AB40,590,14 1349.475 (title) Information about assistance program beneficiaries;
14electronic submission of claims
.
AB40,1171 15Section 1171. 49.475 (2) (except 49.475 (2) (title)) of the statutes is
16renumbered 49.475 (2) (ac), and 49.475 (2) (ac) 1. b. and 4. (intro.), as renumbered,
17are amended to read:
AB40,590,2018 49.475 (2) (ac) 1. b. If subd. 1. a. applies, the nature and period of time of any
19coverage, benefit, or service provided, including the name, address, and identifying
20number of any applicable coverage plan.
AB40,590,2521 4. (intro.) If all of the following apply, agree not to deny a claim submitted by
22the department under par. (b) subd. 2. solely because of the claim's submission date,
23the type or format of the claim form, or failure by a recipient to present proper
24documentation at the time of delivery of the service, benefit, or item that is the basis
25of the claim:
AB40,1172
1Section 1172. 49.475 (2) (bc) of the statutes is created to read:
AB40,591,62 49.475 (2) (bc) A 3rd party shall accept the submission of claims from the
3department under par. (ac) 2. in electronic form and shall timely pay the claims in
4the manner provided in s. 628.46 (1) and (2). For purposes of timely payment of
5claims under this paragraph, "written notice" under s. 628.46 (1) includes receipt of
6a claim in electronic form.
AB40,1173 7Section 1173. 49.475 (2m) (a) of the statutes is amended to read:
AB40,591,118 49.475 (2m) (a) The information that the department may request under this
9section is limited to the information specified in sub. (2) (a) (ac) 1. and does not
10include an employer's name unless that information is necessary for the department
11or a provider to obtain 3rd-party payment for an item or service.
AB40,1174 12Section 1174. 49.475 (2m) (b) of the statutes is amended to read:
AB40,591,1713 49.475 (2m) (b) If information under sub. (2) (a) (ac) 1. may be available from
14more than one source that includes an employer operating a self-insured plan, the
15department shall seek the information first from a 3rd-party administrator or other
16entity identified in sub. (1) (f) 7. or pharmacy benefits manager before seeking the
17information from the employer.
AB40,1175 18Section 1175. 49.475 (3) (intro.) of the statutes is amended to read:
AB40,591,2119 49.475 (3) Written agreement. (intro.) Upon requesting a 3rd party to provide
20the information under sub. (2) (a) (ac) 1., the department and the 3rd party shall
21enter into a written agreement that satisfies all of the following:
AB40,1176 22Section 1176. 49.475 (4) (a) of the statutes is amended to read:
AB40,592,223 49.475 (4) (a) A 3rd party shall provide the information requested under sub.
24(2) (a) (ac) 1. within 180 days after receiving the department's request if it is the first

1time that the department has requested the 3rd party to disclose information under
2this section.
AB40,1177 3Section 1177. 49.475 (4) (b) of the statutes is amended to read:
AB40,592,74 49.475 (4) (b) A 3rd party shall provide the information requested under sub.
5(2) (a) (ac) 1. within 30 days after receiving the department's request if the
6department has previously requested the 3rd party to disclose information under
7this section.
AB40,1178 8Section 1178. 49.475 (5) of the statutes is amended to read:
AB40,592,139 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435
10(4) (bm) and (pa), the department shall reimburse a 3rd party that provides
11information under sub. (2) (a) (ac) 1. for the 3rd party's reasonable costs incurred in
12providing the requested information, including its reasonable costs, if any, to develop
13and operate automated systems specifically for the disclosure of the information.
AB40,1179 14Section 1179. 49.496 (1) (a) of the statutes is renumbered 49.496 (1) (ah).
AB40,1180 15Section 1180. 49.496 (1) (af) of the statutes is created to read:
AB40,592,1716 49.496 (1) (af) "Decedent" means a deceased recipient or a deceased
17nonrecipient surviving spouse, whichever is applicable.
AB40,1181 18Section 1181. 49.496 (1) (bk) of the statutes is created to read:
AB40,592,1919 49.496 (1) (bk) "Long-term care program" means any of the following:
AB40,592,2020 1. The family care program providing the benefit under s. 46.286.
AB40,592,2421 2. The self-directed services option that operates under a waiver from the
22secretary of the federal department of health and human services under 42 USC
231396n
(c) in which an enrolled individual selects his or her own services and service
24providers.
AB40,593,3
13. The family care partnership program that is an integrated health and
2long-term care program operated under an amendment to the state medical
3assistance plan under 42 USC 1396u-2 and a waiver under 42 USC 1396n (c).
AB40,593,444. The program for all-inclusive care for the elderly under 42 USC 1396u-4.
AB40,593,95 5. Any program that provides long-term care services and is operated by the
6department under an amendment to the state medical assistance plan under 42 USC
71396n
(i) or 42 USC 1396u-2; a waiver of medical assistance laws under 42 USC
81396n
(c), 42 USC 1396n (b) and (c), or 42 USC 1396u; or a demonstration project
9under 42 USC 1315 or 42 USC 1396n (c).
AB40,1182 10Section 1182. 49.496 (1) (bw) of the statutes is created to read:
AB40,593,1311 49.496 (1) (bw) "Nonrecipient surviving spouse" means any person who was
12married to a recipient while the recipient was receiving services for which the cost
13may be recovered under sub. (3) (a) and who survived the recipient.
AB40,1183 14Section 1183. 49.496 (1) (cm) of the statutes is created to read:
AB40,593,1915 49.496 (1) (cm) 1. "Property of a decedent" means all real and personal property
16to which the recipient held any legal title or in which the recipient had any legal
17interest immediately before death, to the extent of that title or interest, including
18assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in
19common, survivorship, life estate, living trust, or any other arrangement.
AB40,593,2520 2. Notwithstanding subd. 1., "property of a decedent" includes all real and
21personal property in which the nonrecipient surviving spouse had an ownership
22interest at the recipient's death and in which the recipient had a marital property
23interest with that nonrecipient surviving spouse at any time within 5 years before
24the recipient applied for medical assistance or during the time that the recipient was
25eligible for medical assistance.
AB40,1184
1Section 1184. 49.496 (3) (a) (intro.) of the statutes is amended to read:
AB40,594,62 49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file
3a claim against the estate of a recipient, and against the estate of a nonrecipient
4surviving spouse,
for all of the following, subject to the exclusion of any amounts
5under the Long-Term Care Partnership Program established under s. 49.45 (31),
6unless already recovered by the department under this section:
AB40,1185 7Section 1185. 49.496 (3) (a) 2. a. of the statutes is amended to read:
AB40,594,108 49.496 (3) (a) 2. a. Home-based or community-based services under 42 USC
91396d
(a) (7) and (8) and under any waiver granted under 42 USC 1396n (c) (4) (B)
10or 42 USC 1396u
.
AB40,1186 11Section 1186. 49.496 (3) (a) 2. am. of the statutes is created to read:
AB40,594,1312 49.496 (3) (a) 2. am. All services provided to an individual while the individual
13is participating in a long-term care program.
AB40,1187 14Section 1187. 49.496 (3) (a) 2. b. of the statutes is repealed.
AB40,1188 15Section 1188. 49.496 (3) (a) 2. c. of the statutes is repealed.
AB40,1189 16Section 1189. 49.496 (3) (ad) of the statutes is created to read:
AB40,594,2117 49.496 (3) (ad) The amount the department may claim against an estate of a
18recipient, or an estate of a nonrecipient surviving spouse, for services that are
19described under par. (a) 2. am. and that are provided by a managed long-term care
20program funded by capitated payments is equal to the amount of the capitated
21payment for the recipient.
