
  335  opportunity, subject to federal rules, to be made presumptively
  336  eligible.
  337         Section 7. Subsection (3), paragraph (b) of subsection (5),
  338  and paragraph (a) of subsection (6) of section 624.91, Florida
  339  Statutes, are amended to read:
  340         624.91 The Florida Healthy Kids Corporation Act.—
  341         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only the
  342  following individuals are eligible for state-funded assistance
  343  in paying Florida Healthy Kids premiums:
  344         (a) Residents of this state who are eligible for the
  345  Florida Kidcare program pursuant to s. 409.814.
  346         (b) Notwithstanding s. 409.814, Legal aliens who are
  347  enrolled in the Florida Healthy Kids program as of January 31,
  348  2004, who do not qualify for Title XXI federal funds because
  349  they are not qualified aliens as defined in s. 409.811.
  350         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
  351         (b) The Florida Healthy Kids Corporation shall:
  352         1. Arrange for the collection of any family, local
  353  contributions, or employer payment or premium, in an amount to
  354  be determined by the board of directors, to provide for payment
  355  of premiums for comprehensive insurance coverage and for the
  356  actual or estimated administrative expenses.
  357         2. Arrange for the collection of any voluntary
  358  contributions to provide for payment of Florida Kidcare program
  359  premiums for children who are not eligible for medical
  360  assistance under Title XIX or Title XXI of the Social Security
  361  Act.
  362         3. Subject to the provisions of s. 409.8134, accept
  363  voluntary supplemental local match contributions that comply
  364  with the requirements of Title XXI of the Social Security Act
  365  for the purpose of providing additional Florida Kidcare coverage
  366  in contributing counties under Title XXI.
  367         4. Establish the administrative and accounting procedures
  368  for the operation of the corporation.
  369         5. Establish, with consultation from appropriate
  370  professional organizations, standards for preventive health
  371  services and providers and comprehensive insurance benefits
  372  appropriate to children if, provided that such standards for
  373  rural areas do shall not limit primary care providers to board
  374  certified pediatricians.
  375         6. Determine eligibility for children seeking to
  376  participate in the Title XXI-funded components of the Florida
  377  Kidcare program consistent with the requirements specified in s.
  378  409.814, as well as the non-Title-XXI-eligible children as
  379  provided in subsection (3).
  380         7. Establish procedures under which providers of local
  381  match to, applicants to, and participants in the program may
  382  have grievances reviewed by an impartial body and reported to
  383  the board of directors of the corporation.
  384         8. Establish participation criteria and, if appropriate,
  385  contract with an authorized insurer, health maintenance
  386  organization, or third-party administrator to provide
  387  administrative services to the corporation.
  388         9. Establish enrollment criteria that include penalties or
  389  30-day waiting periods of 30 days for reinstatement of coverage
  390  upon voluntary cancellation for nonpayment of family premiums.
  391         10. Contract with authorized insurers or providers any
  392  provider of health care services, who meet meeting standards
  393  established by the corporation, for the provision of
  394  comprehensive insurance coverage to participants. Such standards
  395  must shall include criteria under which the corporation may
  396  contract with more than one provider of health care services in
  397  program sites. Health plans shall be selected through a
  398  competitive bid process. The Florida Healthy Kids Corporation
  399  shall purchase goods and services in the most cost-effective
  400  manner consistent with the delivery of quality medical care. The
  401  maximum administrative cost for a Florida Healthy Kids
  402  Corporation contract is shall be 15 percent. For health care
  403  contracts, the minimum medical loss ratio for a Florida Healthy
  404  Kids Corporation contract is shall be 85 percent. For dental
  405  contracts, the remaining compensation to be paid to the
  406  authorized insurer or provider must be at least under a Florida
  407  Healthy Kids Corporation contract shall be no less than an
  408  amount which is 85 percent of the premium; to the extent any
  409  contract provision does not provide for this minimum
  410  compensation, this section prevails shall prevail. The health
  411  plan selection criteria and scoring system, and the scoring
  412  results, must shall be available upon request for inspection
  413  after the bids have been awarded.
