Relating to mandatory insurance coverage for medical foods for amino acid-based formulas
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SB 299 — Relating to mandatory insurance coverage for medical foods for amino acid-based formulas
Last action — Chapter 125, Acts, Regular Session, 2018
No card. One bill, free forever — alerts when it moves.
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✓Introduced
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✓In Committee
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✓Passed Senate
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✓Passed House of Delegates
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✓To Executive
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6Enacted
This bill has been enacted into law. Introduced January 16, 2018. Enacted.
Prognosis
Where this bill stands today.
Odds of enactment
HighHow often bills like it became law.
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Enacted
Current position in the legislative process.
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12 sponsors
1 primary, 11 co-sponsors signed on.
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Cleared a recorded vote
Passed 2 recorded votes so far.
Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.
Bill Text
What changed in the latest version
166 added · 241 removedPlain-language change summary
The recent amendments to Bill SB 299 expand insurance coverage to include medically necessary foods for certain diagnosed conditions, specifically amino acid-based formulas, for individuals up to the age of 20. This change ensures that prescribed medical foods are accessible to families who need them, potentially improving health outcomes for children with specific medical needs. Additionally, the bill clarifies coverage details and excludes certain conditions, helping to define what is included under this insurance mandate. This matters because it addresses the healthcare needs of a vulnerable population and supports families in managing costly medical requirements.
NEWS RELEASES HELPFUL LINKS IntroducedEnrolled Version - OriginatingFinal inVersion Committee « Senate Bill 299 History OTHER VERSIONS — EnrolledIntroduced Version - FinalOriginating Versionin Committee | | Email Key:
Red = new code to be enacted WEST virginia legislature regular session OriginatingEnrolled Senate Bill 299 By Senators Boley, Boso, Drennan, Facemire, Facemire, Ferns, Gaunch, Maroney, Palumbo, Plymale, Prezioso, Stollings, and Blair [Originating[Passed inMarch the8, Committee2018; on Finance;
Reportedin oneffect January90 16,days 2018from ]passage] AAN BILLACT to amend and reenact §5-16-7 and §5-16-9 of the Code of West Virginia, 1931, as amended;
to amend said code by adding thereto a new section, designated §5-16B-6f;
to amend said code by adding thereto a new section, designated §9-5-27;
to amend said code by adding thereto a new section, designated §33-16-3aa;§33-16-3bb;
and providing for exclusions.exclusions from such coverage.
and a test for the human papilloma virus (HPV) when medically appropriate and consistent with current guidelines from either the United States Preventive Services Task Force or Thethe American College of Obstetricians and Gynecologists, when performed for cancer screening or diagnostic services on a woman age 18 or over;
No plan may deny payment for a mother or her newborn child prior to 48 hours following a vaginal delivery or prior to 96 hours following a caesarean section delivery if the attending physician considers discharge medically inappropriate;
(5) For plans which provide coverages for post-delivery care to a mother and her newly born child in the home, coverage for inpatient care following childbirth as provided in subdivision§5-16-7(a)(4) (4) of this subsectioncode if inpatient care is determined to be medically necessary by the attending physician.
and (iv) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(B) The coverage required by paragraph§5-16-7(a)(10)(A) (A) of this subdivisioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (D) The provisions of this subdivision shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
(3) A test for the human papilloma virus (HPV) for women age 18 or over, when medically appropriate and consistent with the current guidelines from either the United States Preventive Services Task Force or Thethe American College of Obstetricians and Gynecologists for women age 18 and over;
and (iv) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(B) The coverage required by paragraph§15-16-9(b)(7)(A) (A) of this subdivisioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
(D) The provisions of this subdivision shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
The amount of the group life and accidental death insurance to which an employee would otherwise be entitled shall be reduced to $5,000 upon such employee attaining age sixty-five.65.
Provided, That the director shall negotiate and contract directly with healthcare providers and other entities, organizations and vendors in order to secure competitive premiums, pricesprices, and other financial advantages.
The director shall deal directly with insurers or healthcare providers and other entities, organizationsorganizations, and vendors in presenting specifications and receiving quotations for bid purposes.
(i) The director shall provide by contract or contracts entered into under the provisions of this article the cost for coverage of children’s immunization services from birth through age sixteen16 years to provide immunization against the following illnesses:
ARTICLE 16B.
WEST VIRGINIA CHILDREN’S HEALTH INSURANCE PROGRAM. §5-16B-6f.
Coverage for amino acid-based formulas. (a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this section shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
This includes the following conditions, if diagnosed as related to the disorder by a physician licensed to practice in this state pursuant to either §30-3-1 et seq.
or §30-14-1 et seq.
of this code:
(1) Immunoglobulin E and Nonimmunoglobulin E-medicated allergies to multiple food proteins;
(2) Severe food protein-induced enterocolitis syndrome;
(3) Eosinophilic disorders as evidenced by the results of a biopsy;
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection (a) of this section shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
(c) For purposes of this section, “medically necessary foods” or “medical foods” shall mean prescription amino acid-based elemental formulas obtained through a pharmacy:
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
CHAPTER 9.
HUMAN SERVICES.
ARTICLE 5.
MISCELLANEOUS PROVISIONS. §9-5-27.
Coverage for amino acid-based formulas. (a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this section shall provide coverage, through the age of 20 for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
This includes the following conditions, if diagnosed as related to the disorder by a physician licensed to practice in this state pursuant to either §30-3-1 et seq.
Show all 73 changed lines (33 more)
or §30-14-1 et seq.
of this code:
(1) Immunoglobulin E and Nonimmunoglobulin E-medicated allergies to multiple food proteins;
(2) Severe food protein-induced enterocolitis syndrome;
(3) Eosinophilic disorders as evidenced by the results of a biopsy;
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection (a) of this section shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
(c) For purposes of this section, “medically necessary foods” or “medical foods” shall mean prescription amino acid-based elemental formulas obtained through a pharmacy:
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
Coverage for amino acid-based formulas. (a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this sectionarticle shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection§33-15-4p(a) (a) of this sectioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
§33-16-3aa.§33-16-3bb.
(a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this sectionarticle shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection§33-16-3bb(a) (a) of this sectioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
Coverage for amino acid-based formulas. (a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this sectionarticle shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection§33-24-7q(a) (a) of this sectioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
Coverage for amino acid-based formulas. (a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this sectionarticle shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection§33-25-8n(a) (a) of this sectioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
(a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this sectionarticle shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
and (4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, lengthlength, and motility of the gastrointestinal tract (short bowel).
(b) The coverage required by subsection§33-25A-8p(a) (a) of this sectioncode shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.
Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons diagnosed with cystic fibrosis or persons with an intolerance for lactose or soy.
NOTE:
The purpose of this bill is to mandate insurance coverage for medical foods for amino acid-based formulas.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.
Show all 73 changed rows (33 more)
View plain text versions (2)
- Enrolled Enrolled Version Current html
- Originating in Committee View text html
Action History
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Chapter 125, Acts, Regular Session, 2018
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Approved by Governor 3/27/18
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To Governor 3/20/18
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Approved by Governor 3/27/18 - Senate Journal
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Approved by Governor 3/27/18 - House Journal
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To Governor 3/20/18 - House Journal
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To Governor 3/20/18 - Senate Journal
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House received Senate message
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Completed legislative action
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Communicated to House
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Senate concurred in House amendments and passed bill (Roll No. 391)
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House Message received
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Communicated to Senate
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Title amendment adopted (Voice vote)
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Passed House (Roll No. 366)
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Read 3rd time
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On 3rd reading, Special Calendar
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Committee amendment adopted (Voice vote)
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Read 2nd time
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On 2nd reading, Special Calendar
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Read 1st time
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On 1st reading, Special Calendar
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With amendment, do pass
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To House Finance
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With amendment, do pass, but first to Finance
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To House Health and Human Resources
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To Health and Human Resources then Finance
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Introduced in House
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Ordered to House
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Passed Senate (Roll No. 6)
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Read 3rd time
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On 3rd reading
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Read 2nd time
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On 2nd reading
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Read 1st time
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On 1st reading
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Reported do pass
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Originating in Senate Finance
Sponsors
- Maroney · Cosponsor
- Prezioso · Cosponsor
- Stollings · Cosponsor
- Boso · Cosponsor
- Boley · Primary
- Facemire · Cosponsor
- Plymale · Cosponsor
- Drennan · Cosponsor
- Ferns · Cosponsor
- Gaunch · Cosponsor
- Palumbo · Cosponsor
- Blair · Cosponsor
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 11 co-sponsors · 140 not signed on
Sponsors (1)
- Boley
Co-sponsors (11)
- Maroney
- Prezioso
- Stollings
- Boso
- Facemire
- Plymale
- Drennan
- Ferns
- Gaunch
- Palumbo
- Blair
Not signed on (140)
140 members have not signed on to this bill.
