SB40-SSA1,712,84
49.45
(48) Payment of medicare part B outpatient hospital services
5coinsurances. The department shall include in the state plan for medical assistance
6a methodology for payment of the medicare part B outpatient hospital services
7coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468
8(1) (b),
and 49.47 (6) (a) 6. b., d., and f.
, and 49.471 (6) (j) 1.
SB40-SSA1,712,1310
49.45
(49m) (c) 1. A list of the prescription drugs that are included as a benefit
11under
s. ss. 49.46 (2) (b) 6. h.
and 49.471 (11) (a) that identifies preferred choices
12within therapeutic classes and includes prescription drugs that bear only generic
13names.
SB40-SSA1,712,2515
49.45
(52) Payment adjustments. Beginning on January 1, 2003, the
16department may, from the appropriation account under s. 20.435 (7) (b), make
17Medical Assistance payment adjustments to county departments under s. 46.215,
1846.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
19(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
20(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment
21adjustments under this subsection shall include the state share of the payments.
22The total of any payment adjustments under this subsection and Medical Assistance
23payments made from appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
and (w)
,
24and (xd) may not exceed applicable limitations on payments under
42 USC 1396a (a)
25(30) (A).
SB40-SSA1,713,52
49.45
(53) Payments for certain services. Beginning on January 1, 2003, the
3department may, from the appropriation account under s. 20.435 (7) (b), make
4Medical Assistance payments to providers for covered services under
s. ss. 49.46 (2)
5(a) 4. d. and (b) 6. j. and m.
and 49.471 (11) (f).
SB40-SSA1,713,117
49.45
(54) Managed care pilot program for long-term care of children with
8disabilities. The department shall seek waivers of federal medical assistance
9statutes and regulations from the federal department of health and human services
10necessary to implement, in at least 3 pilot sites, a program of managed care for the
11long-term care of children with disabilities.
SB40-SSA1,713,2213
49.45
(55) Health Opportunity Accounts Demonstration Program. The
14department shall request from the federal Centers for Medicare and Medicaid
15Services approval to participate in a demonstration program under
42 USC 1396u-8,
16under which Badger Care recipients may voluntarily enroll to contribute to health
17opportunity accounts and receive certain alternative benefits under medical
18assistance. If the Centers for Medicare and Medicaid Services approve the
19department's request, the department shall submit a proposed plan for
20implementation of the demonstration program to the joint committee on finance.
21The department may not implement the plan until it is approved by the committee,
22as submitted or as modified.
SB40-SSA1,714,524
49.45
(56) Disease management program. Based on the health conditions
25identified by the physical health risk assessments, if performed under sub. (57), the
1department shall develop and implement, for Medical Assistance recipients, disease
2management programs that are similar to that developed and followed by the
3Marshfield Clinic in this state under the Physician Group Practice Demonstration
4Program authorized under
42 USC 1315 (e) and (f). These programs shall have at
5least the following characteristics:
SB40-SSA1,714,86
(a) The use of information science to improve health care delivery by
7summarizing a patient's health status and providing reminders for preventive
8measures.
SB40-SSA1,714,109
(b) Educating health care providers on health care process improvement by
10developing best practice models.
SB40-SSA1,714,1311
(c) The improvement and expansion of care management programs to assist in
12standardization of best practices, patient education, support systems, and
13information gathering.
SB40-SSA1,714,1514
(d)
Establishment of a system of provider compensation that is aligned with
15clinical quality, practice management, and cost of care.
SB40-SSA1,714,1716
(e) Focus on patient care interventions for certain chronic conditions, to reduce
17hospital admissions.
SB40-SSA1,714,2319
49.45
(57) Physical health risk assessment. The department shall encourage
20each individual who is determined on or after the effective date of this subsection ....
21[revisor inserts date], to be eligible for Medical Assistance to receive a physical health
22risk assessment as part of the first physical examination the individual receives
23under Medical Assistance.
SB40-SSA1,714,2525
49.453
(1) (a) "Assets" has the meaning given in
42 USC 1396p (e) (h) (1).
SB40-SSA1,715,32
49.453
(1) (ar) "Community spouse" means the spouse of either the
3institutionalized person or the noninstitutionalized person.
SB40-SSA1,715,55
49.453
(1) (d) "Income" has the meaning given in
42 USC 1396p (e) (h) (2).
SB40-SSA1,715,87
49.453
(1) (e) "Institutionalized individual" has the meaning given in
42 USC
81396p (e) (h) (3).
SB40-SSA1, s. 1564
9Section
1564. 49.453 (1) (f) (intro.) of the statutes is amended to read:
SB40-SSA1,715,1110
49.453
(1) (f) (intro.) "Look-back date" means
for a covered individual, either
11of the following:
SB40-SSA1,715,15
121m. For transfers made before February 8, 2006, the date that is 36 months
13before, or with respect to payments from a trust or portions of a trust that are treated
14as assets transferred by the covered individual under s. 49.454 (2) (c) or (3) (b) the
15date that is 60 months before:
SB40-SSA1, s. 1565
16Section
1565. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m.
17a.
SB40-SSA1, s. 1566
18Section
1566. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m.
19b.
SB40-SSA1,715,2221
49.453
(1) (f) 2m. For all transfers made on or after February 8, 2006, the date
22that is 60 months before the dates specified in subd. 1m. a. and b.
SB40-SSA1,715,2524
49.453
(1) (fm) "Noninstitutionalized individual" has the meaning given in
42
25USC 1396p (e) (h) (4).
SB40-SSA1,716,22
49.453
(1) (i) "Resources" has the meaning given in
42 USC 1396p (e) (h) (5).
SB40-SSA1, s. 1570
3Section
1570. 49.453 (3) (a) of the statutes is renumbered 49.453 (3) (a) (intro.)
4and amended to read:
SB40-SSA1,716,65
49.453
(3) (a) (intro.) The period of ineligibility under this subsection begins
6on
either of the following:
SB40-SSA1,716,10
71. In the case of a transfer of assets made before February 8, 2006, the first day
8of the first month beginning on or after the look-back date during or after which
9assets have been transferred for less than fair market value and that does not occur
10in any other periods of ineligibility under this subsection.
SB40-SSA1,716,1912
49.453
(3) (a) 2. In the case of a transfer of assets made on or after February
138, 2006, the first day of a month beginning on or after the look-back date during or
14after which assets have been transferred for less than fair market value, or the date
15on which the individual is eligible for medical assistance and would otherwise be
16receiving institutional level care described in sub. (2) (a) 1. to 3. based on an approved
17application for the care but for the application of the penalty period, whichever is
18later, and that does not occur during any other period of ineligibility under this
19subsection.
SB40-SSA1, s. 1572
20Section
1572. 49.453 (3) (b) (intro.) of the statutes is amended to read:
SB40-SSA1,716,2221
49.453
(3) (b) (intro.)
The Subject to par. (bc), the department shall determine
22the number of months of ineligibility as follows:
SB40-SSA1,717,224
49.453
(3) (bc) In determining the number of months of ineligibility under par.
25(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-SSA1, s. 1574
3Section
1574. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (ag).
SB40-SSA1,717,75
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-SSA1,717,88
1. An addition of principal.
SB40-SSA1,717,99
2. An elective withdrawal.
SB40-SSA1,717,1010
3. A request to change the distribution of the annuity.
SB40-SSA1,717,1111
4. An election to annuitize the contract.
SB40-SSA1,717,1212
5. A change in ownership.
SB40-SSA1,717,1614
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-SSA1,717,2018
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-SSA1,718,622
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-SSA1,718,98
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-SSA1,718,1411
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-SSA1,718,1715
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-SSA1,718,2118
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-SSA1,718,2222
3. The annuity satisfies the requirements under par. (e) 1. or 2.
SB40-SSA1,719,224
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-SSA1,719,431. 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-SSA1,719,65a. An account or trust described in section
408 (a), (c), or (p) of the Internal
6Revenue Code of 1986.
SB40-SSA1,719,87b. A simplified employee pension, within the meaning of section
408 (k) of the
8Internal Revenue Code of 1986.
SB40-SSA1,719,99c. A Roth IRA described in section
408A of the Internal Revenue Code of 1986.
SB40-SSA1,719,1010
2. All of the following apply with respect to the annuity:
SB40-SSA1,719,1111
a. The annuity is irrevocable and nonassignable.
SB40-SSA1,719,1312
b. The annuity is actuarily sound, as determined in accordance with actuarial
13publications of the office of the chief actuary of the social security administration.
SB40-SSA1,719,1514
c. The annuity provides for payments in equal amounts during the term of the
15annuity, with no deferral and no balloon payments made.
SB40-SSA1,719,1717
49.453
(4) (em) Paragraphs (d) and (e) apply to all of the following:
SB40-SSA1,719,1818
1. Annuities purchased on or after February 8, 2006.
SB40-SSA1,719,2019
2. Annuities purchased before February 8, 2006, for which a transaction has
20occurred on or after February 8, 2006.
SB40-SSA1,719,2522
49.453
(4c) Purchase of note, loan, or mortgage. (a) For purposes of sub. (2),
23the purchase by an individual or his or her spouse of a promissory note, loan, or
24mortgage after February 8, 2006, is a transfer of assets for less than fair market
25value unless all of the following apply with respect to the note, loan, or mortgage:
SB40-SSA1,720,1
11. The repayment term is actuarially sound.
SB40-SSA1,720,32
2. The payments are to be made in equal amounts during the term of the loan,
3with no deferral and no balloon payment.
SB40-SSA1,720,44
3. Cancellation of the balance upon the death of the lender is prohibited.
