SB40-CSA1,733,2522 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:

11. The repayment term is actuarially sound.

SB40-CSA1,734,32 2. The payments are to be made in equal amounts during the term of the loan,
3with no deferral and no balloon payment.

SB40-CSA1,734,44 3. Cancellation of the balance upon the death of the lender is prohibited.

SB40-CSA1,734,85 (b) The value of a promissory note, loan, or mortgage that does not satisfy the
6requirements under par. (a) 1. to 3. is the outstanding balance due on the date that
7the individual applies for medical assistance for nursing facility services or other
8long-term care services described in sub. (2).

SB40-CSA1,734,1310 49.453 (4m) Purchase of life estate. For purposes of sub. (2), the purchase
11by an individual or his or her spouse of a life estate in another individual's home after
12February 8, 2006, is a transfer of assets for less than fair market value unless the
13purchaser resides in the home for at least one year after the date of the purchase.

SB40-CSA1,734,1716 49.453 (8) (a) (intro.) Subsections (2) and (3) do not apply to transfers of assets
17if the any of the following applies:

SB40-CSA1,734,18 181. The assets are exempt under 42 USC 1396p (c) (2) or if the (A), (B), or (C).

SB40-CSA1,734,21 192. The department determines under the process under par. (b) that application
20of this section would work an undue hardship. The department shall promulgate
21rules concerning the transfer of assets exempt under 42 USC 1396p (c) (2).

SB40-CSA1,734,2423 49.453 (8) (b) The department shall establish a hardship waiver process that
24includes all of the following:

SB40-CSA1,735,4

11. The department determines that undue hardship exists if the application of
2subs. (2) and (3) would deprive the individual of medical care to the extent that the
3individual's health or life would be endangered, or would deprive the individual of
4food, clothing, shelter, or other necessities of life.

SB40-CSA1,735,85 2. A facility in which an institutionalized individual who has transferred assets
6resides is permitted to file an application for undue hardship on behalf of the
7individual with the consent of the individual or the individual's authorized
8representative.

SB40-CSA1,735,129 3. The department may, during the pendency of an undue hardship
10determination, pay the full payment rate under s. 49.45 (6m) for nursing facility
11services for up to 30 days for the individual who transferred assets, to hold a bed in
12the facility in which the individual resides.

SB40-CSA1,735,1614 49.46 (1) (a) 5. Any child in an adoption assistance, foster care, kinship care,
15long-term kinship care, treatment foster care, or subsidized guardianship
16placement under ch. 48 or 938, as determined by the department.

SB40-CSA1,735,2318 49.46 (1) (a) 14m. Any person who would meet the financial and other eligibility
19requirements for home or community-based services under the family care benefit
20but for the fact that the person engages in substantial gainful activity under 42 USC
211382c (a) (3), if a waiver under s. 46.281 (1) (c) (1d) is in effect or federal law permits
22federal financial participation for medical assistance coverage of the person and if
23funding is available for the person under the family care benefit.

SB40-CSA1,736,3

149.46 (2) (b) (intro.) Except as provided in par. pars. (be) and (dc), the
2department shall audit and pay allowable charges to certified providers for medical
3assistance on behalf of recipients for the following services:

SB40-CSA1,736,95 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
6(11), 46.275, 46.277, 46.278, or 46.2785, under the family care benefit if a waiver is
7in effect under s. 46.281 (1) (c) (1d), or under a waiver requested under 2001
8Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c) the
9disabled children's long-term support program, as defined in s. 46.011 (1g).

SB40-CSA1,736,1611 49.46 (2) (dc) For an individual who is eligible for medical assistance and who
12is eligible for coverage under Part D of Medicare under 42 USC 1395w-101 et seq.,
13benefits under par. (b) 6. h. do not include payment for any Part D drug, as defined
14in 42 CFR 423.100, regardless of whether the individual is enrolled in Part D of
15Medicare or whether, if the individual is enrolled, his or her Part D plan, as defined
16in 42 CFR 423.4, covers the Part D drug.

SB40-CSA1,737,618 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage
19under part A of medicare, entitled to coverage under part B of medicare and who does
20not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465 or,
2149.47 (4), or 49.471 but meets the limitations on income and resources under par. (d),
22medical assistance shall pay the deductible and coinsurance portions of medicare
23services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to
241395zz, including those medicare services that are not included in the approved state
25plan for services under 42 USC 1396; the monthly premiums payable under 42 USC

11395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
2enrollment penalty, if applicable, for premiums under part A of medicare. Payment
3of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w,
4other than payment of coinsurance for outpatient hospital services, may not exceed
5the allowable charge for the service under medical assistance minus the medicare
6payment.