AB40,1166
15Section
1166. 49.472 (4) (a) 3. of the statutes is amended to read:
AB40,589,1716
49.472
(4) (a) 3.
The Subject to par. (b), the department may reduce the
17premium by 25% for an individual who is covered by private health insurance.
AB40,1167
18Section
1167
. 49.472 (4) (b) of the statutes is amended to read:
AB40,589,2419
49.472
(4) (b) The
department may waive monthly premiums that are
20calculated to be below $10 minimum premium payable by an individual specified in
21par. (a) 1. is $50 per month. Unless otherwise provided by the department by a policy
22created under s. 49.45 (2m) (c), the department may not assess a monthly premium
23for any individual whose
income level, after adding the individual's total earned
24income and unearned income
, is below 150% of the poverty line
for an individual.
AB40,1168
1Section
1168
. 49.472 (4) (b) of the statutes, as affected by
2011 Wisconsin Act
232 and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
AB40,590,63
49.472
(4) (b) The minimum premium payable by an individual specified in par.
4(a) 1. is $50 per month. The department may not assess a monthly premium for any
5individual whose total earned and unearned income is below 150 percent of the
6poverty line for an individual.
AB40,1169
7Section
1169. 49.472 (5) of the statutes is amended to read:
AB40,590,118
49.472
(5) Community options participants. From the appropriation under s.
920.435 (7) (bd), the department may pay all or a portion of the monthly premium
10calculated under sub. (4)
(a) for an individual who is a participant in the community
11options program under s. 46.27 (11).
AB40,1170
12Section
1170. 49.475 (title) of the statutes is amended to read:
AB40,590,14
1349.475 (title)
Information about assistance program beneficiaries;
14electronic submission of claims.
AB40,1171
15Section
1171. 49.475 (2) (except 49.475 (2) (title)) of the statutes is
16renumbered 49.475 (2) (ac), and 49.475 (2) (ac) 1. b. and 4. (intro.), as renumbered,
17are amended to read:
AB40,590,2018
49.475
(2) (ac) 1. b. If subd. 1.
a. applies, the nature and period of time of any
19coverage, benefit, or service provided, including the name, address, and identifying
20number of any applicable coverage plan.
AB40,590,2521
4. (intro.) If all of the following apply, agree not to deny a claim submitted by
22the department under
par. (b) subd. 2. solely because of the claim's submission date,
23the type or format of the claim form, or failure by a recipient to present proper
24documentation at the time of delivery of the service, benefit, or item that is the basis
25of the claim:
AB40,1172
1Section
1172. 49.475 (2) (bc) of the statutes is created to read:
AB40,591,62
49.475
(2) (bc) A 3rd party shall accept the submission of claims from the
3department under par. (ac) 2. in electronic form and shall timely pay the claims in
4the manner provided in s. 628.46 (1) and (2). For purposes of timely payment of
5claims under this paragraph, "written notice" under s. 628.46 (1) includes receipt of
6a claim in electronic form.
AB40,1173
7Section
1173. 49.475 (2m) (a) of the statutes is amended to read:
AB40,591,118
49.475
(2m) (a) The information that the department may request under this
9section is limited to the information specified in sub. (2)
(a) (ac) 1. and does not
10include an employer's name unless that information is necessary for the department
11or a provider to obtain 3rd-party payment for an item or service.
AB40,1174
12Section
1174. 49.475 (2m) (b) of the statutes is amended to read:
AB40,591,1713
49.475
(2m) (b) If information under sub. (2)
(a) (ac) 1. may be available from
14more than one source that includes an employer operating a self-insured plan, the
15department shall seek the information first from a 3rd-party administrator or other
16entity identified in sub. (1) (f) 7. or pharmacy benefits manager before seeking the
17information from the employer.
AB40,1175
18Section
1175. 49.475 (3) (intro.) of the statutes is amended to read:
AB40,591,2119
49.475
(3) Written agreement. (intro.) Upon requesting a 3rd party to provide
20the information under sub. (2)
(a) (ac) 1., the department and the 3rd party shall
21enter into a written agreement that satisfies all of the following:
AB40,1176
22Section
1176. 49.475 (4) (a) of the statutes is amended to read:
AB40,592,223
49.475
(4) (a) A 3rd party shall provide the information requested under sub.
24(2)
(a) (ac) 1. within 180 days after receiving the department's request if it is the first
1time that the department has requested the 3rd party to disclose information under
2this section.
AB40,1177
3Section
1177. 49.475 (4) (b) of the statutes is amended to read:
AB40,592,74
49.475
(4) (b) A 3rd party shall provide the information requested under sub.
5(2)
(a) (ac) 1. within 30 days after receiving the department's request if the
6department has previously requested the 3rd party to disclose information under
7this section.
AB40,1178
8Section
1178. 49.475 (5) of the statutes is amended to read:
AB40,592,139
49.475
(5) Reimbursement of costs. From the appropriations under s. 20.435
10(4) (bm) and (pa), the department shall reimburse a 3rd party that provides
11information under sub. (2)
(a) (ac) 1. for the 3rd party's reasonable costs incurred in
12providing the requested information, including its reasonable costs, if any, to develop
13and operate automated systems specifically for the disclosure of the information.
AB40,1179
14Section
1179. 49.496 (1) (a) of the statutes is renumbered 49.496 (1) (ah).
AB40,1180
15Section
1180. 49.496 (1) (af) of the statutes is created to read:
AB40,592,1716
49.496
(1) (af) "Decedent" means a deceased recipient or a deceased
17nonrecipient surviving spouse, whichever is applicable.
AB40,1181
18Section
1181. 49.496 (1) (bk) of the statutes is created to read:
AB40,592,1919
49.496
(1) (bk) "Long-term care program" means any of the following:
AB40,592,2020
1. The family care program providing the benefit under s. 46.286.
AB40,592,2421
2. The self-directed services option that operates under a waiver from the
22secretary of the federal department of health and human services under
42 USC
231396n (c) in which an enrolled individual selects his or her own services and service
24providers.
AB40,593,3
13. The family care partnership program that is an integrated health and
2long-term care program operated under an amendment to the state medical
3assistance plan under
42 USC 1396u-2 and a waiver under
42 USC 1396n (c).
AB40,593,444. The program for all-inclusive care for the elderly under
42 USC 1396u-4.
AB40,593,95
5. Any program that provides long-term care services and is operated by the
6department under an amendment to the state medical assistance plan under
42 USC
71396n (i) or
42 USC 1396u-2; a waiver of medical assistance laws under
42 USC
81396n (c),
42 USC 1396n (b) and (c), or
42 USC 1396u; or a demonstration project
9under
42 USC 1315 or
42 USC 1396n (c).
AB40,1182
10Section
1182. 49.496 (1) (bw) of the statutes is created to read:
AB40,593,1311
49.496
(1) (bw) "Nonrecipient surviving spouse" means any person who was
12married to a recipient while the recipient was receiving services for which the cost
13may be recovered under sub. (3) (a) and who survived the recipient.
AB40,1183
14Section
1183. 49.496 (1) (cm) of the statutes is created to read:
AB40,593,1915
49.496
(1) (cm) 1. "Property of a decedent" means all real and personal property
16to which the recipient held any legal title or in which the recipient had any legal
17interest immediately before death, to the extent of that title or interest, including
18assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in
19common, survivorship, life estate, living trust, or any other arrangement.
AB40,593,2520
2. Notwithstanding subd. 1., "property of a decedent" includes all real and
21personal property in which the nonrecipient surviving spouse had an ownership
22interest at the recipient's death and in which the recipient had a marital property
23interest with that nonrecipient surviving spouse at any time within 5 years before
24the recipient applied for medical assistance or during the time that the recipient was
25eligible for medical assistance.
AB40,1184
1Section
1184. 49.496 (3) (a) (intro.) of the statutes is amended to read:
AB40,594,62
49.496
(3) (a) (intro.) Except as provided in par. (b), the department shall file
3a claim against the estate of a recipient
, and against the estate of a nonrecipient
4surviving spouse, for all of the following, subject to the exclusion of any amounts
5under the Long-Term Care Partnership Program established under s. 49.45 (31),
6unless already recovered by the department under this section:
AB40,1185
7Section
1185. 49.496 (3) (a) 2. a. of the statutes is amended to read:
AB40,594,108
49.496
(3) (a) 2. a. Home-based or community-based services under
42 USC
91396d (a) (7) and (8)
and under any waiver granted under 42 USC 1396n (c) (4) (B)
10or 42 USC 1396u.
AB40,1186
11Section
1186. 49.496 (3) (a) 2. am. of the statutes is created to read:
AB40,594,1312
49.496
(3) (a) 2. am. All services provided to an individual while the individual
13is participating in a long-term care program.
AB40,1187
14Section
1187. 49.496 (3) (a) 2. b. of the statutes is repealed.
AB40,1188
15Section
1188. 49.496 (3) (a) 2. c. of the statutes is repealed.
AB40,1189
16Section
1189. 49.496 (3) (ad) of the statutes is created to read:
AB40,594,2117
49.496
(3) (ad) The amount the department may claim against an estate of a
18recipient, or an estate of a nonrecipient surviving spouse, for services that are
19described under par. (a) 2. am. and that are provided by a managed long-term care
20program funded by capitated payments is equal to the amount of the capitated
21payment for the recipient.
AB40,1190
22Section
1190. 49.496 (3) (aj) of the statutes is created to read:
AB40,594,2523
49.496
(3) (aj) 1. Property that is subject to the department's claim under par.
24(a) in the estate of a recipient or in the estate of a nonrecipient surviving spouse is
25all property of a decedent that is included in the estate.
AB40,595,5
12. There is a presumption, which may be rebutted by clear and convincing
2evidence, that all property in the estate of a nonrecipient surviving spouse was
3marital property held with the recipient and that 100 percent of the property in the
4estate of the nonrecipient surviving spouse is subject to the department's claim
5under par. (a).
AB40,1191
6Section
1191. 49.496 (3) (am) (intro.) of the statutes is amended to read:
AB40,595,107
49.496
(3) (am) (intro.) The court shall reduce the amount of a claim under par.
8(a) by up to the amount specified in s. 861.33 (2) if necessary to allow the
recipient's 9decedent's heirs or the beneficiaries of the
recipient's decedent's will to retain the
10following personal property:
AB40,1192
11Section
1192. 49.496 (3) (c) 1. of the statutes is amended to read:
AB40,595,1812
49.496
(3) (c) 1. If the department's claim is not allowable because of par. (b)
13and the estate includes an interest in
any real property, including a home, the court
14exercising probate jurisdiction shall, in the final judgment or summary findings and
15order, assign the interest in the
home real property subject to a lien in favor of the
16department for the amount described in par. (a). The personal representative or
17petitioner for summary settlement or summary assignment of the estate shall record
18the final judgment as provided in s. 863.29, 867.01 (3) (h)
, or 867.02 (2) (h).
AB40,1193
19Section
1193. 49.496 (3) (c) 2. of the statutes is amended to read:
AB40,596,220
49.496
(3) (c) 2. If the department's claim is not allowable because of par. (b),
21the estate includes an interest in
any real property, including a home
, and the
22personal representative closes the estate by sworn statement under s. 865.16, the
23personal representative shall stipulate in the statement that the
home real property 24is assigned subject to a lien in favor of the department for the amount described in
1par. (a). The personal representative shall record the statement in the same manner
2as described in s. 863.29, as if the statement were a final judgment.
AB40,1194
3Section
1194. 49.496 (3) (d) (intro.) of the statutes is amended to read:
AB40,596,54
49.496
(3) (d) (intro.) The department may not enforce
the a lien under par. (c)
5as long as any of the following survive the decedent:
AB40,1195
6Section
1195. 49.496 (3) (dm) of the statutes is created to read:
AB40,596,87
49.496
(3) (dm) All of the following apply to a lien under par. (c) that the
8department may not enforce because of par. (d):
AB40,596,119
1. If the decedent's surviving spouse or child who is under age 21 or disabled
10refinances a mortgage on the real property, the lien is subordinate to the new
11encumbrance.
AB40,596,1312
2. The department shall release the lien in the circumstances described in s.
1349.848 (5) (f).
AB40,1196
14Section
1196. 49.496 (6m) of the statutes is amended to read:
AB40,596,2115
49.496
(6m) Waiver due to hardship. The department shall promulgate rules
16establishing standards for determining whether the application of this section would
17work an undue hardship in individual cases. If the department determines that the
18application of this section would work an undue hardship in a particular case, the
19department shall waive application of this section in that case.
This subsection does
20not apply with respect to claims against the estates of nonrecipient surviving
21spouses.
AB40,1197
22Section
1197. 49.4962 of the statutes is created to read:
AB40,596,24
2349.4962 Voiding certain transfers of real property. (1) Definitions. In
24this section:
AB40,596,2525
(a) "Conveyance" has the meaning given in s. 706.01 (4).
AB40,597,2
1(b) "Fair market value" means the price that a willing buyer would pay a willing
2seller for the purchase of real property.
AB40,597,33
(c) "Fraudulent transfer" means any of the following:
AB40,597,44
1. A transfer of title to real property for less than fair market value.
AB40,597,75
2. A transfer of title to real property by a conveyance that is not recorded during
6the lifetime of the grantor in the office of the register of deeds of the county in which
7the real property is located.
AB40,597,88
(d) "Grantee" has the meaning given in s. 706.01 (6).
AB40,597,99
(e) "Grantor" has the meaning given in s. 706.01 (6).
AB40,597,11
10(2) Voidable transfers. (a) A transfer of real property to which all of the
11following apply is voidable by the department:
AB40,597,1412
1. The transfer was made by a grantor who was receiving or who received
13medical assistance, or by someone on his or her behalf, during the time that the
14grantor was eligible for medical assistance.
AB40,597,1615
2. The department was not notified and was unaware that the transfer was
16made.
AB40,597,1817
3. The transfer was made to hinder, delay, or defraud the department from
18recovering medical assistance benefits that were paid on behalf of the grantor.
AB40,597,2119
(b) The department may commence an action in circuit court against the
20grantee to void the transfer. If the court voids the transfer, the title to the real
21property reverts to the grantor or his or her estate.
AB40,597,25
22(3) Presumption. There is a presumption, which may be rebutted by clear and
23convincing evidence, that a transfer described in sub. (2) (a) 1. that is a fraudulent
24transfer was made to hinder, delay, or defraud the department from recovering
25medical assistance benefits that were paid on behalf of the grantor.
AB40,598,4
1(4) Burden of proof. With respect to a transfer under sub. (1) (c) 1., the burden
2of proof for establishing fair market value is on the grantee. Fair market value must
3be established through a credible methodology, which may include an appraisal
4performed by a licensed appraiser.
AB40,598,8
5(5) Inapplicable to purchaser in good faith. Subsection (2) does not apply if,
6after the transfer described in sub. (2), the real property was transferred by a
7conveyance to a purchaser in good faith and for a valuable consideration and the
8conveyance was recorded.
AB40,598,10
9(6) Applicability. This section applies to any of the following transfers of real
10property:
AB40,598,1211
(a) A transfer that is made on or after the effective date of this paragraph ....
12[LRB inserts date].
AB40,598,1513
(b) A transfer that was made before the effective date of this paragraph .... [LRB
14inserts date], if the grantor is receiving medical assistance on, or receives medical
15assistance after, the effective date of this paragraph .... [LRB inserts date].