SB40: Bill Text

SB40,712,6 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).

SB40, s. 1554 Section 1554. 49.45 (42m) (a) of the statutes is amended to read:

SB40,712,14 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.

SB40, s. 1555 Section 1555. 49.45 (48) of the statutes is amended to read:

SB40,712,20 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.

SB40, s. 1556 Section 1556. 49.45 (49m) (c) 1. of the statutes is amended to read:

SB40,712,25 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.

SB40, s. 1557 Section 1557. 49.45 (52) of the statutes is amended to read:

SB40,713,12 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment adjustments under this subsection shall include the state share of the payments. The total of any payment adjustments under this subsection and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB40, s. 1558 Section 1558. 49.45 (53) of the statutes is amended to read:

SB40,713,17 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).

SB40, s. 1559 Section 1559. 49.45 (54) of the statutes is created to read:

SB40,713,23 49.45 (54) Managed care pilot program for long-term care of children with disabilities. The department shall seek waivers of federal medical assistance statutes and regulations from the federal department of health and human services necessary to implement, in at least 3 pilot sites, a program of managed care for the long-term care of children with disabilities.

SB40, s. 1560 Section 1560. 49.453 (1) (a) of the statutes is amended to read:

SB40,713,25 49.453 (1) (a) "Assets" has the meaning given in 42 USC 1396p (e) (h) (1).

SB40, s. 1561 Section 1561. 49.453 (1) (ar) of the statutes is created to read:

SB40,714,3 49.453 (1) (ar) "Community spouse" means the spouse of either the institutionalized person or the noninstitutionalized person.

SB40, s. 1562 Section 1562. 49.453 (1) (d) of the statutes is amended to read:

SB40,714,5 49.453 (1) (d) "Income" has the meaning given in 42 USC 1396p (e) (h) (2).

SB40, s. 1563 Section 1563. 49.453 (1) (e) of the statutes is amended to read:

SB40,714,8 49.453 (1) (e) "Institutionalized individual" has the meaning given in 42 USC 1396p (e) (h) (3).

SB40, s. 1564 Section 1564. 49.453 (1) (f) (intro.) of the statutes is amended to read:

SB40,714,11 49.453 (1) (f) (intro.) "Look-back date" means for a covered individual, either of the following:

SB40,714,15 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:

SB40, s. 1565 Section 1565. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m. a.

SB40, s. 1566 Section 1566. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m. b.

SB40, s. 1567 Section 1567. 49.453 (1) (f) 2m. of the statutes is created to read:

SB40,714,22 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.

SB40, s. 1568 Section 1568. 49.453 (1) (fm) of the statutes is amended to read:

SB40,714,25 49.453 (1) (fm) "Noninstitutionalized individual" has the meaning given in 42 USC 1396p (e) (h) (4).

SB40, s. 1569 Section 1569. 49.453 (1) (i) of the statutes is amended to read:

SB40,715,2 49.453 (1) (i) "Resources" has the meaning given in 42 USC 1396p (e) (h) (5).

SB40, s. 1570 Section 1570. 49.453 (3) (a) of the statutes is renumbered 49.453 (3) (a) (intro.) and amended to read:

SB40,715,6 49.453 (3) (a) (intro.) The period of ineligibility under this subsection begins on either of the following:

SB40,715,10 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.

SB40, s. 1571 Section 1571. 49.453 (3) (a) 2. of the statutes is created to read:

SB40,715,19 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.

SB40, s. 1572 Section 1572. 49.453 (3) (b) (intro.) of the statutes is amended to read:

SB40,715,22 49.453 (3) (b) (intro.) The Subject to par. (bc), the department shall determine the number of months of ineligibility as follows:

SB40, s. 1573 Section 1573. 49.453 (3) (bc) of the statutes is created to read:

SB40,716,2 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.

SB40, s. 1574 Section 1574. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (ag).

SB40, s. 1575 Section 1575. 49.453 (4) (ac) of the statutes is created to read:

SB40,716,7 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:

SB40,716,8 1. An addition of principal.

SB40,716,9 2. An elective withdrawal.

SB40,716,10 3. A request to change the distribution of the annuity.

SB40,716,11 4. An election to annuitize the contract.

SB40,716,12 5. A change in ownership.

SB40, s. 1576 Section 1576. 49.453 (4) (am) of the statutes is amended to read:

SB40,716,16 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.

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

SB40,716,20 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, s. 1578 Section 1578. 49.453 (4) (c) of the statutes is amended to read:

SB40,717,6 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, s. 1579 Section 1579. 49.453 (4) (cm) of the statutes is created to read:

SB40,717,9 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, s. 1580 Section 1580. 49.453 (4) (d) of the statutes is created to read:

SB40,717,14 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:

SB40,717,17 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.

SB40,717,21 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.

SB40,717,22 3. The annuity satisfies the requirements under par. (e) 1. or 2.

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

SB40,718,2 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:

SB40,718,4 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:

SB40,718,6 a. An account or trust described in section 408 (a), (c), or (p) of the Internal Revenue Code of 1986.

SB40,718,8 b. A simplified employee pension, within the meaning of section 408 (k) of the Internal Revenue Code of 1986.

SB40,718,9 c. A Roth IRA described in section 408A of the Internal Revenue Code of 1986.

SB40,718,10 2. All of the following apply with respect to the annuity:

SB40,718,11 a. The annuity is irrevocable and nonassignable.

SB40,718,13 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.

SB40,718,15 c. The annuity provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.

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

SB40,718,17 49.453 (4) (em) Paragraphs (d) and (e) apply to all of the following:

SB40,718,18 1. Annuities purchased on or after February 8, 2006.

SB40,718,20 2. Annuities purchased before February 8, 2006, for which a transaction has occurred on or after February 8, 2006.

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

SB40,718,25 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:

SB40,719,1 1. The repayment term is actuarially sound.

SB40,719,3 2. The payments are to be made in equal amounts during the term of the loan, with no deferral and no balloon payment.

SB40,719,4 3. Cancellation of the balance upon the death of the lender is prohibited.

SB40,719,8 (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, s. 1584 Section 1584. 49.453 (4m) of the statutes is created to read:

SB40,719,13 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, s. 1585 Section 1585. 49.453 (8) of the statutes is renumbered 49.453 (8) (a) (intro.) and amended to read:

SB40,719,17 49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets if the any of the following applies:

SB40,719,18 1. The assets are exempt under 42 USC 1396p (c) (2) or if the (A), (B), or (C).

SB40,719,21 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, s. 1586 Section 1586. 49.453 (8) (b) of the statutes is created to read: