Amendment ASA2-AB591

AB591-ASA2,58,21 (c) Distribution and administration. From the appropriation under s. 20.445 (3) (dz), the department shall distribute funds for job access loans to a Wisconsin works agency, which shall administer the loans in accordance with rules promulgated by the department.

AB591-ASA2,58,24 (d) Minor custodial parents. An individual who would be eligible for a job access loan under par. (a), except that the individual has not attained the age of 18, is eligible under this paragraph if the individual meets the following requirements:

AB591-ASA2,59,2 1. The individual is in an out-of-home placement or independent living arrangement supervised by an adult, as defined by the department.

AB591-ASA2,59,5 2. The individual has graduated from high school or has met the standards established by the secretary of education for the granting of a declaration of equivalency of high school graduation under s. 115.29 (4).

AB591-ASA2,59,7 3. The individual will be 18 years old within 2 months after applying for the job access loan.

AB591-ASA2, s. 89 Section 89. 49.148 of the statutes is created to read:

AB591-ASA2,59,11 49.148 Wisconsin works; benefits for participants in employment positions. (1) Benefit levels. A participant in a Wisconsin works employment position shall receive the following benefits:

AB591-ASA2,59,17 (a) Trial jobs. For a participant in a trial job, the amount established in the contract between the Wisconsin works agency and the trial job employer, but not less than minimum wage for every hour actually worked in the trial job, not to exceed 40 hours per week paid by the employer. Hours spent participating in education and training activities under s. 49.147 (3) (am) shall be included in determining the number of hours actually worked.

AB591-ASA2,59,24 (b) Community service jobs. 1. For a participant in a community service job, a monthly grant equal to 75% of the minimum wage computed for one month of full-time employment, paid by the Wisconsin works agency. For every hour that the participant misses work without good cause, the Wisconsin works agency shall reduce the grant amount by an amount equal to 75% of minimum wage computed for one hour. Good cause shall be determined by the financial and employment planner in accordance with rules promulgated by the department.

AB591-ASA2,60,5 2. A participant who is a custodial parent of a child who is 12 weeks old or less may receive a monthly grant under this paragraph equal to 75% of the minimum wage computed for a month of full-time employment. A Wisconsin works agency may not require a participant under this subdivision to participate in any employment activities.

AB591-ASA2,60,15 (c) Transitional placements. For a participant in a transitional placement, a grant equal to 70% of the minimum wage computed for one month of full-time employment, paid monthly by the Wisconsin works agency. For every hour that the participant fails to participate in any required activity without good cause, including any activity under s. 49.147 (5) (b) 1. a. to e., the Wisconsin works agency shall reduce the grant amount by an amount equal to 70% of minimum wage computed for one hour. No grant may be paid for a month in which the participant participates less than 25% of the required hours without good cause. Good cause shall be determined by the financial and employment planner in accordance with rules promulgated by the department.

AB591-ASA2,60,18 (2) Benefit review. Notwithstanding sub. (1), the department may promulgate rules establishing benefit levels for participants in Wisconsin works employment positions that are different from those specified under sub. (1).

AB591-ASA2,60,22 (3) Wisconsin works health plan. A participant in a Wisconsin works employment position shall participate in the Wisconsin works health plan under s. 49.153. The participant shall pay a premium in an amount and in the manner established under s. 49.153 (4) (d).

AB591-ASA2, s. 90 Section 90. 49.149 of the statutes is created to read:

AB591-ASA2,60,25 49.149 Wisconsin works; education and training. A Wisconsin works agency shall do all of the following:

AB591-ASA2,61,3 (1) Establish a referral relationship with other employment and training programs for participants to make use of varied education and training opportunities available through integrated job centers, as defined by the department by rule.

AB591-ASA2,61,5 (2) Provide participants in a Wisconsin works employment position with soft-skills and life-skills training, as defined by the department by rule.

AB591-ASA2,61,7 (3) Encourage employers to make training sites available on the business site for participants.

AB591-ASA2,61,10 (4) Work with the department of commerce to coordinate the provision of training to participants in conjunction with employers eligible for the development zone program under subch. VI of ch. 560.

AB591-ASA2, s. 91 Section 91. 49.151 of the statutes is created to read:

AB591-ASA2,61,20 49.151 Wisconsin works; sanctions. (1) Refusal to participate. A participant who refuses to participate 3 times in any Wisconsin works employment position component is ineligible to participate in that component. A participant whom the Wisconsin works agency has determined is ineligible under this section for a particular Wisconsin works employment position component may be eligible to participate in any other Wisconsin works employment position component in which the participant has not refused to participate 3 times. A participant refuses to participate in a Wisconsin works employment position component if the participant does any of the following:

AB591-ASA2,61,22 (a) Expresses verbally or in writing to a Wisconsin works agency that he or she refuses to participate.

AB591-ASA2,62,2 (b) Fails to appear for an interview with a prospective employer or, if the participant is in a Wisconsin works transitional placement, fails to appear for an assigned activity, including an activity under s. 49.147 (5) (b) 1. a. to e., without good cause, as determined by the Wisconsin works agency.

AB591-ASA2,62,4 (c) Voluntarily leaves appropriate employment or training without good cause, as determined by the Wisconsin works agency.

AB591-ASA2,62,5 (d) Loses employment as a result of being discharged for cause.

AB591-ASA2,62,8 (e) Demonstrates through other behavior or action, as specified by the department by rule, that he or she refuses to participate in a Wisconsin works employment position.

AB591-ASA2,62,16 (2) Intentional program violations. If a court finds or it is determined after an administrative hearing that an individual who is a member of a Wisconsin works group applying for or receiving benefits under ss. 49.141 to 49.161, for the purpose of establishing or maintaining eligibility for those benefits or for the purpose of increasing the value of those benefits, has intentionally violated, on 3 separate occasions, any provision in ss. 49.141 to 49.161 or any rule promulgated under those sections, the Wisconsin works agency may permanently deny benefits under ss. 49.141 to 49.161 to the individual.

AB591-ASA2, s. 92 Section 92. 49.152 of the statutes is created to read:

AB591-ASA2,62,25 49.152 Review of agency decisions. (1) Petition for review. Any individual whose application for Wisconsin works under s. 49.147 (1) to (5) is not acted upon by the Wisconsin works agency with reasonable promptness after the filing of the application, as defined by the department by rule, or is denied in whole or in part, whose benefit is modified or canceled, or who believes that the benefit was calculated incorrectly, may petition the Wisconsin works agency for a review of such action. Review is unavailable if the action by the Wisconsin works agency occurred more than 45 days prior to submission of the petition for review.

AB591-ASA2,63,6 (2) Review. (a) Upon a timely petition under sub. (1), the Wisconsin works agency shall give the applicant or participant reasonable notice and opportunity for a review. The Wisconsin works agency shall render its decision as soon as possible after the review and shall send a certified copy of its decision to the applicant or participant. The Wisconsin works agency shall deny a petition for a review or shall refuse to grant relief if the petitioner does any of the following:

AB591-ASA2,63,7 1. Withdraws the petition in writing.

AB591-ASA2,63,10 2. Abandons the petition. Abandonment occurs if the petitioner fails to appear in person or by representative at a scheduled review without good cause, as defined by the department by rule.

AB591-ASA2,63,12 (b) The department may review a decision of a Wisconsin works agency under par. (a) if any of the following occurs:

AB591-ASA2,63,14 1. Within 15 days of receiving the decision of the Wisconsin works agency the applicant or participant petitions the department for a review of that decision.

AB591-ASA2,63,16 2. The Wisconsin works agency requests the department to review the decision of the Wisconsin works agency.

AB591-ASA2, s. 93 Section 93. 49.153 of the statutes is created to read:

AB591-ASA2,63,18 49.153 Wisconsin works health plan. (1) Definitions. In this section:

AB591-ASA2,63,22 (a) "Employer-subsidized health care coverage" means health care coverage offered by the employer for which the employer pays at least 50% of the cost of coverage for the employe, including dependent coverage, or a higher percentage as determined by the department by rule.

AB591-ASA2,63,25 (b) "Unsubsidized employer-offered health care coverage" means health care coverage offered by the employer for which the employer pays less than 50% of the cost of coverage for the employe including dependent coverage.

AB591-ASA2,64,5 (2) Administration. The department of health and family services shall provide health services and benefits under sub. (4) to individuals who have been determined by a Wisconsin works agency to be eligible under sub. (3) for such services and benefits. The Wisconsin works agency shall provide the department of health and family services with a list of eligible individuals.

AB591-ASA2,64,17 (3) Eligibility. (a) General provisions. 1. A Wisconsin works agency shall determine eligibility for benefits and services under this section, in accordance with rules promulgated by the department of health and family services in consultation with the department of industry, labor and job development. An individual who applies for and receives benefits and services under this section is considered to have assigned to the state any rights to medical support or other payment of medical expenses from any other person, including rights to unpaid amounts accrued at the time of application for benefits and services under this section and any rights to support accruing during the time for which benefits and services under this section are provided. Eligibility for benefits and services under this section begins on the day on which the department of health and family services or the provider issues a health plan membership card.

AB591-ASA2,64,21 2. Except as provided in subd. 3. and pars. (em) and (f), an individual who is eligible for the health care coverage under this section remains eligible under this section for 12 consecutive months or until the individual has access to unsubsidized employer-offered health care coverage, whichever is later.

AB591-ASA2,64,24 3. A Wisconsin works agency shall periodically review an individual's eligibility. The individual remains eligible for benefits and services under this section until any of the following applies:

AB591-ASA2,65,3 a. The assets of the individual or, if the individual is a member of a Wisconsin works group, the assets of the Wisconsin works group of which the individual is a member, exceed the asset limits for at least 2 months.

AB591-ASA2,65,6 b. The income of the individual, or, if the individual is a member of a Wisconsin works group, the income of the Wisconsin works group of which the individual is a member, is expected to exceed the income limits for at least 2 consecutive months.

AB591-ASA2,65,9 (b) Wisconsin works groups. Except as provided in pars. (d) and (e), an individual who is a member of a Wisconsin works group is eligible for benefits and services under this section if all of the following conditions apply:

AB591-ASA2,65,11 1. The individual meets the criteria under s. 49.145 (2) (c), (f), (g), (i), (L) and (m) and resides in this state.

AB591-ASA2,65,12 2. The Wisconsin works group meets the asset limitation under s. 49.145 (3) (a).

AB591-ASA2,65,17 3. The gross income of the Wisconsin works group is at or below 165% of the poverty line, or, for a Wisconsin works group that is already receiving health care coverage under this section, the gross income is at or below 200% of the poverty line. In calculating the gross income of the Wisconsin works group, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA2,65,20 (c) Pregnant women. Except as provided in par. (e), a pregnant woman whose pregnancy has been medically verified and who has no dependent children is eligible for benefits and services under this section if she meets the following conditions:

AB591-ASA2,65,22 1. The woman meets the criteria under s. 49.145 (2) (c), (g), (i), (L) and (m) and resides in this state.

AB591-ASA2,65,23 2. The woman meets the asset limitation under s. 49.145 (3) (a).

AB591-ASA2,66,3 3. The gross income of the woman is at or below 165% of the poverty line. In calculating gross income under this subdivision, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. and 3.

AB591-ASA2,66,7 (d) Minor parents. An individual who is a custodial parent and who is under the age of 18, and any dependent children with respect to whom the individual is a custodial parent, are eligible for benefits and services under this section only if the individual meets any of the following conditions:

AB591-ASA2,66,12 1. The individual resides with his or her custodial parent and the gross income of the Wisconsin works group of which the individual is a member does not exceed 165% of the poverty line. In calculating the gross income of the Wisconsin works group, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA2,66,16 2. The individual is in an independent living arrangement supervised by an adult and the gross income of the individual does not exceed 165% of the poverty line. In calculating the gross income of the individual, the Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA2,66,21 (e) Access to employer-subsidized health care coverage. An individual is eligible for health care coverage under this section only if the individual has not had access to employer-subsidized health care coverage for the 18 months immediately preceding application for health care coverage under this section. This paragraph does not apply to any of the following:

AB591-ASA2,67,2 1. An individual who has lost access to employer-subsidized health care coverage within the 18 months immediately preceding application for health care coverage under this subsection because of the termination by the employer of the employment relationship for a reason other than misconduct on the part of the employe and who has not had access to employer-subsidized health care coverage since the termination.

AB591-ASA2,67,6 2. An individual who has lost access to employer-subsidized health care coverage within the 18 months immediately preceding application for health care coverage under this subsection because of the termination by the employe of the employment relationship for just cause.

AB591-ASA2,67,8 3. A dependent child who has lost eligibility for employer-subsidized health care coverage for any reason.

AB591-ASA2,67,9 4. A participant in a Wisconsin works employment position.

AB591-ASA2,67,16 (em) Continuous coverage requirement. An individual who withdraws from health care coverage under this section while the individual is still eligible for health care coverage under this section is ineligible for health care coverage under this section for a period of 6 months following the withdrawal. Failure to pay in a timely manner, as defined by the department of industry, labor and job development by rule, the premium established under sub. (4) (d) constitutes withdrawal for purposes of this paragraph.

AB591-ASA2,67,19 (f) Ineligibility. No individual is eligible for health care coverage under this section in a month in which that individual is eligible for employer-subsidized health care coverage.

AB591-ASA2,68,2 (4) Administration and benefits. (a) Health maintenance organization contract. The department of health and family services shall contract with one or more health maintenance organizations or other health care providers to provide health care services under this subsection. Each contract for the provision of health care services entered into by the department of health and family services under this subsection shall be awarded on the basis of a competitive process in accordance with procedures established by the department of health and family services.

AB591-ASA2,68,5 (b) Health care services provided. 1. Except as provided in subd. 2., the Wisconsin works health plan shall cover the care and services specified under s. 49.46 (2).

AB591-ASA2,68,8 2. Except as otherwise required under a federal waiver received under 42 USC 1315, the Wisconsin works health plan shall not cover the following goods and services:

AB591-ASA2,68,10 a. Home care, as defined in s. 632.895 (1) (b), in excess of the minimum required under s. 632.895 (2).

AB591-ASA2,68,11 b. Skilled nursing care in excess of the minimum required under s. 632.895 (3).

AB591-ASA2,68,12 c. Over-the-counter drugs.

AB591-ASA2,68,14 d. Treatment of alcoholism or other drug abuse problems in excess of the minimum coverage required under s. 632.89 (2).

AB591-ASA2,68,15 e. Services described under 42 USC 1396d (r) (5).

AB591-ASA2,68,20 (c) Distribution of payments. From the appropriations under s. 20.435 (1) (b) and (o), the department of health and family services shall make payments to a health maintenance organization or other health care provider with which the department of health and family services has contracted under par. (a) in accordance with a payment schedule established by contract.

AB591-ASA2,69,8 (d) Premiums. Except as otherwise provided in this paragraph, an individual who receives the Wisconsin works health plan shall pay to the Wisconsin works agency a monthly premium in accordance with criteria based on income and family size and established by the department of health and family services in consultation with the department of industry, labor and job development. The department of industry, labor and job development or the Wisconsin works agency shall deduct the established premium from a trial job participant's wages. The Wisconsin works agency shall deduct the established premium from the monthly grant payment of a participant in a community service job and from the monthly grant of a participant in a transitional placement. The Wisconsin works agency shall remit to the department of industry, labor and job development in the manner prescribed by the department of industry, labor and job development all premium payments that the Wisconsin works agency receives under this paragraph.

AB591-ASA2,69,10 (5) Prohibited conduct. No person, in connection with the health care coverage under this section, may:

AB591-ASA2,69,12 (a) Knowingly and wilfully make or cause to be made any false statement or representation of a material fact in any application for any benefit or payment.

AB591-ASA2,69,17 (b) Having knowledge of the occurrence of any event affecting the initial or continued eligibility for a benefit or payment under this section, conceal or fail to disclose that event with an intent fraudulently to secure a benefit or payment under this section either in a greater amount or quantity than is due or when no such benefit or payment is authorized.

AB591-ASA2,69,21 (6) Penalties. (a) A person who is convicted of violating sub. (5) in connection with the furnishing by that person of items or services for which payment is or may be made under this section may be fined not more than $25,000 or imprisoned for not more than 5 years or both.

AB591-ASA2,69,24 (b) A person, other than a person under par. (a), who is convicted of violating sub. (5) may be fined not more than $10,000 or imprisoned for not more than one year in the county jail or both.

AB591-ASA2,70,10 (7) Damages. If any person is convicted under sub. (5), the state shall have a cause of action for relief against such person in an amount 3 times the amount of actual damages sustained as a result of any excess payments made in connection with the offense for which the conviction was obtained. Proof by the state of a conviction under sub. (5) in a civil action shall be conclusive regarding the state's right to damages and the only issue in controversy shall be the amount, if any, of the actual damages sustained. Actual damages shall consist of the total amount of excess payments, any part of which is paid by state funds. In any such civil action the state may elect to file a motion in expedition of the action. Upon receipt of the motion, the presiding judge shall expedite the action.

AB591-ASA2,70,18 (8) Kickbacks, bribes and rebates. (a) Any person who solicits or receives any remuneration in cash or in-kind, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this section, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this section, may be fined not more than $25,000 or imprisoned for not more than 5 years or both.

AB591-ASA2,70,25 (b) Whoever offers or pays any remuneration in cash or in-kind to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this section, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under this section, may be fined not more than $25,000 or imprisoned for not more than 5 years or both.

AB591-ASA2,71,1 (c) This subsection does not apply to any of the following:

AB591-ASA2,71,5 1. A discount or other reduction in price obtained by a provider of services or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under this section.

AB591-ASA2,71,8 2. Any amount paid by an employer to an employe who has a bona fide employment relationship with such employer for employment in the provision of covered items or services.

AB591-ASA2,71,13 (9) Prohibited charges. (a) No provider may knowingly impose upon a recipient charges in addition to payments received for services under this section or knowingly impose direct charges upon a recipient in lieu of obtaining payment under this section unless benefits or services are not provided under sub. (4) and the recipient is advised of this fact prior to receiving the service.

AB591-ASA2,71,15 (b) A person who violates this subsection may be fined not more than $25,000 or imprisoned not more than 5 years or both.

AB591-ASA2, s. 94 Section 94. 49.155 of the statutes is created to read:

AB591-ASA2,71,18 49.155 Wisconsin works; child care subsidy. (1) Definitions. In this section:

AB591-ASA2,71,20 (a) "Level I day care provider" means a day care provider certified under s. 48.651 (1) (a).