SB40-CSA1,724,1210
1. The policy was not issued before the date specified in the amendment to the
11state plan, which may not be before the first day of the calendar quarter in which the
12amendment is submitted to the federal department of health and human services.
SB40-CSA1,724,1413
2. The policy meets the definition of a qualified long-term care insurance policy
14under
26 USC 7702B (b).
SB40-CSA1,724,1815
3. The policy meets the long-term care insurance model regulations and the
16requirements of the long-term care insurance model act promulgated by the
17National Association of Insurance Commissioners that are specified in
42 USC
181396p (b) (5).
SB40-CSA1,724,20194. The policy includes the applicable inflation protection specified in
42 USC
201396p (b) (1) (C) (iii) (IV).
SB40-CSA1,724,2221
5. The commissioner of insurance certifies to the department that the policy
22meets the criteria under subds. 2. to 4.
SB40-CSA1,725,323
(c) 1. The department and the office of the commissioner of insurance shall
24approve a training program for individuals who sell long-term care insurance
25policies in the state to ensure that those individuals understand the relation of
1long-term care insurance to the Medical Assistance program and are able to explain
2to consumers the protections offered by long-term care insurance and how this type
3of insurance relates to private and public financing of long-term care.
SB40-CSA1,725,94
2. The training program approved under this paragraph shall include initial
5training that is not less than 8 hours long and ongoing training sessions that are not
6less than 4 hours long per session. Individuals who sell long-term care insurance
7policies shall be required to attend an ongoing training session every 24 months after
8the initial training. The commissioner may approve the initial and ongoing training
9sessions for continuing education requirements under s. 628.04 (3).
SB40-CSA1,725,1310
3. The training under this paragraph shall cover at a minimum long-term care
11insurance, long-term care services, qualified partnerships, and the relationship
12between qualified partnerships and other public and private coverage of long-term
13care costs.
SB40-CSA1,725,1914
(d) An insurer that issues a long-term care insurance policy described in par.
15(b) shall be required to submit reports to the secretary of the federal department of
16health and human services, in accordance with regulations developed by the
17secretary, that include notice of when benefits are paid under the policy, the amount
18of the benefits, notice of the termination of the policy, and any other information
19required by the secretary.
SB40-CSA1,725,2522
49.45
(40) Periodic record matches. If the department contracts with the
23department of
workforce development children and families under s. 49.197 (5), the
24department shall cooperate with the department of
workforce development children
25and families in matching records of medical assistance recipients under s. 49.32 (7).
SB40-CSA1,726,82
49.45
(42m) (a) If, in authorizing the provision of physical or occupational
3therapy services under s. 49.46 (2) (b) 6. b.
or 49.471 (11) (i), the department
4authorizes a reduced duration of services from the duration that the provider
5specifies in the authorization request, the department shall substantiate the
6reduction that the department made in the duration of the services if the provider
7of the services requests any additional authorizations for the provision of physical
8or occupational therapy services to the same individual.
SB40-CSA1,726,1710
49.45
(44m) Extension of parent eligibility when child dies. The department
11shall request a waiver from the secretary of the federal department of health and
12human services to permit the department to extend the eligibility of a parent, for up
13to 90 days, under the Medical Assistance program under this subchapter or the
14Badger Care health care program under s. 49.665 if the parent's child dies while both
15the parent and the child are covered under the Medical Assistance program or the
16Badger Care health care program and the parent would lose eligibility solely due to
17the death of the child. The department shall implement any waiver that is granted.
SB40-CSA1,726,2319
49.45
(48) Payment of medicare part B outpatient hospital services
20coinsurances. The department shall include in the state plan for medical assistance
21a methodology for payment of the medicare part B outpatient hospital services
22coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468
23(1) (b),
and 49.47 (6) (a) 6. b., d., and f.
, and 49.471 (6) (j) 1.
SB40-CSA1,727,4
149.45
(49m) (c) 1. A list of the prescription drugs that are included as a benefit
2under
s. ss. 49.46 (2) (b) 6. h.
and 49.471 (11) (a) that identifies preferred choices
3within therapeutic classes and includes prescription drugs that bear only generic
4names.
SB40-CSA1,727,96
49.45
(53) Payments for certain services. Beginning on January 1, 2003, the
7department may, from the appropriation account under s. 20.435 (7) (b), make
8Medical Assistance payments to providers for covered services under
s. ss. 49.46 (2)
9(a) 4. d. and (b) 6. j. and m.
and 49.471 (11) (f).
SB40-CSA1,727,2011
49.45
(55) Health Opportunity Accounts Demonstration Program. The
12department shall request from the federal Centers for Medicare and Medicaid
13Services approval to participate in a demonstration program under
42 USC 1396u-8,
14under which Badger Care recipients may voluntarily enroll to contribute to health
15opportunity accounts and receive certain alternative benefits under medical
16assistance. If the Centers for Medicare and Medicaid Services approve the
17department's request, the department shall submit a proposed plan for
18implementation of the demonstration program to the joint committee on finance.
19The department may not implement the plan until it is approved by the committee,
20as submitted or as modified.
SB40-CSA1,728,322
49.45
(56) Disease management program. Based on the health conditions
23identified by the physical health risk assessments, if performed under sub. (57), the
24department shall develop and implement, for Medical Assistance recipients, disease
25management programs that are similar to that developed and followed by the
1Marshfield Clinic in this state under the Physician Group Practice Demonstration
2Program authorized under
42 USC 1315 (e) and (f). These programs shall have at
3least the following characteristics:
SB40-CSA1,728,64
(a) The use of information science to improve health care delivery by
5summarizing a patient's health status and providing reminders for preventive
6measures.
SB40-CSA1,728,87
(b) Educating health care providers on health care process improvement by
8developing best practice models.
SB40-CSA1,728,119
(c) The improvement and expansion of care management programs to assist in
10standardization of best practices, patient education, support systems, and
11information gathering.
SB40-CSA1,728,1312
(d)
Establishment of a system of provider compensation that is aligned with
13clinical quality, practice management, and cost of care.
SB40-CSA1,728,1514
(e) Focus on patient care interventions for certain chronic conditions, to reduce
15hospital admissions.
SB40-CSA1,728,2117
49.45
(57) Physical health risk assessment. The department shall encourage
18each individual who is determined on or after the effective date of this subsection ....
19[revisor inserts date], to be eligible for Medical Assistance to receive a physical health
20risk assessment as part of the first physical examination the individual receives
21under Medical Assistance.
SB40-CSA1,728,2323
49.453
(1) (a) "Assets" has the meaning given in
42 USC 1396p (e) (h) (1).
SB40-CSA1,729,2
149.453
(1) (ar) "Community spouse" means the spouse of either the
2institutionalized person or the noninstitutionalized person.
SB40-CSA1,729,44
49.453
(1) (d) "Income" has the meaning given in
42 USC 1396p (e) (h) (2).
SB40-CSA1,729,76
49.453
(1) (e) "Institutionalized individual" has the meaning given in
42 USC
71396p (e) (h) (3).
SB40-CSA1, s. 1564
8Section
1564. 49.453 (1) (f) (intro.) of the statutes is amended to read:
SB40-CSA1,729,109
49.453
(1) (f) (intro.) "Look-back date" means
for a covered individual, either
10of the following:
SB40-CSA1,729,14
111m. For transfers made before February 8, 2006, the date that is 36 months
12before, or with respect to payments from a trust or portions of a trust that are treated
13as assets transferred by the covered individual under s. 49.454 (2) (c) or (3) (b) the
14date that is 60 months before:
SB40-CSA1, s. 1565
15Section
1565. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m.
16a.
SB40-CSA1, s. 1566
17Section
1566. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m.
18b.
SB40-CSA1,729,2120
49.453
(1) (f) 2m. For all transfers made on or after February 8, 2006, the date
21that is 60 months before the dates specified in subd. 1m. a. and b.
SB40-CSA1,729,2423
49.453
(1) (fm) "Noninstitutionalized individual" has the meaning given in
42
24USC 1396p (e) (h) (4).
SB40-CSA1,730,1
149.453
(1) (i) "Resources" has the meaning given in
42 USC 1396p (e) (h) (5).
SB40-CSA1, s. 1570
2Section
1570. 49.453 (3) (a) of the statutes is renumbered 49.453 (3) (a) (intro.)
3and amended to read:
SB40-CSA1,730,54
49.453
(3) (a) (intro.) The period of ineligibility under this subsection begins
5on
either of the following:
SB40-CSA1,730,9
61. In the case of a transfer of assets made before February 8, 2006, the first day
7of the first month beginning on or after the look-back date during or after which
8assets have been transferred for less than fair market value and that does not occur
9in any other periods of ineligibility under this subsection.
SB40-CSA1,730,1811
49.453
(3) (a) 2. In the case of a transfer of assets made on or after February
128, 2006, the first day of a month beginning on or after the look-back date during or
13after which assets have been transferred for less than fair market value, or the date
14on which the individual is eligible for medical assistance and would otherwise be
15receiving institutional level care described in sub. (2) (a) 1. to 3. based on an approved
16application for the care but for the application of the penalty period, whichever is
17later, and that does not occur during any other period of ineligibility under this
18subsection.
SB40-CSA1, s. 1572
19Section
1572. 49.453 (3) (b) (intro.) of the statutes is amended to read:
SB40-CSA1,730,2120
49.453
(3) (b) (intro.)
The Subject to par. (bc), the department shall determine
21the number of months of ineligibility as follows:
SB40-CSA1,731,223
49.453
(3) (bc) In determining the number of months of ineligibility under par.
24(b), with respect to asset transfers that occur after February 8, 2006, the department
1may not round down the quotient, or otherwise disregard any fraction of a month,
2obtained in the division under par. (b) 3.
SB40-CSA1, s. 1574
3Section
1574. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (ag).
SB40-CSA1,731,75
49.453
(4) (ac) In this subsection, "transaction" means any action taken by an
6individual that changes the course of payments to be made under an annuity or the
7treatment of the income or principal of an annuity, including all of the following:
SB40-CSA1,731,88
1. An addition of principal.
SB40-CSA1,731,99
2. An elective withdrawal.
SB40-CSA1,731,1010
3. A request to change the distribution of the annuity.
SB40-CSA1,731,1111
4. An election to annuitize the contract.
SB40-CSA1,731,1212
5. A change in ownership.
SB40-CSA1,731,1614
49.453
(4) (am) Paragraph
(a) (ag) 1. does not apply to a variable annuity that
15is tied to a mutual fund that is registered with the federal securities and exchange
16commission.
SB40-CSA1,731,2018
49.453
(4) (b) The amount of assets that is transferred for less than fair market
19value under par.
(a) (ag) is the amount by which the transferred amount exceeds the
20expected value of the benefit.
SB40-CSA1,732,622
49.453
(4) (c) The department shall promulgate rules specifying the method to
23be used in calculating the expected value of the benefit, based on
26 CFR 1.72-
1 to
241.72-
18, and specifying the criteria for adjusting the expected value of the benefit
25based on a medical condition diagnosed by a physician before the assets were
1transferred to the annuity, or transferred by promissory note or similar instrument.
2In calculating the amount of the divestment when a transfer to an annuity, or a
3transfer by promissory note or similar instrument, is made, payments made to the
4transferor in any year subsequent to the year in which the transfer was made shall
5be discounted to the year in which the transfer was made by the applicable federal
6rate specified under par.
(a) (ag) on the date of the transfer.
SB40-CSA1,732,98
49.453
(4) (cm) Paragraphs (ag) to (c) apply to annuities purchased before
9February 8, 2006, for which no transaction has occurred on or after February 8, 2006.
SB40-CSA1,732,1411
49.453
(4) (d) For purposes of sub. (2), the purchase of an annuity by an
12institutionalized individual or his or her community spouse, or anyone acting on
13their behalf, shall be treated as a transfer of assets for less than fair market value
14unless any of the following applies:
SB40-CSA1,732,1715
1. The state is designated as the remainder beneficiary in the first position for
16at least the total amount of medical assistance paid on behalf of the institutionalized
17individual.
SB40-CSA1,732,2118
2. The state is named as a beneficiary in the 2nd position after the community
19spouse or a minor or disabled child and is named in the first position if the community
20spouse or a representative of the minor or disabled child disposes of any remainder
21for less than fair market value.
SB40-CSA1,732,2222
3. The annuity satisfies the requirements under par. (e) 1. or 2.
SB40-CSA1,733,224
49.453
(4) (e) For purposes of sub. (2), the purchase of an annuity by or on behalf
25of an annuitant who has applied for medical assistance for nursing facility services
1or other long-term care services described in sub. (2) is a transfer of assets for less
2than fair market value unless either of the following applies:
SB40-CSA1,733,431. The annuity is either an annuity described in section
408 (b) or (q) of the
4Internal Revenue Code of 1986 or purchased with proceeds from any of the following:
SB40-CSA1,733,65a. An account or trust described in section
408 (a), (c), or (p) of the Internal
6Revenue Code of 1986.
SB40-CSA1,733,87b. A simplified employee pension, within the meaning of section
408 (k) of the
8Internal Revenue Code of 1986.
SB40-CSA1,733,99c. A Roth IRA described in section
408A of the Internal Revenue Code of 1986.
SB40-CSA1,733,1010
2. All of the following apply with respect to the annuity:
