20,1568
Section
1568. 49.453 (1) (fm) of the statutes is amended to read:
49.453
(1) (fm) "Noninstitutionalized individual" has the meaning given in
42 USC 1396p (e) (h) (4).
20,1569
Section
1569. 49.453 (1) (i) of the statutes is amended to read:
49.453
(1) (i) "Resources" has the meaning given in
42 USC 1396p (e) (h) (5).
20,1570
Section
1570. 49.453 (3) (a) of the statutes is renumbered 49.453 (3) (a) (intro.) and amended to read:
49.453 (3) (a) (intro.) The period of ineligibility under this subsection begins on either of the following:
1. In the case of a transfer of assets made before February 8, 2006, the first day of the first month beginning on or after the look-back date during or after which assets have been transferred for less than fair market value and that does not occur in any other periods of ineligibility under this subsection.
20,1571
Section
1571. 49.453 (3) (a) 2. of the statutes is created to read:
49.453 (3) (a) 2. In the case of a transfer of assets made on or after February 8, 2006, the first day of a month beginning on or after the look-back date during or after which assets have been transferred for less than fair market value, or the date on which the individual is eligible for medical assistance and would otherwise be receiving institutional level care described in sub. (2) (a) 1. to 3. based on an approved application for the care but for the application of the penalty period, whichever is later, and that does not occur during any other period of ineligibility under this subsection.
20,1572
Section
1572. 49.453 (3) (b) (intro.) of the statutes is amended to read:
49.453 (3) (b) (intro.) The Subject to par. (bc), the department shall determine the number of months of ineligibility as follows:
20,1573
Section
1573. 49.453 (3) (bc) of the statutes is created to read:
49.453 (3) (bc) In determining the number of months of ineligibility under par. (b), with respect to asset transfers that occur after February 8, 2006, the department may not round down the quotient, or otherwise disregard any fraction of a month, obtained in the division under par. (b) 3.
20,1574
Section
1574. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (ag).
20,1575
Section
1575. 49.453 (4) (ac) of the statutes is created to read:
49.453 (4) (ac) In this subsection, "transaction" means any action taken by an individual that changes the course of payments to be made under an annuity or the treatment of the income or principal of an annuity, including all of the following:
1. An addition of principal.
2. An elective withdrawal.
3. A request to change the distribution of the annuity.
4. An election to annuitize the contract.
5. A change in ownership.
20,1576
Section
1576. 49.453 (4) (am) of the statutes is amended to read:
49.453 (4) (am) Paragraph (a)
(ag) 1. does not apply to a variable annuity that is tied to a mutual fund that is registered with the federal securities and exchange commission.
20,1577
Section
1577. 49.453 (4) (b) of the statutes is amended to read:
49.453 (4) (b) The amount of assets that is transferred for less than fair market value under par. (a) (ag) is the amount by which the transferred amount exceeds the expected value of the benefit.
20,1578
Section
1578. 49.453 (4) (c) of the statutes is amended to read:
49.453
(4) (c) The department shall promulgate rules specifying the method to be used in calculating the expected value of the benefit, based on
26 CFR 1.72-
1 to
1.72-
18, and specifying the criteria for adjusting the expected value of the benefit based on a medical condition diagnosed by a physician before the assets were transferred to the annuity, or transferred by promissory note or similar instrument. In calculating the amount of the divestment when a transfer to an annuity, or a transfer by promissory note or similar instrument, is made, payments made to the transferor in any year subsequent to the year in which the transfer was made shall be discounted to the year in which the transfer was made by the applicable federal rate specified under par.
(a) (ag) on the date of the transfer.
20,1579
Section
1579. 49.453 (4) (cm) of the statutes is created to read:
49.453 (4) (cm) Paragraphs (ag) to (c) apply to annuities purchased before February 8, 2006, for which no transaction has occurred on or after February 8, 2006.
20,1580
Section
1580. 49.453 (4) (d) of the statutes is created to read:
49.453 (4) (d) For purposes of sub. (2), the purchase of an annuity by an institutionalized individual or his or her community spouse, or anyone acting on their behalf, shall be treated as a transfer of assets for less than fair market value unless any of the following applies:
1. The state is designated as the remainder beneficiary in the first position for at least the total amount of medical assistance paid on behalf of the institutionalized individual.
