Amendment CSA1-SB40

SB40-CSA1, s. 1577 Section 1577. 49.453 (4) (b) of the statutes is amended to read:

SB40-CSA1,731,20 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.

SB40-CSA1, s. 1578 Section 1578. 49.453 (4) (c) of the statutes is amended to read:

SB40-CSA1,732,6 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.

SB40-CSA1, s. 1579 Section 1579. 49.453 (4) (cm) of the statutes is created to read:

SB40-CSA1,732,9 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.

SB40-CSA1, s. 1580 Section 1580. 49.453 (4) (d) of the statutes is created to read:

SB40-CSA1,732,14 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:

SB40-CSA1,732,17 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.

SB40-CSA1,732,21 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.

SB40-CSA1,732,22 3. The annuity satisfies the requirements under par. (e) 1. or 2.

SB40-CSA1, s. 1581 Section 1581. 49.453 (4) (e) of the statutes is created to read:

SB40-CSA1,733,2 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:

SB40-CSA1,733,4 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:

SB40-CSA1,733,6 a. An account or trust described in section 408 (a), (c), or (p) of the Internal Revenue Code of 1986.

SB40-CSA1,733,8 b. A simplified employee pension, within the meaning of section 408 (k) of the Internal Revenue Code of 1986.

SB40-CSA1,733,9 c. A Roth IRA described in section 408A of the Internal Revenue Code of 1986.

SB40-CSA1,733,10 2. All of the following apply with respect to the annuity:

SB40-CSA1,733,11 a. The annuity is irrevocable and nonassignable.

SB40-CSA1,733,13 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.

SB40-CSA1,733,15 c. The annuity provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.

SB40-CSA1, s. 1582 Section 1582. 49.453 (4) (em) of the statutes is created to read:

SB40-CSA1,733,17 49.453 (4) (em) Paragraphs (d) and (e) apply to all of the following:

SB40-CSA1,733,18 1. Annuities purchased on or after February 8, 2006.

SB40-CSA1,733,20 2. Annuities purchased before February 8, 2006, for which a transaction has occurred on or after February 8, 2006.

SB40-CSA1, s. 1583 Section 1583. 49.453 (4c) of the statutes is created to read:

SB40-CSA1,733,25 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:

SB40-CSA1,734,1 1. The repayment term is actuarially sound.

SB40-CSA1,734,3 2. The payments are to be made in equal amounts during the term of the loan, with no deferral and no balloon payment.

SB40-CSA1,734,4 3. Cancellation of the balance upon the death of the lender is prohibited.

SB40-CSA1,734,8 (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).

SB40-CSA1, s. 1584 Section 1584. 49.453 (4m) of the statutes is created to read:

SB40-CSA1,734,13 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.

SB40-CSA1, s. 1585 Section 1585. 49.453 (8) of the statutes is renumbered 49.453 (8) (a) (intro.) and amended to read:

SB40-CSA1,734,17 49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets if the any of the following applies:

SB40-CSA1,734,18 1. The assets are exempt under 42 USC 1396p (c) (2) or if the (A), (B), or (C).

SB40-CSA1,734,21 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).

SB40-CSA1, s. 1586 Section 1586. 49.453 (8) (b) of the statutes is created to read:

SB40-CSA1,734,24 49.453 (8) (b) The department shall establish a hardship waiver process that includes all of the following:

SB40-CSA1,735,4 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.

SB40-CSA1,735,8 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.

SB40-CSA1,735,12 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.

SB40-CSA1, s. 1587 Section 1587. 49.46 (1) (a) 5. of the statutes is amended to read:

SB40-CSA1,735,16 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.

SB40-CSA1, s. 1588 Section 1588. 49.46 (1) (a) 14m. of the statutes is amended to read:

SB40-CSA1,735,23 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.

SB40-CSA1, s. 1589 Section 1589. 49.46 (2) (b) (intro.) of the statutes is amended to read:

SB40-CSA1,736,3 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:

SB40-CSA1, s. 1590 Section 1590. 49.46 (2) (b) 8. of the statutes is amended to read:

SB40-CSA1,736,9 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).

SB40-CSA1, s. 1591 Section 1591. 49.46 (2) (dc) of the statutes is created to read:

SB40-CSA1,736,16 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.

SB40-CSA1, s. 1592 Section 1592. 49.468 (1) (b) of the statutes is amended to read:

SB40-CSA1,737,6 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.

SB40-CSA1, s. 1593 Section 1593. 49.468 (1) (c) of the statutes is amended to read:

SB40-CSA1,737,16 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.

SB40-CSA1, s. 1594 Section 1594. 49.468 (1m) (a) of the statutes is amended to read:

SB40-CSA1,737,23 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.

SB40-CSA1, s. 1595 Section 1595. 49.468 (2) (a) of the statutes is amended to read:

SB40-CSA1,738,6 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.

SB40-CSA1, s. 1596 Section 1596. 49.47 (4) (a) (intro.) of the statutes is amended to read:

SB40-CSA1,738,10 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:

SB40-CSA1, s. 1597 Section 1597. 49.47 (4) (as) 1. of the statutes is amended to read:

SB40-CSA1,738,16 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).

SB40-CSA1, s. 1598 Section 1598. 49.47 (4) (as) 3. of the statutes is amended to read:

SB40-CSA1,738,20 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).

SB40-CSA1, s. 1598r Section 1598r. 49.47 (4) (b) (intro.) of the statutes is amended to read:

SB40-CSA1,738,24 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), does not exceed the following:

SB40-CSA1, s. 1599 Section 1599. 49.47 (4) (b) 1. of the statutes is amended to read:

SB40-CSA1,739,3 49.47 (4) (b) 1. A Subject to par. (bc), a home and the land used and operated in connection therewith or in lieu thereof a mobile home if the home or mobile home is used as the person's or his or her family's place of abode.

SB40-CSA1, s. 1600 Section 1600. 49.47 (4) (bc) of the statutes is created to read:

SB40-CSA1,739,9 49.47 (4) (bc) 1. Subject to subd. 2., a person shall be ineligible under this section for medical assistance for nursing facility services or other long-term care services described in s. 49. 453 (2) if the equity in his or her home and the land used and operated in connection with the home exceeds $750,000. This subdivision does not apply if any of the following persons lawfully resides in the home:

SB40-CSA1,739,10 a. The person's spouse.

SB40-CSA1,739,12 b. The person's child who is under age 21 or who is disabled, as defined in s. 49.468 (1) (a) 1.

SB40-CSA1,739,13 2. Subdivision 1. applies to all of the following:

SB40-CSA1,739,16 a. At the time of application, to a person who applies for medical assistance for nursing facility services or other long-term care services described in s. 49.453 (2) after the effective date of this subd. 2. a. .... [revisor inserts date].

SB40-CSA1,739,22 b. At the time of the person's first recertification after the effective date of this subd. 2. b. .... [revisor inserts date], to a person not specified in subd. 2. a. who applied for medical assistance for nursing facility services or other long-term care services described in s. 49.453 (2) on or after January 1, 2006, and who was eligible for medical assistance for those services on the effective date of this subd. 2. b. .... [revisor inserts date].

SB40-CSA1, s. 1601 Section 1601. 49.47 (4) (bm) of the statutes is created to read:

SB40-CSA1,740,3 49.47 (4) (bm) For purposes of determining eligibility or benefits amount for a person described in par. (a) 3. or 4. who resides in a continuing care retirement community or a life care community, any entrance fee paid on admission to the community shall be considered a resource available to the person to the extent that all of the following apply:

SB40-CSA1,740,6 1. The person has the ability to use the entrance fee, or the contract provides that the entrance fee may be used, to pay for care if the person's other resources or income are insufficient to pay for the care.

SB40-CSA1,740,9 2. The person is eligible for a refund of any remaining entrance fee when the person dies or terminates the continuing care retirement community or life care community contract and leaves the community.

SB40-CSA1,740,11 3. The entrance fee does not confer an ownership interest in the continuing care retirement community or life care community.

SB40-CSA1, s. 1602 Section 1602. 49.47 (4) (cr) of the statutes is created to read:

SB40-CSA1,740,23 49.47 (4) (cr) 1. As a condition of receiving medical assistance for long-term care services described in s. 49.453 (2) (a), an applicant for or recipient of the long-term care services shall disclose on the application or recertification form a description of any interest the individual or his or her community spouse, as defined in s. 49.453 (1) (ar), has in an annuity, regardless of whether the annuity is irrevocable or is treated as an asset. The application or recertification form shall include a statement that the state becomes a remainder beneficiary under any annuity in which the individual or his or her spouse has an interest by virtue of the provision of the medical assistance. The applicant or recipient shall, no later than 30 days after the department receives the application or recertification form, take any action required by the annuity issuer to make the state a remainder beneficiary.

SB40-CSA1,741,2 2. The department shall notify the issuer of an annuity disclosed under subd. 1. of the state's right as a remainder beneficiary and shall request that the issuer notify the department of any changes to or payments made under the annuity contract.

SB40-CSA1,741,3 3. This paragraph applies to all of the following:

SB40-CSA1,741,4 a. Annuities purchased on or after February 8, 2006.

SB40-CSA1,741,6 b. Annuities purchased before February 8, 2006, for which a transaction, as defined in s. 49.453 (4) (ac), has occurred on or after February 8, 2006.

SB40-CSA1, s. 1603 Section 1603. 49.47 (6) (a) 1. of the statutes is amended to read: