Amendment ASA2-AB591

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.

AB591-ASA2,75,14 (2) Distribution of funds. The department shall distribute to the Wisconsin works agencies the funds allocated under s. 49.181 (1) (h) for transportation assistance provided under sub. (1).

AB591-ASA2, s. 96 Section 96. 49.159 of the statutes is created to read:

AB591-ASA2,75,23 49.159 Wisconsin works; noncustodial and minor and other custodial parents. (1) Noncustodial parents. An individual who would be eligible under s. 49.145 except that the individual is the noncustodial parent of a dependent child, is eligible for services under this subsection if the dependent child's custodial parent is a participant and if the individual pays child support pursuant to a court order. The Wisconsin works agency may provide job search assistance and case management designed to enable eligible noncustodial parents to obtain and retain employment.

AB591-ASA2,76,6 (2) Minor custodial parents; financial and employment counseling. A custodial parent who is under the age of 18 is eligible, regardless of that individual's or that individual's parent's income or assets, to meet with a financial and employment planner. The financial and employment planner may provide the individual with information regarding Wisconsin works eligibility, available child care services, employment and financial planning, family planning services, community resources, eligibility for food stamps and other food and nutrition programs.

AB591-ASA2,76,10 (3) Other custodial parents. A custodial parent in a Wisconsin works group in which the other custodial parent is a participant in a Wisconsin works employment position is eligible for employment training and job search assistance services provided by the Wisconsin works agency.

AB591-ASA2, s. 97 Section 97. 49.161 of the statutes is created to read:

AB591-ASA2,76,19 49.161 Wisconsin works; overpayments. (1) Trial jobs overpayments. Notwithstanding s. 49.96, the department shall recover an overpayment of benefits paid under s. 49.148 (1) (a) from an individual who receives or has received benefits paid under s. 49.148 (1) (a). The value of the benefit liable for recovery under this subsection may include the value of work performed by the individual in a trial job if the person was ineligible to receive the benefit at the time it was paid. The department shall promulgate rules establishing policies and procedures for administrating this subsection.

AB591-ASA2,76,24 (2) Community service jobs and transitional placements overpayments. Except as provided in sub. (3), the department shall recover an overpayment of benefits paid under s. 49.148 (1) (b) and (c) from an individual who continues to receive benefits under s. 49.148 (1) (b) and (c) by reducing the amount of the individual's benefit payment by no more than 10%.

AB591-ASA2,77,6 (3) Overpayments caused by intentional program violations. If an overpayment under sub. (1) or (2) is the result of an intentional violation of ss. 49.141 to 49.161 or of rules promulgated by the department under those sections, the department shall recover the overpayment by deducting an amount from the benefits received under s. 49.148 (1) (a), (b) or (c), until the overpayment is recovered. The amount to be deducted each month may not exceed the following:

AB591-ASA2,77,8 (a) For intentional program violations resulting in an overpayment that is less than $300, 10% of the amount of the monthly benefit payment.

AB591-ASA2,77,10 (b) For intentional program violations resulting in an overpayment that is at least $300 but less than $1,000, $75.

AB591-ASA2,77,12 (c) For intentional program violations resulting in an overpayment that is at least $1,000 but less than $2,500, $100.

AB591-ASA2,77,14 (d) For intentional program violations resulting in an overpayment that is $2,500 or more, $200.

AB591-ASA2, s. 98 Section 98. 49.181 of the statutes is created to read:

AB591-ASA2,77,22 49.181 Public assistance and local assistance funding. (1) Funds distribution. Except as provided in subs. (2) and (3), within the limits of the appropriation under s. 20.435 (4) (dz), the department shall allocate amounts under this subsection. In this subsection, references to "1993 stats." are as affected by the acts of 1995 that are enacted prior to the effective date of this subsection .... [revisor inserts date]. The department shall allocate the following amounts for the following purposes:

AB591-ASA2,78,4 (a) Child care for recipients and former recipients of aid to families with dependent children. For child care services under s. 49.50 (6g) and for child care services and related transportation costs under s. 49.50 (6e) and (6k) (b), the department shall allocate $4,713,000 in fiscal year 1995-96, less any amounts expended or encumbered in fiscal year 1995-96 from the appropriations under s. 20.435 (4) (cn), 1993 stats., and s. 20.435 (4) (df), 1993 stats., for the purposes specified under this paragraph, and $5,687,400 in fiscal year 1996-97.

AB591-ASA2,78,9 (b) Low-income and at-risk child care. For low-income and at-risk child care services under s. 46.98 (2m) to (4), the department shall allocate $5,576,100 in fiscal year 1995-96, less any amount expended or encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (7) (b) for the purposes specified under this paragraph, and $5,576,100 in fiscal year 1996-97.

AB591-ASA2,78,17 (c) Income maintenance payments to individuals. For income maintenance payments to individuals under s. 49.52 and for foster care and treatment foster care provided by nonlegally responsible relatives under state or county administered programs, if the relatives are licensed to operate foster homes or treatment foster homes under s. 48.62, the department shall allocate $141,277,600 in fiscal year 1995-96, less any amount expended or encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (d), 1993 stats., for the purposes specified under this paragraph, and $122,684,200 in fiscal year 1996-97.

AB591-ASA2,78,24 (cm) Foster, treatment foster and kinship care. For foster care and treatment foster care provided by nonlegally responsible relatives under state or county administered programs, if the relatives are licensed to operate foster homes or treatment foster homes under s. 48.62, and for kinship care under s. 48.57 (3m), including assessments under s. 48.57 (3m) (a) 3. and background investigations under s. 48.57 (3m) (a) 4., the department shall allocate $10,284,500 in fiscal year 1996-97.

AB591-ASA2,79,9 (d) Public assistance administration and medical assistance eligibility determination. For payment distribution under s. 49.52 (1) for county administration of public assistance benefits and medical assistance eligibility determination, for payments to American Indian tribes for administration of public assistance benefits, and for fraud investigation and error reduction under s. 49.197 (1m) and (4), the department shall allocate $28,189,100 in fiscal year 1995-96, less any amount encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (de), 1993 stats., for the purposes specified under this paragraph, and $28,864,400 in fiscal year 1996-97.

AB591-ASA2,79,14 (e) Emergency assistance for families with needy children. For emergency assistance for families with needy children under s. 49.19 (11) (b), the department shall allocate $1,659,700 in fiscal year 1995-96, less any amount encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (dc), 1993 stats., for the purpose specified under this paragraph, and $1,659,700 in fiscal year 1996-97.

AB591-ASA2,79,23 (f) Learnfare; job opportunities and basic skills program; food stamp employment and training; parental responsibility pilot program. For the learnfare program under s. 49.50 (7), the job opportunities and basic skills program under s. 49.193, the food stamp employment and training project under s. 49.124 and the parental responsibility pilot program under s. 49.25, the department shall allocate $25,045,800 in fiscal year 1995-96, less any amounts expended or encumbered in fiscal year 1995-96 from the appropriations under s. 20.435 (4) (cn), 1993 stats., and s. 20.435 (4) (df), 1993 stats., for the purposes specified under this paragraph, and $26,447,100 in fiscal year 1996-97.

AB591-ASA2,80,3 (g) Learnfare case management. For case management for learnfare pupils under s. 46.62, the department shall allocate $1,289,300 in fiscal year 1995-96, less any amount expended or encumbered in fiscal year 1995-96 from the appropriation under s. 20.435 (4) (dg), 1993 stats., for the purpose specified under this paragraph, and $1,309,500 in fiscal year 1996-97.

AB591-ASA2,80,11 (h) Wisconsin works administration. For payments to Wisconsin works agencies under s. 49.143 for administration of Wisconsin works benefits under ss. 49.141 to 49.151 and 49.155 to 49.161, for Wisconsin works health care coverage eligibility determination under s. 49.153 and for fraud investigation and error reduction under s. 49.197 (1m) and (4) and for payments to individuals under s. 49.148 for Wisconsin works employment positions and under ss. 49.155 and 49.157 for child care and related transportation services, the department shall allocate $0 for fiscal year 1996-97.

AB591-ASA2,80,14 (2) Transfer of funds. The department may use up to 30% of the amounts required to be allocated under any paragraph under sub. (1) for any other purpose described under sub. (1) (a) to (g) in each fiscal year.

AB591-ASA2,80,18 (3) Carry-over funds. The department may carry over any unexpended funds allocated under any paragraph under sub. (1) from the previous fiscal year to the following fiscal year within the same biennium to be allocated under any paragraph under sub. (1).