Show all 140 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Unaffiliated | 65 | 2 | 0 | 3 |
| Republican | 26 | 0 | 0 | 0 |
| Democrat | 4 | 0 | 0 | 0 |
| Total | 95 | 2 | 0 | 3 |
| % of votes cast | 95% | 2% | 0% | 3% |
How each member voted (100)
| Member | Party | Vote |
|---|---|---|
| Blair | — | Not Voting |
| Romine, C. | — | Not Voting |
| Ferro | — | Yea |
| Kessinger | — | Yea |
| Love | — | Nay |
| Lane | — | Yea |
| Romine, R. | — | Yea |
| Foster | — | Yea |
| Martin | — | Yea |
| Maynard | — | Yea |
| Sypolt | — | Yea |
| Hartman | — | Yea |
| Thompson | — | Yea |
| Nelson | — | Yea |
| Walters | — | Yea |
| Diserio | — | Yea |
| Phillips | — | Yea |
| Atkinson | — | Yea |
| Bates | — | Yea |
| Boggs | — | Yea |
| Brewer | — | Yea |
| Byrd | — | Yea |
| Canestraro | — | Yea |
| Caputo | — | Yea |
| Fleischauer | — | Yea |
| Frich | — | Yea |
| Hamrick | — | Yea |
| Harshbarger | — | Yea |
| Hicks | — | Yea |
| Hill | — | Yea |
| Hollen | — | Yea |
| Householder | — | Yea |
| Lovejoy | — | Yea |
| Lynch | — | Yea |
| Overington | — | Yea |
| Pack | — | Yea |
| Paynter | — | Yea |
| Pethtel | — | Yea |
| Rodighiero | — | Yea |
| Rowan | — | Yea |
| Shott | — | Yea |
| Sponaugle | — | Yea |
| Storch | — | Yea |
| Summers | — | Yea |
| Upson | — | Yea |
| Wagner | — | Yea |
| Evans, A. | — | Yea |
| Speaker Armstead | — | Yea |
| Evans, E. | — | Yea |
| Espinosa | — | Yea |
| Isner | — | Yea |
| Pyles | — | Yea |
| Wilson | — | Yea |
| Ambler | — | Yea |
| Capito | — | Yea |
| Cowles | — | Yea |
| Deem | — | Not Voting |
| Fast | — | Nay |
| Folk | — | Yea |
| Graves | — | Yea |
| Higginbotham | — | Yea |
| Iaquinta | — | Yea |
| Longstreth | — | Yea |
| Marcum | — | Yea |
| Miley | — | Yea |
| Moye | — | Yea |
| Robinson | — | Yea |
| Rowe | — | Yea |
| Sobonya | — | Yea |
| Westfall | — | Yea |
| John Williams | Democrat | Yea |
| Mike Pushkin | Democrat | Yea |
| Sean Hornbuckle | Democrat | Yea |
| Shawn Fluharty | Democrat | Yea |
| Ben Queen | Republican | Yea |
| Betsy Kelly | Republican | Yea |
| Bill Hamilton | Republican | Yea |
| D. Rolland Jennings | Republican | Yea |
| Erica Moore | Republican | Yea |
| Gary G. Howell | Republican | Yea |
| George Miller | Republican | Yea |
| George Miller | Republican | Yea |
| Guy Ward | Republican | Yea |
| Jason Barrett | Republican | Yea |
| Jeff Campbell | Republican | Yea |
| Jeff Eldridge | Republican | Yea |
| Jim Butler | Republican | Yea |
| Joe Ellington | Republican | Yea |
| Joe Statler | Republican | Yea |
| Lisa White | Republican | Yea |
| Mark Dean | Republican | Yea |
| Mark Zatezalo | Republican | Yea |
| Marty Gearheart | Republican | Yea |
| Matthew Rohrbach | Republican | Yea |
| Pat McGeehan | Republican | Yea |
| Roger Hanshaw | Republican | Yea |
| Roy Cooper | Republican | Yea |
| Stanley Adkins | Republican | Yea |
| Vernon Criss | Republican | Yea |
| William Anderson | Republican | Yea |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Republican | 3 | 0 | 0 | 0 |
| Unaffiliated | 28 | 0 | 0 | 2 |
| Total | 31 | 0 | 0 | 2 |
| % of votes cast | 94% | 0% | 0% | 6% |
How each member voted (33)
| Member | Party | Vote |
|---|---|---|
| GAUNCH | — | Yea |
| RUCKER | — | Yea |
| BALDWIN | — | Yea |
| JEFFRIES | — | Yea |
| SMITH | — | Yea |
| BEACH | — | Not Voting |
| KARNES | — | Yea |
| STOLLINGS | — | Yea |
| BLAIR | — | Yea |
| MANN | — | Yea |
| SWOPE | — | Yea |
| BOLEY | — | Yea |
| MARONEY | — | Yea |
| SYPOLT | — | Yea |
| BOSO | — | Yea |
| MAYNARD | — | Yea |
| TAKUBO | — | Yea |
| OJEDA | — | Yea |
| TRUMP | — | Yea |
| CLINE | — | Yea |
| PALUMBO | — | Yea |
| UNGER | — | Yea |
| PLYMALE | — | Yea |
| WELD | — | Yea |
| FACEMIRE | — | Yea |
| PREZIOSO | — | Yea |
| WOELFEL | — | Yea |
| FERNS | — | Yea |
| ROMANO | — | Not Voting |
| MR PRESIDENT | — | Yea |
| Charles H. Clements | Republican | Yea |
| Mike Azinger | Republican | Yea |
| Sarah Drennan | Republican | Yea |
Subjects
Frequently asked questions
- Who sponsors SB 299?
- SB 299 is sponsored by Maroney, Prezioso, Stollings, Boso, Boley, Facemire, Plymale, Drennan, Ferns, Gaunch, Palumbo, and Blair.
- What is the current status of SB 299?
- This bill has been enacted into law. Introduced January 16, 2018. Enacted.
- Where can I track SB 299?
- Track SB 299 free on One Click Politics — get push/email alerts when it moves.
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