AB40,1190 22Section 1190. 49.496 (3) (aj) of the statutes is created to read:
AB40,594,2523 49.496 (3) (aj) 1. Property that is subject to the department's claim under par.
24(a) in the estate of a recipient or in the estate of a nonrecipient surviving spouse is
25all property of a decedent that is included in the estate.
AB40,595,5
12. There is a presumption, which may be rebutted by clear and convincing
2evidence, that all property in the estate of a nonrecipient surviving spouse was
3marital property held with the recipient and that 100 percent of the property in the
4estate of the nonrecipient surviving spouse is subject to the department's claim
5under par. (a).
AB40,1191 6Section 1191. 49.496 (3) (am) (intro.) of the statutes is amended to read:
AB40,595,107 49.496 (3) (am) (intro.) The court shall reduce the amount of a claim under par.
8(a) by up to the amount specified in s. 861.33 (2) if necessary to allow the recipient's
9decedent's heirs or the beneficiaries of the recipient's decedent's will to retain the
10following personal property:
AB40,1192 11Section 1192. 49.496 (3) (c) 1. of the statutes is amended to read:
AB40,595,1812 49.496 (3) (c) 1. If the department's claim is not allowable because of par. (b)
13and the estate includes an interest in any real property, including a home, the court
14exercising probate jurisdiction shall, in the final judgment or summary findings and
15order, assign the interest in the home real property subject to a lien in favor of the
16department for the amount described in par. (a). The personal representative or
17petitioner for summary settlement or summary assignment of the estate shall record
18the final judgment as provided in s. 863.29, 867.01 (3) (h), or 867.02 (2) (h).
AB40,1193 19Section 1193. 49.496 (3) (c) 2. of the statutes is amended to read:
AB40,596,220 49.496 (3) (c) 2. If the department's claim is not allowable because of par. (b),
21the estate includes an interest in any real property, including a home, and the
22personal representative closes the estate by sworn statement under s. 865.16, the
23personal representative shall stipulate in the statement that the home real property
24is assigned subject to a lien in favor of the department for the amount described in

1par. (a). The personal representative shall record the statement in the same manner
2as described in s. 863.29, as if the statement were a final judgment.
AB40,1194 3Section 1194. 49.496 (3) (d) (intro.) of the statutes is amended to read:
AB40,596,54 49.496 (3) (d) (intro.) The department may not enforce the a lien under par. (c)
5as long as any of the following survive the decedent:
AB40,1195 6Section 1195. 49.496 (3) (dm) of the statutes is created to read:
AB40,596,87 49.496 (3) (dm) All of the following apply to a lien under par. (c) that the
8department may not enforce because of par. (d):
AB40,596,119 1. If the decedent's surviving spouse or child who is under age 21 or disabled
10refinances a mortgage on the real property, the lien is subordinate to the new
11encumbrance.
AB40,596,1312 2. The department shall release the lien in the circumstances described in s.
1349.848 (5) (f).
AB40,1196 14Section 1196. 49.496 (6m) of the statutes is amended to read:
AB40,596,2115 49.496 (6m) Waiver due to hardship. The department shall promulgate rules
16establishing standards for determining whether the application of this section would
17work an undue hardship in individual cases. If the department determines that the
18application of this section would work an undue hardship in a particular case, the
19department shall waive application of this section in that case. This subsection does
20not apply with respect to claims against the estates of nonrecipient surviving
21spouses.
AB40,1197 22Section 1197. 49.4962 of the statutes is created to read:
AB40,596,24 2349.4962 Voiding certain transfers of real property. (1) Definitions. In
24this section:
AB40,596,2525 (a) "Conveyance" has the meaning given in s. 706.01 (4).
AB40,597,2
1(b) "Fair market value" means the price that a willing buyer would pay a willing
2seller for the purchase of real property.
AB40,597,33 (c) "Fraudulent transfer" means any of the following:
AB40,597,44 1. A transfer of title to real property for less than fair market value.
AB40,597,75 2. A transfer of title to real property by a conveyance that is not recorded during
6the lifetime of the grantor in the office of the register of deeds of the county in which
7the real property is located.
AB40,597,88 (d) "Grantee" has the meaning given in s. 706.01 (6).
AB40,597,99 (e) "Grantor" has the meaning given in s. 706.01 (6).
AB40,597,11 10(2) Voidable transfers. (a) A transfer of real property to which all of the
11following apply is voidable by the department:
AB40,597,1412 1. The transfer was made by a grantor who was receiving or who received
13medical assistance, or by someone on his or her behalf, during the time that the
14grantor was eligible for medical assistance.
AB40,597,1615 2. The department was not notified and was unaware that the transfer was
16made.
AB40,597,1817 3. The transfer was made to hinder, delay, or defraud the department from
18recovering medical assistance benefits that were paid on behalf of the grantor.
AB40,597,2119 (b) The department may commence an action in circuit court against the
20grantee to void the transfer. If the court voids the transfer, the title to the real
21property reverts to the grantor or his or her estate.
AB40,597,25 22(3) Presumption. There is a presumption, which may be rebutted by clear and
23convincing evidence, that a transfer described in sub. (2) (a) 1. that is a fraudulent
24transfer was made to hinder, delay, or defraud the department from recovering
25medical assistance benefits that were paid on behalf of the grantor.
AB40,598,4
1(4) Burden of proof. With respect to a transfer under sub. (1) (c) 1., the burden
2of proof for establishing fair market value is on the grantee. Fair market value must
3be established through a credible methodology, which may include an appraisal
4performed by a licensed appraiser.
AB40,598,8 5(5) Inapplicable to purchaser in good faith. Subsection (2) does not apply if,
6after the transfer described in sub. (2), the real property was transferred by a
7conveyance to a purchaser in good faith and for a valuable consideration and the
8conveyance was recorded.
AB40,598,10 9(6) Applicability. This section applies to any of the following transfers of real
10property:
AB40,598,1211 (a) A transfer that is made on or after the effective date of this paragraph ....
12[LRB inserts date].
AB40,598,1513 (b) A transfer that was made before the effective date of this paragraph .... [LRB
14inserts date], if the grantor is receiving medical assistance on, or receives medical
15assistance after, the effective date of this paragraph .... [LRB inserts date].
AB40,1198 16Section 1198. 49.67 of the statutes is repealed.
AB40,1199 17Section 1199. 49.682 (1) (am) of the statutes is created to read:
AB40,598,1918 49.682 (1) (am) "Decedent" means a deceased client or a deceased nonclient
19surviving spouse, whichever is applicable.
AB40,1200 20Section 1200. 49.682 (1) (d) of the statutes is created to read:
AB40,598,2321 49.682 (1) (d) "Nonclient surviving spouse" means any person who was married
22to a client while the client was receiving services for which the cost may be recovered
23under sub. (2) (a) and who survived the client.
AB40,1201 24Section 1201. 49.682 (1) (e) of the statutes is created to read:
AB40,599,5
149.682 (1) (e) 1. "Property of a decedent" means all real and personal property
2to which the client held any legal title or in which the client had any legal interest
3immediately before death, to the extent of that title or interest, including assets
4transferred to a survivor, heir, or assignee through joint tenancy, tenancy in common,
5survivorship, life estate, living trust, or any other arrangement.
AB40,599,116 2. Notwithstanding subd. 1., "property of a decedent" includes all real and
7personal property in which the nonclient surviving spouse had an ownership interest
8at the client's death and in which the client had a marital property interest with that
9nonclient surviving spouse at any time within 5 years before the client applied for
10aid under s. 49.68, 49.683, or 49.685 or during the time that the recipient was eligible
11for aid under s. 49.68, 49.683, or 49.685.
AB40,1202 12Section 1202. 49.682 (2) (a) of the statutes is amended to read:
Loading...
Loading...