(d) An insurer that issues a long-term care insurance policy described in par. (b) shall be required to submit reports to the secretary of the federal department of health and human services, in accordance with regulations developed by the secretary, that include notice of when benefits are paid under the policy, the amount of the benefits, notice of the termination of the policy, and any other information required by the secretary.
20,1552
Section
1552. 49.45 (35) of the statutes is repealed.
20,1553
Section
1553. 49.45 (40) of the statutes is amended to read:
49.45 (40) Periodic record matches. If the department contracts with the department of workforce development children and families under s. 49.197 (5), the department shall cooperate with the department of workforce development children and families in matching records of medical assistance recipients under s. 49.32 (7).
20,1554
Section
1554. 49.45 (42m) (a) of the statutes is amended to read:
49.45 (42m) (a) If, in authorizing the provision of physical or occupational therapy services under s. 49.46 (2) (b) 6. b. or 49.471 (11) (i), the department authorizes a reduced duration of services from the duration that the provider specifies in the authorization request, the department shall substantiate the reduction that the department made in the duration of the services if the provider of the services requests any additional authorizations for the provision of physical or occupational therapy services to the same individual.
20,1554m
Section 1554m. 49.45 (44m) of the statutes is created to read:
49.45 (44m) Extension of parent eligibility when child dies. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to extend the eligibility of a parent, for up to 90 days, under the Medical Assistance program under this subchapter or the Badger Care health care program under s. 49.665 if the parent's child dies while both the parent and the child are covered under the Medical Assistance program or the Badger Care health care program and the parent would lose eligibility solely due to the death of the child. The department shall implement any waiver that is granted.
20,1555
Section
1555. 49.45 (48) of the statutes is amended to read:
49.45 (48) Payment of medicare part B outpatient hospital services coinsurances. The department shall include in the state plan for medical assistance a methodology for payment of the medicare part B outpatient hospital services coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468 (1) (b), and 49.47 (6) (a) 6. b., d., and f., and 49.471 (6) (j) 1.
20,1556
Section
1556. 49.45 (49m) (c) 1. of the statutes is amended to read:
49.45 (49m) (c) 1. A list of the prescription drugs that are included as a benefit under s. ss. 49.46 (2) (b) 6. h. and 49.471 (11) (a) that identifies preferred choices within therapeutic classes and includes prescription drugs that bear only generic names.
20,1558
Section
1558. 49.45 (53) of the statutes is amended to read:
49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under s. ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f).
20,1559e
Section 1559e. 49.45 (55) of the statutes is created to read:
49.45
(55) Health Opportunity Accounts Demonstration Program. The department shall request from the federal Centers for Medicare and Medicaid Services approval to participate in a demonstration program under
42 USC 1396u-8, under which Badger Care recipients may voluntarily enroll to contribute to health opportunity accounts and receive certain alternative benefits under medical assistance. If the Centers for Medicare and Medicaid Services approve the department's request, the department shall submit a proposed plan for implementation of the demonstration program to the joint committee on finance. The department may not implement the plan until it is approved by the committee, as submitted or as modified.
20,1559g
Section 1559g. 49.45 (56) of the statutes is created to read:
49.45
(56) Disease management program. Based on the health conditions identified by the physical health risk assessments, if performed under sub. (57), the department shall develop and implement, for Medical Assistance recipients, disease management programs
that are similar to that developed and followed by the Marshfield Clinic in this state under the Physician Group Practice Demonstration Program authorized under 42 USC 1315 (e) and (f) . These programs shall have at least the following characteristics:
(a) The use of information science to improve health care delivery by summarizing a patient's health status and providing reminders for preventive measures.
(b) Educating health care providers on health care process improvement by developing best practice models.
(c) The improvement and expansion of care management programs to assist in standardization of best practices, patient education, support systems, and information gathering.
(d) Establishment of a system of provider compensation that is aligned with clinical quality, practice management, and cost of care.
(e) Focus on patient care interventions for certain chronic conditions, to reduce hospital admissions.
20,1559h
Section 1559h. 49.45 (57) of the statutes is created to read:
49.45 (57) Physical health risk assessment. The department shall encourage each individual who is determined on or after the effective date of this subsection .... [revisor inserts date], to be eligible for Medical Assistance to receive a physical health risk assessment as part of the first physical examination the individual receives under Medical Assistance.
20,1560
Section
1560. 49.453 (1) (a) of the statutes is amended to read:
49.453
(1) (a) "Assets" has the meaning given in
42 USC 1396p (e) (h) (1).
20,1561
Section
1561. 49.453 (1) (ar) of the statutes is created to read:
49.453 (1) (ar) "Community spouse" means the spouse of either the institutionalized person or the noninstitutionalized person.
20,1562
Section
1562. 49.453 (1) (d) of the statutes is amended to read:
49.453
(1) (d) "Income" has the meaning given in
42 USC 1396p (e) (h) (2).
20,1563
Section
1563. 49.453 (1) (e) of the statutes is amended to read:
49.453
(1) (e) "Institutionalized individual" has the meaning given in
42 USC 1396p (e) (h) (3).
20,1564
Section
1564. 49.453 (1) (f) (intro.) of the statutes is amended to read:
49.453 (1) (f) (intro.) "Look-back date" means
for a covered individual, either of the following:
1m. For transfers made before February 8, 2006, the date that is 36 months before, or with respect to payments from a trust or portions of a trust that are treated as assets transferred by the covered individual under s. 49.454 (2) (c) or (3) (b) the date that is 60 months before:
20,1565
Section
1565. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m. a.
20,1566
Section
1566. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m. b.
20,1567
Section
1567. 49.453 (1) (f) 2m. of the statutes is created to read:
49.453 (1) (f) 2m. For all transfers made on or after February 8, 2006, the date that is 60 months before the dates specified in subd. 1m. a. and b.
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:
