SB40,711,220
(b) If the waiver is granted and in effect, the department may promulgate rules
21defining the health care benefit plan, including more specific eligibility
22requirements and cost-sharing requirements. Notwithstanding s. 227.24 (3), the
23plan details under this subsection may be promulgated as an emergency rule under
24s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the
1demonstration project under this subsection shall begin on January 1, 2009, or on
2the effective date of the waiver, whichever is later.
SB40, s. 1547
3Section
1547. 49.45 (24g) of the statutes is repealed.
SB40, s. 1548
4Section
1548. 49.45 (24m) (intro.) of the statutes is amended to read:
SB40,711,95
49.45
(24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b),
6(gp), (o),
and (w)
, and (xd), in order to test the feasibility of instituting a system of
7reimbursement for providers of home health care and personal care services for
8medical assistance recipients that is based on competitive bidding, the department
9shall:
SB40, s. 1549
10Section
1549. 49.45 (24r) of the statutes is amended to read:
SB40,711,2011
49.45
(24r) Family planning demonstration project. The department shall
12request
a an amended waiver from the secretary of the federal department of health
13and human services to permit the department to conduct a demonstration project to
14provide family planning
services, as defined in s. 253.07 (1)
(b) (a), under medical
15assistance to any woman
or man between the ages of 15 and 44 whose family income
16does not exceed
185% 200 percent of the poverty line for a family the size of the
17woman's
or man's family.
If The department shall implement any waiver granted
18and, if the
amendment to the waiver is granted and in effect, the department shall
19implement the
amended waiver no later than
July 1, 1998 January 1, 2008, or on the
20federally approved effective date of the
amended waiver, whichever is later.
SB40, s. 1550
21Section
1550. 49.45 (29) of the statutes is amended to read:
SB40,711,2422
49.45
(29) Hospice reimbursement. The department shall promulgate rules
23limiting aggregate payments made to a hospice under ss. 49.46
and, 49.47
, and
2449.471.
SB40, s. 1551
25Section
1551. 49.45 (31) of the statutes is repealed.
SB40, s. 1552
1Section
1552. 49.45 (35) of the statutes is repealed.
SB40, s. 1553
2Section
1553. 49.45 (40) of the statutes is amended to read:
SB40,712,63
49.45
(40) Periodic record matches. If the department contracts with the
4department of
workforce development children and families under s. 49.197 (5), the
5department shall cooperate with the department of
workforce development children
6and families in matching records of medical assistance recipients under s. 49.32 (7).
SB40, s. 1554
7Section
1554. 49.45 (42m) (a) of the statutes is amended to read:
SB40,712,148
49.45
(42m) (a) If, in authorizing the provision of physical or occupational
9therapy services under s. 49.46 (2) (b) 6. b.
or 49.471 (11) (i), the department
10authorizes a reduced duration of services from the duration that the provider
11specifies in the authorization request, the department shall substantiate the
12reduction that the department made in the duration of the services if the provider
13of the services requests any additional authorizations for the provision of physical
14or occupational therapy services to the same individual.
SB40, s. 1555
15Section
1555. 49.45 (48) of the statutes is amended to read:
SB40,712,2016
49.45
(48) Payment of medicare part B outpatient hospital services
17coinsurances. The department shall include in the state plan for medical assistance
18a methodology for payment of the medicare part B outpatient hospital services
19coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468
20(1) (b),
and 49.47 (6) (a) 6. b., d., and f.
, and 49.471 (6) (j) 1.
SB40, s. 1556
21Section
1556. 49.45 (49m) (c) 1. of the statutes is amended to read:
SB40,712,2522
49.45
(49m) (c) 1. A list of the prescription drugs that are included as a benefit
23under
s. ss. 49.46 (2) (b) 6. h.
and 49.471 (11) (a) that identifies preferred choices
24within therapeutic classes and includes prescription drugs that bear only generic
25names.
SB40, s. 1557
1Section
1557. 49.45 (52) of the statutes is amended to read:
SB40,713,122
49.45
(52) Payment adjustments. Beginning on January 1, 2003, the
3department may, from the appropriation account under s. 20.435 (7) (b), make
4Medical Assistance payment adjustments to county departments under s. 46.215,
546.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
6(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
7(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment
8adjustments under this subsection shall include the state share of the payments.
9The total of any payment adjustments under this subsection and Medical Assistance
10payments made from appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
and (w)
,
11and (xd) may not exceed applicable limitations on payments under
42 USC 1396a (a)
12(30) (A).
SB40, s. 1558
13Section
1558. 49.45 (53) of the statutes is amended to read:
SB40,713,1714
49.45
(53) Payments for certain services. Beginning on January 1, 2003, the
15department may, from the appropriation account under s. 20.435 (7) (b), make
16Medical Assistance payments to providers for covered services under
s. ss. 49.46 (2)
17(a) 4. d. and (b) 6. j. and m.
and 49.471 (11) (f).
SB40, s. 1559
18Section
1559. 49.45 (54) of the statutes is created to read:
SB40,713,2319
49.45
(54) Managed care pilot program for long-term care of children with
20disabilities. The department shall seek waivers of federal medical assistance
21statutes and regulations from the federal department of health and human services
22necessary to implement, in at least 3 pilot sites, a program of managed care for the
23long-term care of children with disabilities.
SB40, s. 1560
24Section
1560. 49.453 (1) (a) of the statutes is amended to read:
SB40,713,2525
49.453
(1) (a) "Assets" has the meaning given in
42 USC 1396p (e) (h) (1).
SB40, s. 1561
1Section
1561. 49.453 (1) (ar) of the statutes is created to read:
SB40,714,32
49.453
(1) (ar) "Community spouse" means the spouse of either the
3institutionalized person or the noninstitutionalized person.
SB40, s. 1562
4Section
1562. 49.453 (1) (d) of the statutes is amended to read:
SB40,714,55
49.453
(1) (d) "Income" has the meaning given in
42 USC 1396p (e) (h) (2).
SB40, s. 1563
6Section
1563. 49.453 (1) (e) of the statutes is amended to read:
SB40,714,87
49.453
(1) (e) "Institutionalized individual" has the meaning given in
42 USC
81396p (e) (h) (3).
SB40, s. 1564
9Section
1564. 49.453 (1) (f) (intro.) of the statutes is amended to read:
SB40,714,1110
49.453
(1) (f) (intro.) "Look-back date" means
for a covered individual, either
11of the following:
SB40,714,15
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, s. 1565
16Section
1565. 49.453 (1) (f) 1. of the statutes is renumbered 49.453 (1) (f) 1m.
17a.
SB40, s. 1566
18Section
1566. 49.453 (1) (f) 2. of the statutes is renumbered 49.453 (1) (f) 1m.
19b.
SB40, s. 1567
20Section
1567. 49.453 (1) (f) 2m. of the statutes is created to read:
SB40,714,2221
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, s. 1568
23Section
1568. 49.453 (1) (fm) of the statutes is amended to read:
SB40,714,2524
49.453
(1) (fm) "Noninstitutionalized individual" has the meaning given in
42
25USC 1396p (e) (h) (4).
SB40, s. 1569
1Section
1569. 49.453 (1) (i) of the statutes is amended to read:
SB40,715,22
49.453
(1) (i) "Resources" has the meaning given in
42 USC 1396p (e) (h) (5).
SB40, s. 1570
3Section
1570. 49.453 (3) (a) of the statutes is renumbered 49.453 (3) (a) (intro.)
4and amended to read:
SB40,715,65
49.453
(3) (a) (intro.) The period of ineligibility under this subsection begins
6on
either of the following:
SB40,715,10
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, s. 1571
11Section
1571. 49.453 (3) (a) 2. of the statutes is created to read:
SB40,715,1912
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, s. 1572
20Section
1572. 49.453 (3) (b) (intro.) of the statutes is amended to read:
SB40,715,2221
49.453
(3) (b) (intro.)
The Subject to par. (bc), the department shall determine
22the number of months of ineligibility as follows:
SB40, s. 1573
23Section
1573. 49.453 (3) (bc) of the statutes is created to read:
SB40,716,224
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, s. 1574
3Section
1574. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (ag).
SB40, s. 1575
4Section
1575. 49.453 (4) (ac) of the statutes is created to read:
SB40,716,75
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:
SB40,716,88
1. An addition of principal.
SB40,716,99
2. An elective withdrawal.
SB40,716,1010
3. A request to change the distribution of the annuity.
SB40,716,1111
4. An election to annuitize the contract.
SB40,716,1212
5. A change in ownership.
SB40, s. 1576
13Section
1576. 49.453 (4) (am) of the statutes is amended to read:
SB40,716,1614
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, s. 1577
17Section
1577. 49.453 (4) (b) of the statutes is amended to read:
SB40,716,2018
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, s. 1578
21Section
1578. 49.453 (4) (c) of the statutes is amended to read:
SB40,717,622
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, s. 1579
7Section
1579. 49.453 (4) (cm) of the statutes is created to read:
SB40,717,98
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, s. 1580
10Section
1580. 49.453 (4) (d) of the statutes is created to read:
SB40,717,1411
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:
SB40,717,1715
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.
SB40,717,2118
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.
SB40,717,2222
3. The annuity satisfies the requirements under par. (e) 1. or 2.
SB40, s. 1581
23Section
1581. 49.453 (4) (e) of the statutes is created to read:
SB40,718,224
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:
SB40,718,431. 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:
SB40,718,65a. An account or trust described in section
408 (a), (c), or (p) of the Internal
6Revenue Code of 1986.
SB40,718,87b. A simplified employee pension, within the meaning of section
408 (k) of the
8Internal Revenue Code of 1986.
SB40,718,99c. A Roth IRA described in section
408A of the Internal Revenue Code of 1986.
SB40,718,1010
2. All of the following apply with respect to the annuity:
SB40,718,1111
a. The annuity is irrevocable and nonassignable.
SB40,718,1312
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.
SB40,718,1514
c. The annuity provides for payments in equal amounts during the term of the
15annuity, with no deferral and no balloon payments made.
SB40, s. 1582
16Section
1582. 49.453 (4) (em) of the statutes is created to read:
SB40,718,1717
49.453
(4) (em) Paragraphs (d) and (e) apply to all of the following:
SB40,718,1818
1. Annuities purchased on or after February 8, 2006.
SB40,718,2019
2. Annuities purchased before February 8, 2006, for which a transaction has
20occurred on or after February 8, 2006.
SB40, s. 1583
21Section
1583. 49.453 (4c) of the statutes is created to read:
SB40,718,2522
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: