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18252.16 (title)
Continuation coverage Health insurance premium
19subsidies.
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252.16
(1) (ar) "Dependent" has the meaning given in s. 635.02 (3c).
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252.16
(1) (b) "Group health plan" means an insurance policy or a partially or
25wholly uninsured plan or program, that provides hospital, medical or other health
1coverage to members of a group
, whether or not dependents of the members are also
2covered. The term includes a medicare supplement policy, as defined in s. 600.03
3(28r), but does not include a medicare replacement policy, as defined in s. 600.03
4(28p), or a long-term care insurance policy, as defined in s. 600.03 (28g).
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252.16
(1) (c) "Individual health policy" means an insurance policy or a
7partially or wholly uninsured plan or program, that provides hospital, medical or
8other health coverage to an individual on an individual basis and not as a member
9of a group, whether or not dependents of the individual are also covered. The term
10includes a medicare supplement policy, as defined in s. 600.03 (28r), but does not
11include a medicare replacement policy, as defined in s. 600.03 (28p), or a long-term
12care insurance policy, as defined in s. 600.03 (28g).
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252.16
(1) (d) "Medicare" has the meaning given in s. 49.498 (1) (f).
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252.16
(2) Subsidy program. From the appropriation under s. 20.435
(1) (5) 17(am), the department shall distribute funding in each fiscal year to subsidize the
18premium costs under s. 252.17 (2) and, under this subsection, the premium costs for
19continuation health insurance coverage available to an individual who has HIV
20infection and who is unable to continue his or her employment or must reduce his or
21her hours because of an illness or medical condition arising from or related to HIV
22infection.
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1252.16
(3) (b) Has a family income, as defined by rule under sub. (6), that does
2not exceed
200% 300% of the federal poverty line, as defined under
42 USC 9902 (2),
3for a family the size of the individual's family.
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252.16
(3) (dm) Has, or is eligible for, health insurance coverage under a group
7health plan or an individual health policy.
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252.16
(3) (e) 1. Contact the individual's
employer or former employer or
the
10administrator of the group health plan under which the individual is covered, health
11insurer to verify the individual's eligibility for
continuation coverage
under the group
12health plan or individual health policy and the premium and any other conditions
13of coverage, to make premium payments as provided in sub. (4) and for other
14purposes related to the administration of this section.
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252.16
(3) (e) 1m. Contact the individual's employer or former employer to
17verify that the individual's employment has been terminated or that his or her hours
18have been reduced and for other purposes related to the administration of this
19section.
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252.16
(3) (e) 2. Make any necessary disclosure to the individual's
employer or 22former employer or
the administrator of the group health plan under which the
23individual is covered health insurer regarding the individual's HIV status.
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252.16
(4) (a) Except as provided in pars. (b) and
(c) (d), if an individual satisfies
4sub. (3), the department shall pay the full amount of each premium payment for
5continuation coverage that is due from the individual under s. 632.897 (2) (d), 29 USC
61162 (3) or 42 USC 300bb-2 (3), whichever is applicable the individual's health
7insurance coverage under the group health plan or individual health policy under
8sub. (3) (dm), on or after the date on which the individual becomes eligible for a
9subsidy under sub. (3).
The Except as provided in pars. (b) and (d), the department
10may not refuse to shall pay the full amount of each premium payment
because the
11continuation coverage that is available to the individual who satisfies sub. (3) 12regardless of whether the individual's health insurance coverage under sub. (3) (dm) 13includes coverage of the individual's
spouse and dependents. Except as provided in
14par. (b), the department shall terminate the payments under this section when the
15individual's
continuation health insurance coverage ceases
, or when the individual
16no longer satisfies sub. (3)
or upon the expiration of 29 months after the continuation
17coverage began, whichever occurs first. The department may not make payments
18under this section for premiums for
a conversion policy or plan that is available to
19an individual under s. 632.897 (4) or (6), 29 USC 1162 (5) or 42 USC 300bb-2 (5) 20medicare.
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252.16
(4) (b) The obligation of the department to make payments under this
23section is subject to the availability of funds in the appropriation under s. 20.435
(1) 24(5) (am).
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252.16
(4) (d) For an individual who satisfies sub. (3) and who has a family
3income, as defined by rule under sub. (6) (a), that exceeds 200% but does not exceed
4300% of the federal poverty line, as defined under
42 USC 9902 (2), for a family the
5size of the individual's family, the department shall pay a portion of the amount of
6each premium payment for the individual's health insurance coverage. The portion
7that the department pays shall be determined according to a schedule established
8by the department by rule under sub. (6) (c). The department shall pay the portion
9of the premium determined according to the schedule regardless of whether the
10individual's health insurance coverage under sub. (3) (dm) includes coverage of the
11individual's dependents.
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252.16
(5) Application process. The department may establish, by rule, a
14procedure under which an individual who does not satisfy sub. (3) (b), (c) 2. or
(d) (dm) 15may submit to the department an application for a premium subsidy under this
16section that the department shall hold until the individual satisfies each
17requirement of sub. (3), if the department determines that the procedure will assist
18the department to make premium payments in a timely manner once the individual
19satisfies each requirement of sub. (3). If an application is submitted by an employed
20individual under a procedure established by rule under this subsection, the
21department may not contact the individual's employer or
the administrator of the
22group health plan under which the individual is covered, health insurer unless the
23individual authorizes the department, in writing, to make that contact and to make
24any necessary disclosure to the individual's employer or
the administrator of the
1group health plan under which the individual is covered
health insurer regarding the
2individual's HIV status.
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252.16
(6) (b) Establish a procedure for making payments under this section
5that ensures that the payments are actually used to pay premiums for
continuation 6health insurance coverage available to individuals who satisfy sub. (3).
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252.16
(6) (c) Establish a premium contribution schedule for individuals who
9have a family income, as defined by rule under par. (a), that exceeds 200% but does
10not exceed 300% of the federal poverty line, as defined under
42 USC 9902 (2), for
11a family the size of the individual's family. In establishing the schedule under this
12paragraph, the department shall take into consideration both income level and
13family size.
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252.17
(2) Subsidy program. The department shall establish and administer
16a program to subsidize, from the appropriation under s. 20.435
(1) (5) (am), as
17provided in s. 252.16 (2), the premium costs for coverage under a group health plan
18that are paid by an individual who has HIV infection and who is on unpaid medical
19leave from his or her employment because of an illness or medical condition arising
20from or related to HIV infection.
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252.17
(4) (b) The obligation of the department to make payments under this
23section is subject to the availability of funds in the appropriation under s. 20.435
(1) 24(5) (am).
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1253.02
(2) (a) Reproductive health services, including health services prior to
2conception and family planning services
, as defined in s. 253.07 (1) (b).
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253.02
(2m) (intro.) Nothing in this section authorizes the performance,
6promotion
or, encouragement
of or counseling in favor of, or referral either directly
7or through an intermediary for, voluntary termination of pregnancy.
Nothing in this
8section prohibits the providing of nondirective information explaining any of the
9following:
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253.02
(2m) (a) Prenatal care and delivery.
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(b) Infant care, foster care or adoption.
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(c) Pregnancy termination.
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253.06
(2) From the appropriation under s. 20.435
(1) (5) (em), the department
17shall supplement the provision of supplemental foods, nutrition education and other
18services, including nutritional counseling, to low-income women, infants and
19children who meet the eligibility criteria under the federal special supplemental food
20program for women, infants and children authorized under
42 USC 1786. To the
21extent that funds are available under this section and to the extent that funds are
22available under
42 USC 1786, the department shall provide the supplemental food,
23nutrition education and other services authorized under this section and shall
24administer that provision in every county. The department may enter into contracts
25for this purpose.
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253.06
(1) Definitions. In this section:
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(a) "Authorized food" means food identified by the department in accordance
4with
7 CFR 246.10 as acceptable for use under the federal special supplemental food
5program for women, infants and children under
42 USC 1786.
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(b) "Authorized vendor" means a vendor that has been authorized by the
7department to accept drafts from participants and have the drafts redeemed by the
8department.
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(c) "Draft" means the negotiable instrument distributed by the department for
10use by a participant to purchase authorized food.
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(cm) "Food distribution center" means an entity, other than a vendor, that is
12under contract with the department under sub. (3m) to distribute authorized food to
13participants.
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(d) "Participant" means a person who is eligible for services under this section
15and who receives services under this section.
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(dm) "Proxy" means a person who has been designated in writing by a
17participant or by the department to obtain and exchange drafts for authorized food
18on behalf of the participant.
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(e) "Vendor" means a grocery store or pharmacy that sells authorized food.
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(f) "Vendor stamp" means a rubber stamp provided to a vendor or food
21distribution center by the department for the purpose of validating drafts.
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253.06
(2) (title)
Use of funds.
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1253.06
(3) Authorization of vendors. (a) The department may authorize a
2vendor to accept drafts only if the vendor meets all of the following conditions:
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1. The vendor submits to the department a completed application.
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2. The vendor meets the minimum requirements for authorization, as
5established by the department by rule under sub. (5) (a) 1.
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3. The vendor does not have any outstanding fines, forfeitures, recoupment
7assessments or enforcement assessments that were levied against that vendor for a
8violation of this section or for a violation of rules promulgated under this section.
9This subdivision does not apply if the vendor has contested the fine, forfeiture,
10recoupment assessment or enforcement assessment and has not exhausted
11administrative or judicial review.
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4. The vendor is fit and qualified, as determined by the department. In
13determining whether a vendor is fit and qualified, the department shall consider any
14relevant conviction of the vendor or any of the vendor's employes for civil or criminal
15violations substantially related to the operation of a grocery store or pharmacy.
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(bg) The department may limit the number of vendors that it authorizes under
17this subsection if the department determines that the number of vendors already
18authorized under this subsection is sufficient to permit participants to obtain
19authorized food conveniently.
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(bm) The department shall approve or deny initial authorization within 90
21days after the receipt of a completed application. If the application is denied, the
22department shall give the applicant reasons, in writing, for the denial and shall
23inform the applicant of the right to appeal that decision under sub. (6).
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(c) The department may not redeem drafts submitted by a person who is not
25an authorized vendor except as provided in sub. (3m).
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253.06
(3m) Food distribution centers. (a) The department may contract for
3an alternative system of authorized food distribution with an entity other than a
4vendor only if the entity meets all of the following requirements:
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1. The entity meets the minimum requirements established by the department
6by rule under sub. (5) (a) 1.
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2. The entity does not have any outstanding fines, forfeitures, recoupment
8assessments or enforcement assessments that were levied against that entity for a
9violation of this section or for a violation of rules promulgated under this section.
10This subdivision does not apply if the entity has contested the fine, forfeiture,
11recoupment assessment or enforcement assessment and has not exhausted
12administrative or judicial review.
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3. The entity is fit and qualified, as determined by the department.
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(b) The department shall redeem valid drafts submitted by a food distribution
15center.
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253.06
(4) Prohibited practices. (a) No person may do any of the following:
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1. Accept drafts or submit drafts to the department for redemption without
19authorization.
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2. Provide cash or commodities, other than authorized food, in exchange for
21drafts or in exchange for authorized food purchased with a draft.
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3. Accept a draft other than in exchange for authorized food that is provided
23by the person.
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3m. Provide authorized food or other commodities to a participant or proxy in
25exchange for a draft accepted by a 3rd party.
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14. Enter on a draft a dollar amount that is higher than the actual retail price
2of the item for which the draft was used.
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5. Require a participant or proxy to sign a draft before entering the dollar
4amount on the draft in permanent ink.
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6. Accept a draft except during the period specified on the draft.
