Amendment ASA2-AB591

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).

AB591-ASA2,71,22 (b) "Level II day care provider" means a day care provider certified under s. 48.651 (1) (b).

AB591-ASA2,72,2 (1m) Eligibility. A Wisconsin works agency shall determine eligibility for a child care subsidy under this section. Under this section, an individual may receive a subsidy for child care for a child who has not attained the age of 13 if the individual meets all of the following conditions:

AB591-ASA2,72,6 (a) The individual is a custodial parent of a child who is under the age of 13, or is a person who, under s. 48.57 (3m), is providing care and maintenance for a child who is under the age of 13, and child care services for that child are needed in order for the individual to do any of the following:

AB591-ASA2,72,7 1. Meet the school attendance requirement under s. 49.26 (1) (ge).

AB591-ASA2,72,9 2. Work in an unsubsidized job, including training provided by an employer during the regular hours of employment.

AB591-ASA2,72,11 3. Work in a Wisconsin works employment position, including participation in education or training activities under s. 49.147 (3) (am), (4) (am) or (5) (bm).

AB591-ASA2,72,13 4. Participate in other employment skills training, as defined by the department by rule, if the individual meets any of the following conditions:

AB591-ASA2,72,15 a. The individual has been employed in unsubsidized employment for 9 consecutive months and continues to be so employed.

AB591-ASA2,72,16 b. The individual is a participant in a Wisconsin works employment position.

AB591-ASA2,72,20 (b) The individual meets the eligibility conditions under s. 49.145 (2) (c) to (g) and (3) (a), except that an individual may be eligible for a child care subsidy under this section regardless of the number of days the individual has resided in this state prior to applying for the child care subsidy.

AB591-ASA2,72,24 (c) The gross income of the individual's family is at or below 165% of the poverty line for a family the size of the individual's family. In calculating the gross income of the family, the department shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA2,73,2 (d) The individual satisfies other eligibility criteria established by the department by rule.

AB591-ASA2,73,5 (2) Distribution of child care funds. From the appropriation under s. 20.445 (3 (dz), the department shall distribute funds allocated for child care services under this section.

AB591-ASA2,73,8 (3) County administration. (a) A Wisconsin works agency shall refer an individual who has been determined eligible under sub. (1m) to a county department under s. 46.215, 46.22 or 46.23 for child care assistance.

AB591-ASA2,73,12 (b) The county department under s. 46.215, 46.22 or 46.23 shall administer child care assistance under this section. In administering child care assistance under this section, the county department under s. 46.215, 46.22 or 46.23 shall do all of the following:

AB591-ASA2,73,13 1. Determine an individual's liability under sub. (5).

AB591-ASA2,73,15 2. Provide a voucher to an eligible individual for the payment of child care services provided by a child care provider.

AB591-ASA2,73,16 3. Set maximum reimbursement rates as provided under sub. (6) (b).

AB591-ASA2,73,17 4. Reimburse child care providers.

AB591-ASA2,73,18 5. Certify child care providers under s. 48.651.

AB591-ASA2,73,21 6. Assist individuals who are eligible for child care subsidies under this section to identify available child care providers and select appropriate child care arrangements.

AB591-ASA2,73,25 (4) Choice of provider. An eligible individual shall choose whether the child care will be provided by a day care center licensed under s. 48.65, a Level I day care provider, a Level II day care provider or a day care program provided or contracted for by a school board under s. 120.13 (14).

AB591-ASA2,74,4 (5) Liability for payment. An individual who receives aid under this section is liable for a percentage of the cost of child care received, payable in accordance with a sliding scale formula established by the department that is based on the individual's ability to pay and the cost of the child care.

AB591-ASA2,74,10 (6) Child care rates and quality standards. (a) The department shall establish the maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for child care services provided under this section. The department shall set the rate so that at least 75% of the number of places for children within the licensed capacity of all child care providers in each county or in a multicounty area determined by the department can be purchased at or below that maximum rate.

AB591-ASA2,74,14 (b) The department shall set a maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for Level I day care providers for services provided to eligible individuals. The maximum rate set under this paragraph may not exceed 75% of the rate established under par. (a).

AB591-ASA2,74,18 (c) The department shall set a maximum rate that a county department under s. 46.215, 46.22 or 46.23 may pay for Level II day care providers for services provided to eligible individuals. The maximum rate set under this paragraph may not exceed 50% of the rate established under par. (a).

AB591-ASA2,74,21 (d) The department may establish a system of rates for child care programs that exceed the quality of care standards required for licensure under s. 48.65 or for certification under s. 48.651 (1) (a).

AB591-ASA2,74,25 (7) Refusal to pay child care providers. The department or the county department under s. 46.215, 46.22 or 46.23 may refuse to pay a child care provider for child care provided under this section if any of the following applies to the child care provider, employe or person living on the premises where child care is provided:

AB591-ASA2,75,3 (a) The person has been convicted of a felony or misdemeanor that the department or county department determines substantially relates to the care of children.

AB591-ASA2,75,5 (b) The person is the subject of a pending criminal charge that the department or county department determines substantially relates to the care of children.

AB591-ASA2,75,7 (c) The person has been determined under s. 48.981 to have abused or neglected a child.

AB591-ASA2, s. 95 Section 95. 49.157 of the statutes is created to read:

AB591-ASA2,75,11 49.157 Wisconsin works; transportation costs. (1) Assistance. In accordance with rules promulgated by the department, a Wisconsin works agency may grant financial assistance to a participant for transportation costs.