  414         11. Establish disenrollment criteria if in the event local
  415  matching funds are insufficient to cover enrollments.
  416         12. Develop and implement a plan to publicize the Florida
  417  Kidcare program, the eligibility requirements of the program,
  418  and the procedures for enrollment in the program and to maintain
  419  public awareness of the corporation and the program.
  420         13. Secure staff necessary to properly administer the
  421  corporation. Staff costs shall be funded from state and local
  422  matching funds and such other private or public funds as become
  423  available. The board of directors shall determine the number of
  424  staff members necessary to administer the corporation.
  425         14. In consultation with the partner agencies, provide a
  426  report on the Florida Kidcare program annually to the Governor,
  427  the Chief Financial Officer, the Commissioner of Education, the
  428  President of the Senate, the Speaker of the House of
  429  Representatives, and the Minority Leaders of the Senate and the
  430  House of Representatives.
  431         15. Provide information on a quarterly basis to the
  432  Legislature and the Governor which compares the costs and
  433  utilization of the full-pay enrolled population and the Title
  434  XXI-subsidized enrolled population in the Florida Kidcare
  435  program. The information, At a minimum, the information must
  436  include:
  437         a. The monthly enrollment and expenditure for full-pay
  438  enrollees in the Medikids and Florida Healthy Kids programs
  439  compared to the Title XXI-subsidized enrolled population; and
  440         b. The costs and utilization by service of the full-pay
  441  enrollees in the Medikids and Florida Healthy Kids programs and
  442  the Title XXI-subsidized enrolled population.
  443  
  444  By February 1, 2010, the Florida Healthy Kids Corporation shall
  445  provide a study to the Legislature and the Governor on premium
  446  impacts to the subsidized portion of the program from the
  447  inclusion of the full-pay program, which must shall include
  448  recommendations on how to eliminate or mitigate possible impacts
  449  to the subsidized premiums.
  450         16. Establish benefit packages that conform to the
  451  provisions of the Florida Kidcare program, as created in ss.
  452  409.810-409.821.
  453         (6) BOARD OF DIRECTORS.—
  454         (a) The Florida Healthy Kids Corporation is shall operate
  455  subject to the supervision and approval of a board of directors
  456  chaired by the Chief Financial Officer or her or his designee,
  457  and composed of 12 11 other members selected for 3-year terms of
  458  office as follows:
  459         1. The Secretary of Health Care Administration, or his or
  460  her designee.
  461         2. One member appointed by the Commissioner of Education
  462  from the Office of School Health Programs of the Florida
  463  Department of Education.
  464         3. One member appointed by the Chief Financial Officer from
  465  among three members nominated by the Florida Pediatric Society.
  466         4. One member, appointed by the Governor, who represents
  467  the Children’s Medical Services Program.
  468         5. One member appointed by the Chief Financial Officer from
  469  among three members nominated by the Florida Hospital
  470  Association.
  471         6. One member, appointed by the Governor, who is an expert
  472  on child health policy.
  473         7. One member, appointed by the Chief Financial Officer,
  474  from among three members nominated by the Florida Academy of
  475  Family Physicians.
  476         8. One member, appointed by the Governor, who represents
  477  the state Medicaid program.
  478         9. One member, appointed by the Chief Financial Officer,
  479  from among three members nominated by the Florida Association of
  480  Counties.
  481         10. The State Health Officer, or her or his designee.
  482         11. The Secretary of Children and Family Services, or his
  483  or her designee.
  484         12.One member, appointed by the Governor, from among three
  485  members nominated by the Florida Dental Association.
  486         Section 8. Subject to appropriation, the Agency for Health
  487  Care Administration shall implement the federal Family
  488  Opportunity Act, ss. 6062-6071 of the Deficit Reduction Act of
  489  2005, to allow families whose income is up to 300 percent of the
  490  federal poverty level to buy Medicaid coverage for their
  491  disabled children.
  492         Section 9. This act shall take effect October 1, 2010.
  493  

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