AB40: Bill Text

AB40,590,14 49.475 (title) Information about assistance program beneficiaries; electronic submission of claims.

AB40,1171 Section 1171. 49.475 (2) (except 49.475 (2) (title)) of the statutes is renumbered 49.475 (2) (ac), and 49.475 (2) (ac) 1. b. and 4. (intro.), as renumbered, are amended to read:

AB40,590,20 49.475 (2) (ac) 1. b. If subd. 1. a. applies, the nature and period of time of any coverage, benefit, or service provided, including the name, address, and identifying number of any applicable coverage plan.

AB40,590,25 4. (intro.) If all of the following apply, agree not to deny a claim submitted by the department under par. (b) subd. 2. solely because of the claim's submission date, the type or format of the claim form, or failure by a recipient to present proper documentation at the time of delivery of the service, benefit, or item that is the basis of the claim:

AB40,1172 Section 1172. 49.475 (2) (bc) of the statutes is created to read:

AB40,591,6 49.475 (2) (bc) A 3rd party shall accept the submission of claims from the department under par. (ac) 2. in electronic form and shall timely pay the claims in the manner provided in s. 628.46 (1) and (2). For purposes of timely payment of claims under this paragraph, "written notice" under s. 628.46 (1) includes receipt of a claim in electronic form.

AB40,1173 Section 1173. 49.475 (2m) (a) of the statutes is amended to read:

AB40,591,11 49.475 (2m) (a) The information that the department may request under this section is limited to the information specified in sub. (2) (a) (ac) 1. and does not include an employer's name unless that information is necessary for the department or a provider to obtain 3rd-party payment for an item or service.

AB40,1174 Section 1174. 49.475 (2m) (b) of the statutes is amended to read:

AB40,591,17 49.475 (2m) (b) If information under sub. (2) (a) (ac) 1. may be available from more than one source that includes an employer operating a self-insured plan, the department shall seek the information first from a 3rd-party administrator or other entity identified in sub. (1) (f) 7. or pharmacy benefits manager before seeking the information from the employer.

AB40,1175 Section 1175. 49.475 (3) (intro.) of the statutes is amended to read:

AB40,591,21 49.475 (3) Written agreement. (intro.) Upon requesting a 3rd party to provide the information under sub. (2) (a) (ac) 1., the department and the 3rd party shall enter into a written agreement that satisfies all of the following:

AB40,1176 Section 1176. 49.475 (4) (a) of the statutes is amended to read:

AB40,592,2 49.475 (4) (a) A 3rd party shall provide the information requested under sub. (2) (a) (ac) 1. within 180 days after receiving the department's request if it is the first time that the department has requested the 3rd party to disclose information under this section.

AB40,1177 Section 1177. 49.475 (4) (b) of the statutes is amended to read:

AB40,592,7 49.475 (4) (b) A 3rd party shall provide the information requested under sub. (2) (a) (ac) 1. within 30 days after receiving the department's request if the department has previously requested the 3rd party to disclose information under this section.

AB40,1178 Section 1178. 49.475 (5) of the statutes is amended to read:

AB40,592,13 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435 (4) (bm) and (pa), the department shall reimburse a 3rd party that provides information under sub. (2) (a) (ac) 1. for the 3rd party's reasonable costs incurred in providing the requested information, including its reasonable costs, if any, to develop and operate automated systems specifically for the disclosure of the information.

AB40,1179 Section 1179. 49.496 (1) (a) of the statutes is renumbered 49.496 (1) (ah).

AB40,1180 Section 1180. 49.496 (1) (af) of the statutes is created to read:

AB40,592,17 49.496 (1) (af) "Decedent" means a deceased recipient or a deceased nonrecipient surviving spouse, whichever is applicable.

AB40,1181 Section 1181. 49.496 (1) (bk) of the statutes is created to read:

AB40,592,19 49.496 (1) (bk) "Long-term care program" means any of the following:

AB40,592,20 1. The family care program providing the benefit under s. 46.286.

AB40,592,24 2. The self-directed services option that operates under a waiver from the secretary of the federal department of health and human services under 42 USC 1396n (c) in which an enrolled individual selects his or her own services and service providers.

AB40,593,3 3. The family care partnership program that is an integrated health and long-term care program operated under an amendment to the state medical assistance plan under 42 USC 1396u-2 and a waiver under 42 USC 1396n (c).

AB40,593,4 4. The program for all-inclusive care for the elderly under 42 USC 1396u-4.

AB40,593,9 5. Any program that provides long-term care services and is operated by the department under an amendment to the state medical assistance plan under 42 USC 1396n (i) or 42 USC 1396u-2; a waiver of medical assistance laws under 42 USC 1396n (c), 42 USC 1396n (b) and (c), or 42 USC 1396u; or a demonstration project under 42 USC 1315 or 42 USC 1396n (c).

AB40,1182 Section 1182. 49.496 (1) (bw) of the statutes is created to read:

AB40,593,13 49.496 (1) (bw) "Nonrecipient surviving spouse" means any person who was married to a recipient while the recipient was receiving services for which the cost may be recovered under sub. (3) (a) and who survived the recipient.

AB40,1183 Section 1183. 49.496 (1) (cm) of the statutes is created to read:

AB40,593,19 49.496 (1) (cm) 1. "Property of a decedent" means all real and personal property to which the recipient held any legal title or in which the recipient had any legal interest immediately before death, to the extent of that title or interest, including assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in common, survivorship, life estate, living trust, or any other arrangement.

AB40,593,25 2. Notwithstanding subd. 1., "property of a decedent" includes all real and personal property in which the nonrecipient surviving spouse had an ownership interest at the recipient's death and in which the recipient had a marital property interest with that nonrecipient surviving spouse at any time within 5 years before the recipient applied for medical assistance or during the time that the recipient was eligible for medical assistance.

AB40,1184 Section 1184. 49.496 (3) (a) (intro.) of the statutes is amended to read:

AB40,594,6 49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file a claim against the estate of a recipient, and against the estate of a nonrecipient surviving spouse, for all of the following, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), unless already recovered by the department under this section:

AB40,1185 Section 1185. 49.496 (3) (a) 2. a. of the statutes is amended to read:

AB40,594,10 49.496 (3) (a) 2. a. Home-based or community-based services under 42 USC 1396d (a) (7) and (8) and under any waiver granted under 42 USC 1396n (c) (4) (B) or 42 USC 1396u.

AB40,1186 Section 1186. 49.496 (3) (a) 2. am. of the statutes is created to read:

AB40,594,13 49.496 (3) (a) 2. am. All services provided to an individual while the individual is participating in a long-term care program.

AB40,1187 Section 1187. 49.496 (3) (a) 2. b. of the statutes is repealed.

AB40,1188 Section 1188. 49.496 (3) (a) 2. c. of the statutes is repealed.

AB40,1189 Section 1189. 49.496 (3) (ad) of the statutes is created to read:

AB40,594,21 49.496 (3) (ad) The amount the department may claim against an estate of a recipient, or an estate of a nonrecipient surviving spouse, for services that are described under par. (a) 2. am. and that are provided by a managed long-term care program funded by capitated payments is equal to the amount of the capitated payment for the recipient.

AB40,1190 Section 1190. 49.496 (3) (aj) of the statutes is created to read:

AB40,594,25 49.496 (3) (aj) 1. Property that is subject to the department's claim under par. (a) in the estate of a recipient or in the estate of a nonrecipient surviving spouse is all property of a decedent that is included in the estate.

AB40,595,5 2. There is a presumption, which may be rebutted by clear and convincing evidence, that all property in the estate of a nonrecipient surviving spouse was marital property held with the recipient and that 100 percent of the property in the estate of the nonrecipient surviving spouse is subject to the department's claim under par. (a).

AB40,1191 Section 1191. 49.496 (3) (am) (intro.) of the statutes is amended to read:

AB40,595,10 49.496 (3) (am) (intro.) The court shall reduce the amount of a claim under par. (a) by up to the amount specified in s. 861.33 (2) if necessary to allow the recipient's decedent's heirs or the beneficiaries of the recipient's decedent's will to retain the following personal property:

AB40,1192 Section 1192. 49.496 (3) (c) 1. of the statutes is amended to read:

AB40,595,18 49.496 (3) (c) 1. If the department's claim is not allowable because of par. (b) and the estate includes an interest in any real property, including a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the home real property subject to a lien in favor of the department for the amount described in par. (a). The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in s. 863.29, 867.01 (3) (h), or 867.02 (2) (h).

AB40,1193 Section 1193. 49.496 (3) (c) 2. of the statutes is amended to read:

AB40,596,2 49.496 (3) (c) 2. If the department's claim is not allowable because of par. (b), the estate includes an interest in any real property, including a home, and the personal representative closes the estate by sworn statement under s. 865.16, the personal representative shall stipulate in the statement that the home real property is assigned subject to a lien in favor of the department for the amount described in par. (a). The personal representative shall record the statement in the same manner as described in s. 863.29, as if the statement were a final judgment.

AB40,1194 Section 1194. 49.496 (3) (d) (intro.) of the statutes is amended to read:

AB40,596,5 49.496 (3) (d) (intro.) The department may not enforce the a lien under par. (c) as long as any of the following survive the decedent:

AB40,1195 Section 1195. 49.496 (3) (dm) of the statutes is created to read:

AB40,596,8 49.496 (3) (dm) All of the following apply to a lien under par. (c) that the department may not enforce because of par. (d):

AB40,596,11 1. If the decedent's surviving spouse or child who is under age 21 or disabled refinances a mortgage on the real property, the lien is subordinate to the new encumbrance.

AB40,596,13 2. The department shall release the lien in the circumstances described in s. 49.848 (5) (f).

AB40,1196 Section 1196. 49.496 (6m) of the statutes is amended to read:

AB40,596,21 49.496 (6m) Waiver due to hardship. The department shall promulgate rules establishing standards for determining whether the application of this section would work an undue hardship in individual cases. If the department determines that the application of this section would work an undue hardship in a particular case, the department shall waive application of this section in that case. This subsection does not apply with respect to claims against the estates of nonrecipient surviving spouses.

AB40,1197 Section 1197. 49.4962 of the statutes is created to read:

AB40,596,24 49.4962 Voiding certain transfers of real property. (1) Definitions. In this section:

AB40,596,25 (a) "Conveyance" has the meaning given in s. 706.01 (4).

AB40,597,2 (b) "Fair market value" means the price that a willing buyer would pay a willing seller for the purchase of real property.

AB40,597,3 (c) "Fraudulent transfer" means any of the following:

AB40,597,4 1. A transfer of title to real property for less than fair market value.

AB40,597,7 2. A transfer of title to real property by a conveyance that is not recorded during the lifetime of the grantor in the office of the register of deeds of the county in which the real property is located.

AB40,597,8 (d) "Grantee" has the meaning given in s. 706.01 (6).

AB40,597,9 (e) "Grantor" has the meaning given in s. 706.01 (6).

AB40,597,11 (2) Voidable transfers. (a) A transfer of real property to which all of the following apply is voidable by the department:

AB40,597,14 1. The transfer was made by a grantor who was receiving or who received medical assistance, or by someone on his or her behalf, during the time that the grantor was eligible for medical assistance.

AB40,597,16 2. The department was not notified and was unaware that the transfer was made.

AB40,597,18 3. The transfer was made to hinder, delay, or defraud the department from recovering medical assistance benefits that were paid on behalf of the grantor.

AB40,597,21 (b) The department may commence an action in circuit court against the grantee to void the transfer. If the court voids the transfer, the title to the real property reverts to the grantor or his or her estate.

AB40,597,25 (3) Presumption. There is a presumption, which may be rebutted by clear and convincing evidence, that a transfer described in sub. (2) (a) 1. that is a fraudulent transfer was made to hinder, delay, or defraud the department from recovering medical assistance benefits that were paid on behalf of the grantor.

AB40,598,4 (4) Burden of proof. With respect to a transfer under sub. (1) (c) 1., the burden of proof for establishing fair market value is on the grantee. Fair market value must be established through a credible methodology, which may include an appraisal performed by a licensed appraiser.

AB40,598,8 (5) Inapplicable to purchaser in good faith. Subsection (2) does not apply if, after the transfer described in sub. (2), the real property was transferred by a conveyance to a purchaser in good faith and for a valuable consideration and the conveyance was recorded.

AB40,598,10 (6) Applicability. This section applies to any of the following transfers of real property:

AB40,598,12 (a) A transfer that is made on or after the effective date of this paragraph .... [LRB inserts date].

AB40,598,15 (b) A transfer that was made before the effective date of this paragraph .... [LRB inserts date], if the grantor is receiving medical assistance on, or receives medical assistance after, the effective date of this paragraph .... [LRB inserts date].

AB40,1198 Section 1198. 49.67 of the statutes is repealed.

AB40,1199 Section 1199. 49.682 (1) (am) of the statutes is created to read:

AB40,598,19 49.682 (1) (am) "Decedent" means a deceased client or a deceased nonclient surviving spouse, whichever is applicable.

AB40,1200 Section 1200. 49.682 (1) (d) of the statutes is created to read:

AB40,598,23 49.682 (1) (d) "Nonclient surviving spouse" means any person who was married to a client while the client was receiving services for which the cost may be recovered under sub. (2) (a) and who survived the client.

AB40,1201 Section 1201. 49.682 (1) (e) of the statutes is created to read:

AB40,599,5 49.682 (1) (e) 1. "Property of a decedent" means all real and personal property to which the client held any legal title or in which the client had any legal interest immediately before death, to the extent of that title or interest, including assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in common, survivorship, life estate, living trust, or any other arrangement.

AB40,599,11 2. Notwithstanding subd. 1., "property of a decedent" includes all real and personal property in which the nonclient surviving spouse had an ownership interest at the client's death and in which the client had a marital property interest with that nonclient surviving spouse at any time within 5 years before the client applied for aid under s. 49.68, 49.683, or 49.685 or during the time that the recipient was eligible for aid under s. 49.68, 49.683, or 49.685.

AB40,1202 Section 1202. 49.682 (2) (a) of the statutes is amended to read: