DHS 109.13(4)(c)(c) Meeting a spend-down. A SeniorCare spend-down shall be met and the person’s subsequent prescription purchases shall count toward meeting the deductible under sub. (3) (c) and (d) when the member or members of the fiscal test group, under the following conditions, have spent the amount of the spend-down in purchasing prescription drugs at the retail price: DHS 109.13(4)(c)1.1. When only one person is an eligible member of the SeniorCare fiscal test group in a calendar month, only purchases of prescription drugs prescribed for that person may be counted toward meeting the spend-down in that calendar month. DHS 109.13(4)(c)2.2. When 2 spouses are both eligible members of the same SeniorCare fiscal test group in a calendar month, purchases of prescription drugs prescribed for either person may be counted toward meeting the spend-down in that month. DHS 109.13(4)(c)3.3. Only prescription drugs dispensed with a date of service during the benefit period described in s. DHS 109.14 may count toward meeting the spend-down. DHS 109.13(4)(c)4.4. If a person has other available coverage from any third party insurer legally liable to contribute in whole or in part to the cost of prescription drugs provided to a SeniorCare participant, including coverage by a county relief program under ch. 49, Stats., only costs for prescription drugs for the person that are not paid under the person’s other available coverage may be counted toward meeting the spend-down. DHS 109.13(4)(c)6.6. Only claims submitted by a SeniorCare provider may be considered in determining whether the participant has met the spend-down. DHS 109.13(4)(d)(d) Carryover of spend-down. When the cost of a prescription applied towards meeting the spend-down under par. (c) exceeds the remaining spend-down amount, the excess prescription costs shall be applied towards meeting the deductible under sub. (3) (d). The program payment rate may not apply to that portion of the prescription counted for the deductible. DHS 109.13(5)(5) Review of benefits. After the department learns of an error or omission in the information on the application form or other information provided by the recipient used to determine the benefits and services, the department shall promptly redetermine which SeniorCare benefits and services a participant may receive under this section. The benefits and services may only be changed if the error or omission is of factual information available to the recipient at the time he or she filed the application. DHS 109.13(6)(6) Correction of benefits. The department shall correct in the following ways the benefits and services received in error under this section: DHS 109.13(6)(a)(a) For underpayment errors caused by the department, benefits will be corrected back to the beginning of the benefit period. DHS 109.13(6)(b)(b) For underpayment errors caused by the recipient when the recipient reports the error within 45 days after the date of the initial eligibility notice, benefits will be corrected back to the beginning of the benefit period. DHS 109.13(6)(c)(c) For underpayment errors caused by the recipient when the recipient reports the error more than 45 days after the date of the initial eligibility notice, benefits will be corrected back to the first of the month in which the error was reported. DHS 109.13(6)(d)(d) For overpayment errors, benefits will be corrected beginning the first of the month following the issuance by the department of a timely notice of decision under s. DHS 109.11 (5) (b). Recovery of benefits issued in error shall be in accordance with s. DHS 109.62. DHS 109.13 HistoryHistory: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03; CR 04-050: am. (3) (c) and (d) (intro) and 2. Register October 2004 No. 586, eff. 11-1-04; CR 22-046: cr. (2) (bm), am. (2) (c) (title), cr. (2) (d), (e) Register June 2023 No. 810, eff. 7-1-23; correction in (2) (d) (intro.), 1. made under s. 35.17, Stats., Register June 2023 No. 810. DHS 109.14(2)(2) Eligibility begin date. Except as provided in sub. (3), a person’s SeniorCare eligibility begins on the first day of the month after the date the department receives a complete application and the person meets all of the eligibility requirements. DHS 109.14(3)(3) Exception for medicaid recipients. If the department receives a complete application and determines that the person meets all other eligibility requirements prior to the date medical assistance eligibility ends, the person’s SeniorCare eligibility begins the day after the person’s medical assistance eligibility ends. DHS 109.14(4)(a)(a) Except as provided in sub. (5), the department shall terminate the SeniorCare benefit period of a SeniorCare participant who no longer meets the eligibility conditions in s. DHS 109.11, or who requests a withdrawal from the program under s. DHS 109.11 (5) (d). DHS 109.14(4)(b)(b) The department shall restore the SeniorCare benefit period for a person terminated from SeniorCare without a break in coverage if, within one calendar month of the effective termination date, he or she does both of the following: DHS 109.14(4)(c)(c) The department shall reinstate the SeniorCare benefit period for a person who has requested a withdrawal from the program under s. DHS 109.11 (5) (d) if within 30 calendar days of the effective date of the withdrawal both of the following occur: DHS 109.14(4)(c)1.1. The department receives the person’s request to have SeniorCare benefits restored. DHS 109.14(5)(5) Continuation of benefit period for medical assistance recipients. The department may not terminate the benefit period of SeniorCare participants who lose eligibility solely due to receipt of medical assistance benefits. A SeniorCare participant is not eligible for any SeniorCare benefits or services under s. DHS 109.13 for any calendar months in which he or she receives medical assistance benefits. DHS 109.14(6)(6) Request for new benefit period. A SeniorCare participant may request a new benefit period for SeniorCare at any time. Upon receipt of a new application, the department shall determine the participant’s eligibility for a new benefit period in the following manner unless the application is from the spouse of a participant and meets the conditions under s. DHS 109.15: