This bill requires the secretary of health and family services to certify to each
county, nursing home, community-based residential facility, adult family home and
residential care apartment complex the date on which a resource center that serves
the area of the county, home, facility or complex is first available to provide a
functional and financial screen to specific groups of eligible individuals or for
specified facilities. Each affected nursing home, community-based residential
facility, adult family home and residential care apartment complex must inform
prospective residents of the facility about the services of the resource center, the
family care benefit and the availability of a functional and financial screen to
determine eligibility. Also, these facilities and hospitals must refer to the resource
center any person who seeks admission and who is aged at least 65 years or has a
physical disability, unless the person has received a screen for functional eligibility
within the previous six months, is entering the facility only for respite care or is an
enrollee of a care management organization. Failure to comply with these
requirements subjects the facility to an administrative forfeiture. Current
prohibitions on the admittance to nursing homes of persons without a COP or other
assessment do not apply to persons for whom the secretary of health and family
services has certified that a resource center is available.
Council on long-term care and board on aging and long-term care
This bill creates in DHFS a 15-member council on long-term care that
terminates on July 1, 2001. The council must assist DHFS in developing policy
related to long-term care issues. The council also must review and make
recommendations to DHFS concerning the DHFS standard contract provisions for
resource centers and care management organizations, the family care benefit and
other matters, and must monitor patterns of complaints, persons on waiting lists and
patterns of enrollments and disenrollments.
The bill makes several changes to the membership of the board on aging and
long-term care and requires the board to contract with organizations to provide
advocacy services, including negotiation, mediation and assistance in
administrative hearings or judicial proceedings, to potential or actual recipients of
the family care benefit or their families or guardians.
Other long-term care
Under current law, a county may not use COP or CIP funds to provide services
to an individual who resides in a community-based residential facility unless the
individual receives, before admission, an assessment of his or her functional
abilities, disabilities and need for medical and social long-term community support
services.
Current law also requires a community-based residential facility, prior to
admitting a person, to prepare a statement of financial condition for a person who
intends to pay for residence in the facility from private funds. The statement of
financial condition must estimate a date, if any, by which the person's assets and
other private funding would be depleted if he or she were to reside continuously in
the community-based residential facility. If that date is less than 24 months after
the date of the statement of financial condition, the community-based residential
facility must provide the statement to the county department of social services.
This bill allows a county, in accordance with guidelines established by DHFS,
to waive the requirement to conduct a functional assessment prior to a person's
admission to a community-based residential facility. However, if a person applies
for admission to a community-based residential facility on or after the date that this
bill becomes law and his or her statement of financial condition indicates that, if the
individual were to reside in the community-based residential facility, his or her
assets and other private funds would be depleted within 12 months, the
community-based residential facility must refer him or her to the county
department of social services to determine whether an assessment should be
conducted.
Currently, revenues received by DHFS from skilled nursing facility violation
forfeiture assessment surcharges and interest pay for certain costs that are
associated with the violations, such as resident relocation to another facility and
reimbursement for misappropriated property. This bill permits DHFS to use a
portion of the penalty assessment surcharge and interest revenues for innovative
projects that aim to protect health and property of residents of skilled nursing
facilities.
Public assistance
Under current law, a county department of human services or social services
(county department) or, in Milwaukee County, DHFS must make payments of $215
per month to a relative of a child who is providing care and maintenance for the child
if certain conditions are met (kinship care and long-term kinship care). Under this
bill, a county department or DHFS may, but is not required to, make those payments
if certain conditions are met. The bill also provides that, notwithstanding fulfillment
of the conditions of eligibility for the receipt of those payments, a relative who is
providing kinship care or long-term kinship care for a child is not entitled to receive
those payments.
Under current law, a parent who receives federal supplemental security income
(SSI), or a state supplemental payment, receives a monthly supplemental payment
of $100 for each dependent child with whom the parent lives, if certain conditions are
met. This bill increases that monthly supplemental payment to $150 per dependent
child.
Current federal law permits states to establish a demonstration project under
which certain low-income individuals may establish savings accounts, referred to as
individual development accounts. The funds deposited into an individual
development account may be used for certain expenses associated with
postsecondary education, first home purchases, business capital expenses or medical
expenses, to meet necessary living expenses following loss of employment or to make
payments necessary to prevent the eviction of the individual from his or her
residence or the foreclosure on the mortgage for the principal residence of the
individual. An individual may only deposit earned income into the account. For
every dollar that the individual deposits into the account, the administering state or
local agency or American Indian tribal governing body, or a qualified nonprofit
agency, must deposit at least 50 cents and not more than four dollars into that
account. The federal government makes a grant to the matching contributor that
equals the lesser of the aggregate amount of funds committed as matching
contributions from nonfederal funds or $1,000,000.
This bill allows the department of workforce development (DWD) to establish
an individual development account demonstration project in this state in accordance
with the federal law.
Under current law, DWD is required to recover benefit overpayments made
under the aid to families with dependent children (AFDC) program and under the
Wisconsin works (W-2) program (this state's welfare reform initiative which
emphasizes work for benefits).
This bill permits DWD to recover overpaid AFDC or W-2 benefit amounts from
former benefit recipients by issuing a warrant directed to the clerk of circuit court.
The warrant is considered a perfected lien upon the person's right, title and interest
in all real and personal property. DWD may then file an execution commanding the
sheriff of any county in which property of the person is found to collect and sell
sufficient property to pay the amount stated in the warrant.
The bill also allows DWD to collect the overpaid AFDC or W-2 benefits by levy
upon any property of the person to whom the benefits were paid. Under the bill, such
a person who refuses to surrender the property is subject to enforcement
proceedings. A third party who fails to surrender property that is subject to a levy
is liable for up to 25% of the amount the debt. The bill sets forth the process for
serving the levy and releasing the levy. The bill also exempts certain wages, the first
$1,000 in a bank account and certain other property from a levy.
Under current law, DWD must allocate certain moneys for various public
assistance programs. This bill eliminates the requirement that moneys be allocated
for some of the programs and adds the following new programs to the list of those for
which moneys must be allocated:
1. A program to fund efforts to provide an emotionally and intellectually
stimulating environment for certain low-income children under the age of five.
2. A literacy program targeted at certain low-income individuals.
3. A competitive grant program to fund programs that improve social, academic
and employment skills of certain low-income youth.
4. A program to assist low-income workers to maintain their jobs and to
improve their basic skills.
5. A program to match retirees with youth to provide the youth with workforce
mentoring.
6. A program to encourage the positive involvement of fathers in their
children's lives.
7. A grant program under which DWD may award up to $1,000,000 to counties
and private entities to provide community-based alcohol and other drug abuse
treatment that is targeted to certain low-income individuals.
The bill also permits DWD to transfer funds received under the federal
temporary assistance for needy families block grant program to other agencies for
various programs.
Under current law, a county department of social or human services must
certify eligibility for and issue food coupons to needy households, except that a
Wisconsin works (W-2) agency is required, to the extent permitted under federal law
or waiver, to certify eligibility for and issue food coupons to eligible participants in
the W-2 program.
This bill requires a W-2 agency, to the extent permitted under federal law or
waiver, also to certify eligibility for and issue food coupons to: 1) persons who may
be required to participate in the food stamp employment and training program; and
2) other persons who are under the age of 61 and who are not disabled.
Under current law, certain federal economic support programs require that a
state maintain or increase its average annual expenditures for those programs. This
is commonly referred to as a maintenance-of-effort requirement.
This bill allows DWD to expend moneys from its economic support programs
appropriation for services to identify funds that may be used for the
maintenance-of-effort requirement.
Currently, under the learnfare program, a child between the ages of 6 and 17
who is the dependent child of a recipient of benefits under the W-2 program must
meet a school attendance requirement to avoid the imposition of certain sanctions.
Currently, DWD may expend moneys for a study of the school attendance
requirement under the learnfare program for children who are 6 to 12 years of age.
This bill eliminates that expenditure authority.
Under current law, if a recipient of certain public assistance benefits dies and
the estate of the deceased recipient is insufficient to pay for the funeral, burial and
cemetery expenses, the county or applicable American Indian tribal governing body
or the organization responsible for burial of the recipient must pay the cemetery
expenses that are not paid by the deceased recipient's estate (but not more than
$1,000) and must pay the funeral and burial expenses that are not paid by the
deceased recipient's estate (but not more than $1,000).
Under this bill, a county, tribal governing body or organization responsible for
burying the recipient is not required to make a payment for funeral, burial or
cemetery expenses if the request for the payment is made more than 12 months after
the recipient died.
Under current law, DWD administers a work experience program for
noncustodial parents (parents who do not live with their children for substantial
periods of time), commonly referred to as the children first program. A parent who
fails to pay court-ordered child support or to meet the child's needs for support
because of unemployment or underemployment is required to participate in the
program, under which the person is provided with certain types of work experience,
job training and job search assistance. Currently, DWD may contract with any
county to administer the children first program. DWD pays the county $200 for each
person who participates in the program in that county.
This bill permits DWD to contract with a W-2 agency or a county to administer
the children first program. The bill requires DWD to pay the administering county
or W-2 agency $400 for each person who participates in the program in the region
in which the county or W-2 agency administers the program.
This bill provides that DHFS may use moneys derived from Indian gaming
compacts to fund relief block grants to American Indian tribal governing bodies.
Wisconsin works
Under current law, two W-2 agencies in Milwaukee County are permitted to
implement a program under which certain participants in community service jobs
(wholly subsidized employment) may be paid wages rather than monthly grants. To
qualify for a wage-paying community service job, the participant must already be
engaged in unsubsidized employment for at least 15 hours per week. Currently, a
W-2 agency may not require a person to work in a wage-paying community service
job more than the lesser of 15 hours per week or the difference between 40 hours and
the number of hours per week that the participant works in unsubsidized
employment. If the participant qualifies for the federal earned income tax credit
(EITC), current law qualifies the participant for the state EITC as well. Currently,
the wage-paying community service job program is scheduled to sunset on October
1, 2001.
This bill eliminates the sunset date for the wage-paying community service job
program and expands the program, beginning on January 1, 2001, to allow all W-2
agencies to implement it for any individual that the W-2 agency determines is
capable of working in an unsubsidized job but who, despite reasonable efforts, is
unable to secure full-time unsubsidized employment. However, the bill caps the
number of slots for the program at 2,500 statewide. Under the bill, a participant in
a wage-paying community service job is disqualified from the state EITC with
respect to any wages earned under the wage-paying community service job.
Additionally, under the bill, the participant need not be engaged in unsubsidized
employment to qualify for a wage-paying community service job. Finally, the bill
allows a W-2 agency to require a participant in a wage-paying community service
job to work in a community service job for not more than 30 hours per week and to
participate in job search activities for not more than ten hours per week.
This bill requires a W-2 agency to assess the educational needs of an individual
whom the W-2 agency proposes to place in unsubsidized employment or a trial job.
Under the bill, if the W-2 agency determines that the individual needs basic
education, such as courses leading to the granting of the equivalent of a high school
diploma, and if the individual wishes to pursue the basic education, the W-2 agency
must make basic education a part of an employability plan that the W-2 agency
develops for the individual. The bill requires the W-2 agency to pay for the basic
education services.
Under current law, with certain limited exceptions, a participant in the W-2
program may be required to work in a community service job for not more than 30
hours per week and to participate in education or training activities for not more
than ten hours per week. If the W-2 agency requires fewer than 30 hours of work
per week because the participant has part-time unsubsidized employment, the
participant's grant amount may be reduced by an amount equal to the product of
$5.15 and the difference between 30 and the number of hours that the participant
is required to work. This bill specifies that if a W-2 agency places a person in a
community service job for fewer than 30 hours per week because that person has
part-time unsubsidized employment, the W-2 agency may reduce the monthly grant
in accordance with a schedule developed by DWD.
Under current law, a child care subsidy is available to a parent or guardian of
a child who is under the age of 13 if the parent or guardian meets certain income and
asset limits and needs child care to participate in certain work-related activities,
including employment skills training. If child care is needed in order to participate
in employment skills training (which includes English as a second language courses,
high school graduation equivalency courses and technical college courses), the
parent or guardian must demonstrate that he or she has been employed in an
unsubsidized job for at least nine consecutive months or that he or she is a
participant in a W-2 employment position in order to receive a child care subsidy.
Under this bill, if a person wishes to receive a subsidy for child care that is
needed in order to pursue basic education (such as English as a second language
courses, high school graduation equivalency courses or literacy tutoring), that
person must demonstrate that he or she is employed in unsubsidized employment
(without regard to length of employment) or that he or she is a participant in a W-2
employment position. A person who wishes to receive a subsidy for child care that
is needed in order for the person to participate in a course of study at a technical
college, or to pursue education that provides an employment skill, must demonstrate
that he or she has been working in unsubsidized employment for three months (and
continues to be so employed) or that he or she is in a W-2 employment position. As
under current law, the W-2 agency must determine that the basic, technical or other
education would facilitate the person's efforts to obtain employment.
Under current law, a contract to operate as a W-2 agency must require that the
W-2 agency provide, or contract with another person to provide, credit
establishment and credit repair assistance to W-2 participants. Currently, DWD
may allocate not more than $3,000,000 annually for credit assistance to W-2
recipients in the city of Milwaukee.
Under this bill, rather than requiring credit establishment and credit repair
services, a W-2 agency contract must require that the W-2 agency provide, or
contract with another to provide, budgeting and financial planning services. The bill
eliminates the allocation for credit establishment and credit repair services offered
to W-2 participants in the city of Milwaukee.
Current contracts between DWD and W-2 agencies require the agencies to offer
follow-up services for 60 days after a W-2 participant moves from a W-2
employment position to unsubsidized employment. This bill permits a W-2 agency,
subsequent to that follow-up period, to offer case management services, including
the provision of employment skills training, English as a second language classes
and basic education, to an individual who has moved from a W-2 employment
position to unsubsidized employment, regardless of the individual's income or asset
level.
Currently, in calculating a person's income for the purpose of determining
financial eligibility for W-2 or for a W-2 child care subsidy, a W-2 agency must
include child support payments received by the person on behalf of any child who is
a member of that person's household. This bill removes child support payments from
the income consideration. The bill also directs the W-2 agency to include in the
calculation of income for W-2 child care eligibility net earnings and certain
business-related expenses reported to the Internal Revenue Service for farm and
self-employment income.
Medical assistance
Under current law, certain people are eligible for MA because of substantial
medical needs that consume so much of their income as to qualify them as
low-income. This category of MA recipients is commonly referred to as medically
needy. Other people are eligible for MA by virtue of their receipt of other federal
assistance, such as SSI. This category of MA recipients is commonly referred to as
categorically needy.
This bill directs DHFS to seek federal approval and to request any necessary
waivers to expand MA eligibility to disabled persons who would qualify for SSI but
for excess income and assets. Under the bill, a disabled person whose family's income
is less than 250% of the federal poverty line and whose assets do not exceed $20,000
is eligible to receive MA if the person pays a monthly premium and a one-time initial
premium established by DHFS. The bill directs DHFS, however, to pay the monthly
premium for a person who is eligible for this MA purchase plan and who is receiving
services under COP. The bill also authorizes DHFS to pay for that person's one-time
entry premium.
The bill also requires DHFS to evaluate how to coordinate the MA purchase
plan with HIRSP, which provides major medical health insurance coverage for,
among others, persons who are covered under medicare because they are disabled
but for which persons who are eligible for MA are not eligible. DHFS is required, if
necessary, to develop proposed legislation that coordinates the two programs and
that addresses the provision of health care coverage for individuals who are eligible
for both HIRSP and the MA purchase plan.
Under the current MA program, DHFS certifies persons or facilities that meet
certain criteria as providers and pays for services and items that MA recipients
receive from the certified providers. DHFS is authorized or required to enforce
numerous sanctions, including decertification or suspension from the MA program,
against providers who fail to comply with requirements under the program or to
whom improper or erroneous payments or overpayments have been made. To
implement these sanctions, DHFS must provide written notice, a fair hearing and
a written decision.
This bill prohibits MA providers from submitting false claims for payment of
services or items. The bill permits DHFS to assess forfeitures for violations of the
prohibitions and to impose a surcharge on a forfeiture that is assessed.
The bill authorizes DHFS to require certain MA providers, as a condition of
certification, to file with DHFS a surety bond, payable to DHFS, under terms and in
an amount specified by DHFS, that would reasonably pay the amount of a recovery
and DHFS's costs to pursue recovery of overpayments or to investigate and pursue
allegations of false claims or statements.
The bill authorizes DHFS, if DHFS first makes specified findings, to prescribe
MA provider certification criteria that limit the number of providers of particular
services or that limit the amount of resources, including employes and equipment,
that a certified provider may use to provide MA services and items.
The bill makes various changes relating to the procedures for the recovery by
DHFS of improper or erroneous MA payments or overpayments.
The bill eliminates DHFS's general authority to suspend a provider, but
authorizes DHFS, if certain criteria are met, to suspend certification for a provider
pending a hearing on whether the provider must be decertified for violation of federal
or state laws. The bill eliminates the right of notice, a fair hearing and a written
decision for most sanctions against providers that DHFS may enforce, except for
decertification from or restriction of a provider's participation in the MA program.
The bill authorizes DHFS to prescribe conditions of MA participation and
reimbursement terms and to impose additional sanctions for noncompliance. The
bill requires immediate access, upon request by DHFS, to provider records and
specifies that a provider's failure to provide access constitutes grounds for
decertification.
The bill changes provisions concerning liability for repayment of improper or
erroneous payments or overpayments of a provider who sells or otherwise transfers
ownership of his or her business. Under the bill, before such a sale or transfer may
take place, the provider must notify DHFS of the impending sale and DHFS must
inform the provider of the extent of liability, if any. If liability exists, the provider
must so inform the prospective transferee of the extent of the liability and the
liability attaches to both the provider and the transferee, with the sale or other
transfer conditioned upon repayment. If the provider fails to inform the transferee,
liability does not attach to the transferee. Repayment must be made prior to the sale
or transfer and, if not done, the sale or transfer is void.
Currently, a person who disposes of assets for less than the fair market value
in order to qualify for MA is ineligible for MA for a certain period. Current law
specifies that a transfer of assets to an irrevocable annuity is a transfer that is below
the fair market value if the amount of the transfer exceeds the expected benefit.
This bill provides that a transfer of an asset to an irrevocable annuity, or a
transfer of an asset by promissory note or similar instrument, is a transfer for the
fair market value of the asset if certain conditions are met.
Under current law, DHFS must recover from the estate of a deceased MA
recipient the amount of MA paid on behalf of the recipient while the recipient was
a resident in a nursing home or an inpatient in a medical institution and the amount
of MA paid on behalf of the recipient for certain services received by the recipient
after the recipient was over the age of 55. One mechanism for recovery is a claim filed
against the estate, which may include a lien placed on the home of a recipient who
is a nursing home resident and not expected to return home. Currently, a lien may
only be for the amount of MA paid on behalf of the recipient while the recipient
resides in a nursing home.
This bill expands the estate recovery program as follows:
1. In addition to obtaining a lien on the home of a nursing home resident who
is not expected to return home, the bill directs DHFS to obtain a lien on the home of
an inpatient in a hospital who is not expected to return home. The lien, in both cases,
is for the amount of MA paid on behalf of that recipient that is generally recoverable,
rather than only the amount paid while the recipient was in the nursing home (or
hospital).
2. DHFS must recover expenditures for personal care services, which include
assistance with meals, dressing, movement, bathing or other personal needs or
maintenance.
