Proposed Committee Substitute by the Committee on Health and Human

Services Appropriations

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A bill to be entitled

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An act relating to certificates of need; amending s.

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408.035, F.S.; revising the requirements for the Agency

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for Health Care Administration with respect to reviewing

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an application for a certificate of need for a general

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hospital; amending s. 408.037, F.S.; revising the

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requirements for an application for a certificate of need

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by an applicant for a general hospital; amending s.

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408.039, F.S.; prohibiting an applicant for a general

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hospital that is awaiting issuance of a final order from

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filing a letter of intent to file an application; limiting

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the period of a continuance that may be granted with

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respect to an administrative hearing considering an

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application for a general hospital; requiring that the

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party appealing a final order granting a certificate of

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need for a general hospital pay the appellee's attorney's

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fees and costs and post a bond to maintain the appeal;

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repealing s. 408.040(3), F.S., relating to a requirement

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for an architect's certification of final payment before

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issuance of a certificate of need; providing for

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application of the act; providing an effective date.

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1.  Section 408.035, Florida Statutes, is amended to

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read:

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     408.035  Review criteria.--

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     (1) The agency shall determine the reviewability of

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applications and shall review applications for certificate-of-

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need determinations for health care facilities and health

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services in context with the following criteria, except for

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general hospitals as defined in s. 395.002:

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     (a)(1) The need for the health care facilities and health

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services being proposed.

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     (b)(2) The availability, quality of care, accessibility,

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and extent of utilization of existing health care facilities and

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health services in the service district of the applicant.

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     (c)(3) The ability of the applicant to provide quality of

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care and the applicant's record of providing quality of care.

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     (d)(4) The availability of resources, including health

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personnel, management personnel, and funds for capital and

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operating expenditures, for project accomplishment and operation.

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     (e)(5) The extent to which the proposed services will

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enhance access to health care for residents of the service

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district.

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     (f)(6) The immediate and long-term financial feasibility of

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the proposal.

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     (g)(7) The extent to which the proposal will foster

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competition that promotes quality and cost-effectiveness.

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     (h)(8) The costs and methods of the proposed construction,

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including the costs and methods of energy provision and the

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availability of alternative, less costly, or more effective

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methods of construction.

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     (i)(9) The applicant's past and proposed provision of

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health care services to Medicaid patients and the medically

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indigent.

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     (j)(10) The applicant's designation as a Gold Seal Program

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nursing facility pursuant to s. 400.235, when the applicant is

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requesting additional nursing home beds at that facility.

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     (2) For a general hospital, the agency shall consider only

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the criteria specified in paragraphs (1)(a), (b), (e), (g), and

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(i).

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     Section 2.  Section 408.037, Florida Statutes, is amended to

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read:

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     408.037  Application content.--

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     (1) Except as provided in subsection (2) for a general

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hospital, an application for a certificate of need must contain:

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     (a)  A detailed description of the proposed project and

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statement of its purpose and need in relation to the district

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health plan.

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     (b)  A statement of the financial resources needed by and

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available to the applicant to accomplish the proposed project.

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This statement must include:

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     1.  A complete listing of all capital projects, including

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new health facility development projects and health facility

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acquisitions applied for, pending, approved, or underway in any

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state at the time of application, regardless of whether or not

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that state has a certificate-of-need program or a capital

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expenditure review program pursuant to s. 1122 of the Social

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Security Act. The agency may, by rule, require less-detailed

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information from major health care providers. This listing must

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include the applicant's actual or proposed financial commitment

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to those projects and an assessment of their impact on the

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applicant's ability to provide the proposed project.

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     2.  A detailed listing of the needed capital expenditures,

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including sources of funds.

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     3.  A detailed financial projection, including a statement

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of the projected revenue and expenses for the first 2 years of

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operation after completion of the proposed project. This

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statement must include a detailed evaluation of the impact of the

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proposed project on the cost of other services provided by the

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applicant.

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     (c)  An audited financial statement of the applicant. In an

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application submitted by an existing health care facility, health

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maintenance organization, or hospice, financial condition

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documentation must include, but need not be limited to, a balance

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sheet and a profit-and-loss statement of the 2 previous fiscal

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years' operation.

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     (2) An application for a certificate of need for a general

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hospital must contain a detailed description of the proposed

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general hospital project and a statement of its purpose and need.

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The proposed project's location, as well as its primary and

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secondary service areas, must be identified by zip code. In

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addition, the application for the certificate of need must

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include a statement of intent that, if approved by final order of

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the agency, the application for licensure pursuant to ss. 395.003

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and 408.810 will include the items specified in subparagraph

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(1)(b)3. and paragraph (1)(c).

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     (3)(2) The applicant must certify that it will license and

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operate the health care facility. For an existing health care

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facility, the applicant must be the licenseholder of the

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facility.

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     Section 3.  Paragraph (a) of subsection (2), paragraph (b)

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of subsection (3), and paragraph (b) of subsection (5) of section

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408.039, Florida Statutes, are amended, and paragraph (d) is

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added to subsection (6) of that section, to read:

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     408.039  Review process.--The review process for

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certificates of need shall be as follows:

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     (2)  LETTERS OF INTENT.--

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     (a)  At least 30 days prior to filing an application, a

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letter of intent shall be filed by the applicant with the agency,

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respecting the development of a proposal subject to review. A

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letter of intent may not be filed by an applicant for approval of

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a general hospital that was previously reviewed by the agency and

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that is awaiting issuance of a final order pursuant to paragraph

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(5)(e). No letter of intent is required for expedited projects as

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defined by rule by the agency.

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     (3)  APPLICATION PROCESSING.--

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     (b)  Upon the request of any applicant or substantially

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affected person within 14 days after notice that an application

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has been filed, a public hearing may be requested by the

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interested parties held at the agency's discretion if the agency

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determines that a proposed project involves issues of great local

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public interest. The public hearing shall allow applicants and

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other interested parties reasonable time to present their

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positions and to present rebuttal information. A recorded

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verbatim record of the hearing shall be maintained. The public

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hearing shall be held at the local level within 21 days after the

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application is deemed complete.

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     (5)  ADMINISTRATIVE HEARINGS.--

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     (b)  Hearings shall be held in Tallahassee unless the

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administrative law judge determines that changing the location

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will facilitate the proceedings. The agency shall assign

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proceedings requiring hearings to the Division of Administrative

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Hearings of the Department of Management Services within 10 days

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after the time has expired for requesting a hearing. Except upon

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unanimous consent of the parties or upon the granting by the

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administrative law judge of a motion of continuance, hearings

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shall commence within 60 days after the administrative law judge

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has been assigned. For an application for a general hospital, a

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continuance may not be granted for longer than 4 months following

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the original date of assignment to the administrative law judge.

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All parties, except the agency, shall bear their own expense of

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preparing a transcript. In any application for a certificate of

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need which is referred to the Division of Administrative Hearings

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for hearing, the administrative law judge shall complete and

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submit to the parties a recommended order as provided in ss.

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120.569 and 120.57. The recommended order shall be issued within

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30 days after the receipt of the proposed recommended orders or

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the deadline for submission of such proposed recommended orders,

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whichever is earlier. The division shall adopt procedures for

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administrative hearings which shall maximize the use of

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stipulated facts and shall provide for the admission of prepared

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testimony.

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     (6)  JUDICIAL REVIEW.--

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     (d) The party appealing a final order granting a general

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hospital certificate of need shall pay the appellee's attorney's

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fees and costs, in an amount up to $1 million, from the beginning

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of the original administrative action if the appealing party

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loses the appeal. Except as provided in s. 120.595(5), the agency

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may not be held liable for any other party's attorney's fees and

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costs. The party appealing a final order must post a bond in the

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amount of $1 million in order to maintain the appeal.

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     Section 4. Subsection (3) of section 408.040, Florida

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Statutes, is repealed.

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     Section 5. The provisions of this act do not apply to a

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project that is under initial review by the Agency for Health

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Care Administration on the effective date of this act if an

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initial decision pursuant to s. 408.039, Florida Statutes, has

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not been made.

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     Section 6.  This act shall take effect upon becoming a law.