49.45(30m)(am)1.1. The department shall provide the portion of the payment that is not provided by the federal government for any of the services specified in par.
(a) 1. to
3. that are provided to an individual with developmental disability who is eligible for medical assistance, as determined under the contract under s.
46.279 (4m).
49.45(30m)(am)2.
2. For individuals receiving the family care benefit under s.
46.286, the care management organization that manages the family care benefit for the recipient shall pay the portion of the payment that is not covered by the federal government for services that are described under par.
(a) 1. and are covered services under the family care benefit; the department shall pay the remainder of the portion of the payment that is not covered by the federal government.
49.45(30m)(b)
(b) No payment under this section may be made for services specified under par.
(a) or
(am) unless the individual who receives the services is provided protective placement under s.
55.06 (9) (a), 2003 stats., or s.
55.12, is provided emergency protective services under s.
55.05 (4), 2003 stats., or s.
55.13, or is provided an emergency protective placement under s.
55.06 (11) (a), 2003 stats., or s.
55.135 or a temporary protective placement under s.
55.06 (11) (c), 2003 stats., or s.
55.135 (5) or
55.055 (5).
49.45(30m)(c)
(c) No payment under this section may be made for services specified under par.
(a) 2. or
3. that are provided to an individual who was placed in or admitted to an intermediate facility, as defined in s.
46.279 (1) (b), or nursing facility, as defined in s.
46.279 (1) (c), unless one of the following applies:
49.45(30m)(c)1.
1. Any placement or admission that is made after April 30, 2005, complied with the requirements of s.
46.279.
49.45(30r)
(30r) Services in a mental health institute. A county shall provide the portion of payment that is not provided by the federal government for services under s.
49.46 (2) (b) 6. e. in a mental health institute under s.
51.05.
49.45(30x)(a)
(a)
Provider reimbursement. Beginning January 1, 2016, services under s.
49.46 (2) (b) 12t. provided to an individual are reimbursable under the Medical Assistance program if an amendment to the state medical assistance plan approved by the federal department of health and human services permits reimbursement under s.
49.46 (2) (b) 12t. 49.45(30x)(b)
(b)
Plan amendment. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of par.
(a). The department may not pay reimbursement under par.
(a) unless the amendment to the state plan allowing reimbursement under s.
49.46 (2) (b) 12t. is approved and in effect.
49.45(31)
(31) Long-Term Care Partnership Program. 49.45(31)(a)(a) The department shall submit to the federal department of health and human services, not later than 3 months after October 27, 2007, an amendment to the state medical assistance plan that establishes in this state a Long-Term Care Partnership Program, as described in this subsection, and shall implement the program if the amendment to the state plan is approved. Under the program, the department shall exclude an amount equal to the amount of benefits that an individual receives under a qualifying long-term care insurance policy, as described in par.
(b), when determining any of the following:
49.45(31)(a)1.
1. The individual's resources for purposes of determining the individual's eligibility for medical assistance.
49.45(31)(a)2.
2. The amount to be recovered from the individual's estate if the individual receives medical assistance.
49.45(31)(b)
(b) To be eligible for the program, an individual must have been a resident of this state when the long-term care insurance policy was issued, and the policy must satisfy all of the following criteria:
49.45(31)(b)1.
1. The policy was not issued before the date specified in the amendment to the state plan, which may not be before the first day of the calendar quarter in which the amendment is submitted to the federal department of health and human services.
49.45(31)(b)3.
3. The policy meets the long-term care insurance model regulations and the requirements of the long-term care insurance model act promulgated by the National Association of Insurance Commissioners that are specified in
42 USC 1396p (b) (5).
49.45(31)(b)5.
5. The commissioner of insurance certifies to the department that the policy meets the criteria under subds.
2. to
4. 49.45(31)(c)1.1. The department and the office of the commissioner of insurance shall approve a training program for individuals who sell long-term care insurance policies in the state to ensure that those individuals understand the relation of long-term care insurance to the Medical Assistance program and are able to explain to consumers the protections offered by long-term care insurance and how this type of insurance relates to private and public financing of long-term care.
49.45(31)(c)2.
2. The training program approved under this paragraph shall include initial training that is not less than 8 hours long and ongoing training sessions that are not less than 4 hours long per session. Individuals who sell long-term care insurance policies shall be required to attend an ongoing training session every 24 months after the initial training. The commissioner may approve the initial and ongoing training sessions for continuing education requirements under s.
628.04 (3).
49.45(31)(c)3.
3. The training under this paragraph shall cover at a minimum long-term care insurance, long-term care services, qualified partnerships, and the relationship between qualified partnerships and other public and private coverage of long-term care costs.
49.45(31)(d)
(d) An insurer that issues a long-term care insurance policy described in par.
(b) shall be required to submit reports to the secretary of the federal department of health and human services, in accordance with regulations developed by the secretary, that include notice of when benefits are paid under the policy, the amount of the benefits, notice of the termination of the policy, and any other information required by the secretary.
49.45(31)(e)1.1. Notwithstanding par.
(b) (intro.), the department, when making a determination under par.
(a) 1. or
2. with respect to an individual, shall disregard an amount equal to the insurance benefit payments that are made to or on behalf of the individual under a qualified long-term care insurance policy under
26 USC 7702B (b) that was purchased in a state that had a state plan amendment that provided for a qualified state long-term care partnership, as defined in
42 USC 1396p (b) (1) (C) (iii), at the time of the purchase of the policy.