2. The state is named as a beneficiary in the 2nd position after the community spouse or a minor or disabled child and is named in the first position if the community spouse or a representative of the minor or disabled child disposes of any remainder for less than fair market value.
3. The annuity satisfies the requirements under par. (e) 1. or 2.
20,1581
Section
1581. 49.453 (4) (e) of the statutes is created to read:
49.453 (4) (e) For purposes of sub. (2), the purchase of an annuity by or on behalf of an annuitant who has applied for medical assistance for nursing facility services or other long-term care services described in sub. (2) is a transfer of assets for less than fair market value unless either of the following applies:
1. The annuity is either an annuity described in section
408 (b) or (q) of the Internal Revenue Code of 1986 or purchased with proceeds from any of the following:
a. An account or trust described in section
408 (a), (c), or (p) of the Internal Revenue Code of 1986.
b. A simplified employee pension, within the meaning of section
408 (k) of the Internal Revenue Code of 1986.
c. A Roth IRA described in section
408A of the Internal Revenue Code of 1986.
2. All of the following apply with respect to the annuity:
a. The annuity is irrevocable and nonassignable.
b. The annuity is actuarily sound, as determined in accordance with actuarial publications of the office of the chief actuary of the social security administration.
c. The annuity provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.
20,1582
Section
1582. 49.453 (4) (em) of the statutes is created to read:
49.453 (4) (em) Paragraphs (d) and (e) apply to all of the following:
1. Annuities purchased on or after February 8, 2006.
2. Annuities purchased before February 8, 2006, for which a transaction has occurred on or after February 8, 2006.
20,1583
Section
1583. 49.453 (4c) of the statutes is created to read:
49.453 (4c) Purchase of note, loan, or mortgage. (a) For purposes of sub. (2), the purchase by an individual or his or her spouse of a promissory note, loan, or mortgage after February 8, 2006, is a transfer of assets for less than fair market value unless all of the following apply with respect to the note, loan, or mortgage:
1. The repayment term is actuarially sound.
2. The payments are to be made in equal amounts during the term of the loan, with no deferral and no balloon payment.
3. Cancellation of the balance upon the death of the lender is prohibited.
(b) The value of a promissory note, loan, or mortgage that does not satisfy the requirements under par. (a) 1. to 3. is the outstanding balance due on the date that the individual applies for medical assistance for nursing facility services or other long-term care services described in sub. (2).
20,1584
Section
1584. 49.453 (4m) of the statutes is created to read:
49.453 (4m) Purchase of life estate. For purposes of sub. (2), the purchase by an individual or his or her spouse of a life estate in another individual's home after February 8, 2006, is a transfer of assets for less than fair market value unless the purchaser resides in the home for at least one year after the date of the purchase.
20,1585
Section
1585. 49.453 (8) of the statutes is renumbered 49.453 (8) (a) (intro.) and amended to read:
49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets if the any of the following applies:
1. The assets are exempt under
42 USC 1396p (c) (2)
or if the (A), (B), or (C).
2. The department determines under the process under par. (b) that application of this section would work an undue hardship. The department shall promulgate rules concerning the transfer of assets exempt under 42 USC 1396p (c) (2).
20,1586
Section
1586. 49.453 (8) (b) of the statutes is created to read:
49.453 (8) (b) The department shall establish a hardship waiver process that includes all of the following:
1. The department determines that undue hardship exists if the application of subs. (2) and (3) would deprive the individual of medical care to the extent that the individual's health or life would be endangered, or would deprive the individual of food, clothing, shelter, or other necessities of life.
2. A facility in which an institutionalized individual who has transferred assets resides is permitted to file an application for undue hardship on behalf of the individual with the consent of the individual or the individual's authorized representative.
3. The department may, during the pendency of an undue hardship determination, pay the full payment rate under s. 49.45 (6m) for nursing facility services for up to 30 days for the individual who transferred assets, to hold a bed in the facility in which the individual resides.
20,1587
Section
1587. 49.46 (1) (a) 5. of the statutes is amended to read:
49.46 (1) (a) 5. Any child in an adoption assistance, foster care, kinship care, long-term kinship care, treatment foster care, or subsidized guardianship placement under ch. 48 or 938, as determined by the department.
20,1588
Section
1588. 49.46 (1) (a) 14m. of the statutes is amended to read:
49.46
(1) (a) 14m. Any person who would meet the financial and other eligibility requirements for home or community-based services under the family care benefit but for the fact that the person engages in substantial gainful activity under
42 USC 1382c (a) (3), if a waiver under s. 46.281
(1) (c) (1d) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under the family care benefit.
20,1589
Section
1589. 49.46 (2) (b) (intro.) of the statutes is amended to read:
49.46 (2) (b) (intro.) Except as provided in par. pars. (be) and (dc), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:
20,1590
Section
1590. 49.46 (2) (b) 8. of the statutes is amended to read:
49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277, 46.278, or 46.2785, under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) (1d), or under a waiver requested under 2001 Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c) the disabled children's long-term support program, as defined in s. 46.011 (1g).
20,1591
Section
1591. 49.46 (2) (dc) of the statutes is created to read:
49.46
(2) (dc) For an individual who is eligible for medical assistance and who is eligible for coverage under Part D of Medicare under
42 USC 1395w-101 et seq., benefits under par. (b) 6. h. do not include payment for any Part D drug, as defined in
42 CFR 423.100, regardless of whether the individual is enrolled in Part D of Medicare or whether, if the individual is enrolled, his or her Part D plan, as defined in
42 CFR 423.4, covers the Part D drug.
20,1592
Section
1592. 49.468 (1) (b) of the statutes is amended to read:
49.468
(1) (b) For an elderly or disabled individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the limitations on income and resources under par. (d), medical assistance shall pay the deductible and coinsurance portions of medicare services under
42 USC 1395 to
1395zz which are not paid under
42 USC 1395 to
1395zz, including those medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.
20,1593
Section
1593. 49.468 (1) (c) of the statutes is amended to read:
49.468
(1) (c) For an elderly or disabled individual who is only entitled to coverage under part A of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the limitations on income and resources under par. (d), medical assistance shall pay the deductible and coinsurance portions of medicare services under
42 USC 1395 to
1395i which are not paid under
42 USC 1395 to
1395i, including those medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty for premiums under part A of medicare, if applicable.
20,1594
Section
1594. 49.468 (1m) (a) of the statutes is amended to read:
49.468
(1m) (a) Beginning on January 1, 1993, for an elderly or disabled individual who is entitled to coverage under part A of medicare and is entitled to coverage under part B of medicare, does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465
or
, 49.47 (4)
, or 49.471 but meets the limitations on income and resources under par. (b), medical assistance shall pay the monthly premiums under
42 USC 1395r.
20,1595
Section
1595. 49.468 (2) (a) of the statutes is amended to read:
49.468
(2) (a) Beginning on January 1, 1991, for a disabled working individual who is entitled under P.L.
101-239, section 6012 (a), to coverage under part A of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465
or, 49.47 (4)
, or 49.471 but meets the limitations on income and resources under par. (b), medical assistance shall pay the monthly premiums for the coverage under part A of medicare, including late enrollment fees, if applicable.
20,1596
Section
1596. 49.47 (4) (a) (intro.) of the statutes is amended to read:
49.47 (4) (a) (intro.) Any individual who meets the limitations on income and resources under pars. (b) and to (c) and who complies with par.
pars. (cm) and (cr) shall be eligible for medical assistance under this section if such individual is:
20,1597
Section
1597. 49.47 (4) (as) 1. of the statutes is amended to read:
49.47
(4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11), 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281
(1) (c) (1d) but for the fact that the person engages in substantial gainful activity under
42 USC 1382c (a) (3).
20,1598
Section
1598. 49.47 (4) (as) 3. of the statutes is amended to read:
49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11), 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) (1d).
