Amendment ASA3-AB591

AB591-ASA3,88,14 1. The individual is eligible for employer-subsidized health care coverage. This subdivision does not apply to any of the following:

AB591-ASA3,88,16 a. A pregnant woman in a Wisconsin works group with an income that is equal to or less than 165% of the poverty line.

AB591-ASA3,88,18 b. A child who has not attained the age of 6 in a Wisconsin works group with an income equal to or less than 165% of the poverty line.

AB591-ASA3,88,21 c. A child who has attained the age of 6 and has not attained the age of 12 in a Wisconsin works group with an income that is equal to or less than 100% of the poverty line.

AB591-ASA3,89,2 d. A child who has attained the age of 6 and has not attained the age of 12 in a Wisconsin works group with an income in excess of 100% of the poverty line if the total amount obligated or expended for medical care or other type of remedial care and for health insurance premiums, when subtracted from the Wisconsin works group's income, places the Wisconsin works group at or below 100% of the poverty line.

AB591-ASA3,89,4 2. The individual fails to pay the established premium in a timely manner, as defined by the department of industry, labor and job development by rule.

AB591-ASA3,89,6 (3g) Eligible groups. Subject to the requirements under sub. (3), the following individuals are eligible for benefits and services under this section:

AB591-ASA3,89,8 (a) Wisconsin works groups. Except as provided in par. (c), an individual who is a member of a Wisconsin works group, if all of the following conditions apply:

AB591-ASA3,89,10 1. The individual meets the criteria under s. 49.145 (2) (c), (f), (g), (i), (L) and (m) and resides in this state.

AB591-ASA3,89,14 2. The Wisconsin works group meets the asset limitation under s. 49.145 (3) (a). In determining the assets under this subdivision, the Wisconsin works agency shall exclude all of the resources specified under 42 USC 1382b (a) if any of the following conditions is met:

AB591-ASA3,89,15 a. The group contains a child who has not attained the age of 6.

AB591-ASA3,89,18 b. The group contains a child who has attained the age of 6 and has not attained the age of 12 and the gross income of the group, as determined under subd. 3., does not exceed 100% of the poverty line.

AB591-ASA3,89,23 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-ASA3,90,3 (b) Pregnant women. A pregnant woman whose pregnancy has been medically verified and who has no dependent children, if she meets all of the following conditions:

AB591-ASA3,90,5 1. The woman meets the criteria under s. 49.145 (2) (c), (g), (i), (L) and (m) and resides in this state.

AB591-ASA3,90,8 2. The woman meets the asset limitation under s. 49.145 (3) (a). In determining the assets of the woman, the Wisconsin works agency shall exclude all of the resources specified under 42 USC 1382b (a).

AB591-ASA3,90,11 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-ASA3,90,14 (c) 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, only if the individual meets one of the following conditions:

AB591-ASA3,90,19 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-ASA3,90,23 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-ASA3,91,4 (3m) Medically needy. (a) An individual who meets all of the requirements of sub. (3g) (a) or (c), except that the income calculated for the individual under sub. (3g) (a) 3. or (c) 1. or 2. exceeds the applicable income limit under sub. (3g) (a) 3. or (c) 1. or 2., is eligible for benefits and services under this section only if all of the excess income above the applicable limit has been obligated or expended for medical care or other type of remedial care.

AB591-ASA3,91,12 (am) Notwithstanding par. (a) and sub. (3) (a) 2. a., (e) and (f) 1., if the individual is a pregnant woman or a child who has not attained the age of 6, and the individual meets all of the requirements of sub. (3g) (a), (b) or (c), except that the income calculated for the individual under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2. exceeds the applicable income limit under sub. (3g) (a) 3., (b) 3. or (c) 1. or 2., the individual is eligible for benefits and services under this section if all of the excess income above the applicable limit has been obligated or expended for medical care or other type of remedial care or for personal health insurance premiums.

AB591-ASA3,91,20 (as) Notwithstanding par. (a) and sub. (3) (a) 2. a., if the individual is a child who has attained the age of 6 and has not attained the age of 12, and the individual meets all of the requirements of sub. (3g) (a) except that the income calculated for the individual under sub. (3g) (a) 3. exceeds the income level under sub. (3g) (a) 3., the individual is eligible for benefits and services under this section if the total amount obligated or expended for medical care or other type of remedial care and for health insurance premiums, when subtracted from the Wisconsin works group's income, places the Wisconsin works group at 100% of the poverty line.

AB591-ASA3,91,23 (b) In determining the income for an individual under this subsection for purposes of determining the premium amount under sub. (4) (d), the Wisconsin works agency shall exclude the excess income specified under par. (a), (am) or (as).

AB591-ASA3,92,6 (3p) Presumptive eligibility for pregnant women. (a) Notwithstanding sub. (3g) (a), (b) and (c), a pregnant woman is eligible under this subsection for ambulatory prenatal care services under this section during the period beginning on the day on which an authorized health care provider under contract under sub. (4) (a) determines, on the basis of preliminary information, that the woman's family income does not exceed 165% of the poverty line and that the woman's family's assets do not exceed the asset limits under s. 49.145 (3) (a). Eligibility under this subsection ends as follows:

AB591-ASA3,92,10 1. If the woman applies under sub. (3g) (a), (b) or (c) for benefits and services under this section within the time required under par. (c), on the day on which the Wisconsin works agency determines whether the woman is eligible for benefits and services under sub. (3g) (a), (b) or (c).

AB591-ASA3,92,14 2. If the woman does not apply under sub. (3g) (a), (b) or (c) for benefits and services under this section within the time required under par. (c), on the last day of the month following the month in which the health care provider makes the determination under this paragraph.

AB591-ASA3,92,17 (c) A woman who is determined to be eligible under this subsection shall apply under sub. (3g) (a), (b) or (c) for benefits and services under this section within 14 days after the date on which the health care provider makes that determination.

AB591-ASA3,92,20 (cm) A woman who receives services under this subsection is liable for a monthly premium payable in the amount and in the manner prescribed under sub. (4) (d) beginning with the first month in which she receives those services.

AB591-ASA3,92,23 (d) A health care provider under contract under sub. (4) (a) that determines that a woman is eligible under this subsection for benefits and services under this section shall do all of the following:

AB591-ASA3,92,25 1. Notify the Wisconsin works agency of that determination within 5 working days after the day on which the determination is made.

AB591-ASA3,93,1 2. Notify the woman of the requirements under pars. (c) and (cm).

AB591-ASA3,93,4 (e) The Wisconsin works agency shall provide health care providers under contract under sub. (4) (a) with application forms for benefits and services under this section and information on how to assist women in completing the forms.

AB591-ASA3,93,6 (f) No provider may make more than one eligibility determination under this subsection with respect to an individual.

AB591-ASA3,93,13 (4) Administration and benefits. (a) Health maintenance organization contract. The department of health and family services shall contract with health maintenance organizations or other health care providers, including federally qualified health centers, to provide health care services under this subsection. A health maintenance organization or other health care provider that contracts under this subsection shall meet the certification criteria established by the department of health and family services under s. 49.45 (2) (a) 11.

AB591-ASA3,93,16 (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-ASA3,93,19 1m. The Wisconsin works health plan shall cover in-home psychotherapy for individuals who are under the age of 21 if the in-home psychotherapy is prescribed pursuant to a physical examination under 42 USC 1396 (r) (1).

AB591-ASA3,93,21 1s. The Wisconsin works health plan shall cover insulin if it is prescribed by a physician.

AB591-ASA3,93,24 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-ASA3,94,2 a. Home care, as defined in s. 632.895 (1) (b), in excess of the minimum required under s. 632.895 (2).

AB591-ASA3,94,3 b. Skilled nursing care in excess of the minimum required under s. 632.895 (3).

AB591-ASA3,94,4 c. Over-the-counter drugs.

AB591-ASA3,94,6 d. Treatment of alcoholism or other drug abuse problems in excess of the minimum coverage required under s. 632.89 (2).

AB591-ASA3,94,8 e. Services described under 42 USC 1396d (r) (5), unless the services are otherwise covered under this section.

AB591-ASA3,94,9 (bm) Abortion coverage excluded. 1. In this paragraph:

AB591-ASA3,94,10 a. "Abortion" means the intentional destruction of the life of an unborn child.

AB591-ASA3,94,12 b. "Unborn child" means a human being from the time of conception until it is born alive.

AB591-ASA3,94,15 2. Except as provided in subd. 3., each contract that is entered into under par. (a) shall explicitly provide that it does not include coverage for the performance of an abortion.

AB591-ASA3,94,16 3. This paragraph does not apply to any of the following:

AB591-ASA3,95,2 a. The performance by a physician of an abortion which is directly and medically necessary to save the life of the woman or in a case of sexual assault or incest, provided that prior thereto the physician signs a certification which so states, and provided that, in the case of sexual assault or incest the crime has been reported to the law enforcement authorities. The certification shall be affixed to the claim form or invoice when submitted to any agency or fiscal intermediary of the state for payment or when submitted by an individual health care provider to the coverage provider for payment or for submittal to any agency or fiscal intermediary of the state for payment, and shall specify and attest to the direct medical necessity of the abortion upon the best clinical judgment of the physician or attest to his or her belief that sexual assault or incest has occurred.

AB591-ASA3,95,12 b. The performance by a physician of an abortion if, due to a medical condition existing prior to the abortion, the physician determines that the abortion is directly and medically necessary to prevent grave, long-lasting physical health damage to the woman, provided that prior thereto the physician signs a certification which so states. The certification shall be affixed to the claim form or invoice when submitted to any agency or fiscal intermediary of the state for payment or when submitted by an individual health care provider to the coverage provider for payment or for submittal to any agency or fiscal intermediary of the state for payment, and shall specify and attest to the direct medical necessity of the abortion upon the best clinical judgment of the physician.

AB591-ASA3,95,15 c. The authorization or payment of funds to a physician or surgeon or a hospital, clinic or medical facility for or in connection with the prescription of a drug or the insertion of a device to prevent the implantation of a fertilized ovum.

AB591-ASA3,95,23 4. Quarterly, as determined by the department of health and family services, following any annual quarter in which health care services have been provided under coverage that is affected by this paragraph, the coverage provider shall submit a written report to the agency which contracted for the services of the provider. The report shall specify the number of abortions provided in the previous quarter by the provider to individuals who have coverage for the abortion under this subsection, as permitted under subd. 3. a. or b., the reason for each abortion, and the total cost of each abortion.

AB591-ASA3,96,2 5. A copy of each report submitted under subd. 4. shall be forwarded to the department of health and family services, which shall review the data for compliance with this paragraph and annually publish a summary of the information obtained under this subdivision.

AB591-ASA3,96,7 (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-ASA3,96,10 (d) Premiums. 1. Subject to a modification made pursuant to subd. 2, an individual who receives the Wisconsin works health plan shall pay, in the manner prescribed in subd. 3., the following monthly premium:

AB591-ASA3,96,12 a. For an individual with an income equal to or less than 159% of the poverty line, $20.

AB591-ASA3,96,15 b. For an individual with an income greater than 159% of the poverty line and not greater than 200% of the poverty line, $20 plus $3 for every percentage point by which the individual's income exceeds 159%.

AB591-ASA3,97,2 2. The department of health and family services may submit a proposal to the joint committee on finance to modify the premium amounts under subd. 1. If, within 14 days after the date of receipt of the department's proposal, the cochairpersons of the committee do not notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposed modifications, the department of health and family services may make the modifications specified in the proposal. If, within 14 days after the date of receipt of the department's proposal, the cochairpersons of the committee notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposed modifications, the department of health and family services may not make the modifications specified in the proposal until the committee approves the proposal.

AB591-ASA3,97,3 3. Payment of the premium shall be made as follows:

AB591-ASA3,97,6 a. For a participant in a trial job, the Wisconsin works agency shall deduct the premium from the subsidy that is paid to the employer under s. 49.147 (3) (a). The employer shall deduct the premium from the trial job participant's wages.

AB591-ASA3,97,9 b. For a participant in a community service job or transitional placement, the Wisconsin works agency shall deduct the premium from the participant's monthly grant amount under s. 49.148 (1) (b) or (c).

AB591-ASA3,97,13 c. For an individual not specified under subd. 3. a. or b., the individual shall pay the premium directly to the Wisconsin works agency, or, if the individual and his or her employer agree, the individual's employer may deduct the premium from the individual's payroll and pay the premium to the Wisconsin works agency.

AB591-ASA3,97,17 4. 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-ASA3, s. 94 Section 94. 49.155 of the statutes is created to read:

AB591-ASA3,97,20 49.155 Wisconsin works; child care subsidy. (1) Definitions. In this section:

AB591-ASA3,97,22 (a) "Level I certified family day care provider" means a day care provider certified under s. 48.651 (1) (a).

AB591-ASA3,97,24 (b) "Level II certified family day care provider" means a day care provider certified under s. 48.651 (1) (b).

AB591-ASA3,98,4 (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-ASA3,98,8 (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-ASA3,98,9 1. Meet the school attendance requirement under s. 49.26 (1) (ge).

AB591-ASA3,98,11 2. Work in an unsubsidized job, including training provided by an employer during the regular hours of employment.

AB591-ASA3,98,13 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-ASA3,98,22 4. Participate in other employment skills training, including an English as a 2nd language course, if the Wisconsin works agency determines that the course would facilitate the individual's efforts to obtain employment; a course of study meeting the standards established by the secretary of education under s. 115.29 (4) for the granting of a declaration of equivalency of high school graduation; a course of study at a technical college; or participation in educational courses that provide an employment skill, as determined by the department. An individual may receive aid under this subdivision for up to one year. An individual may not receive aid under this subdivision unless the individual meets at least one of the following conditions:

AB591-ASA3,98,24 a. The individual has been employed in unsubsidized employment for 9 consecutive months and continues to be so employed.

AB591-ASA3,98,25 b. The individual is a participant in a Wisconsin works employment position.

AB591-ASA3,99,4 (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-ASA3,99,8 (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 Wisconsin works agency shall include income described under s. 49.145 (3) (b) 1. to 3.

AB591-ASA3,99,10 (d) The individual satisfies other eligibility criteria established by the department by rule.

AB591-ASA3,99,13 (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-ASA3,99,17 (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-ASA3,99,18 1. Determine an individual's liability under sub. (5).

AB591-ASA3,99,21 2. Provide a voucher to an eligible individual for the payment of child care services provided by a child care provider or otherwise reimburse child care providers.

AB591-ASA3,99,22 3. Set maximum reimbursement rates as provided under sub. (6) (b).

AB591-ASA3,99,23 5. Certify child care providers under s. 48.651.

AB591-ASA3,100,3 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-ASA3,100,7 (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 certified family day care provider, a Level II certified family day care provider or a day care program provided or contracted for by a school board under s. 120.13 (14).

AB591-ASA3,100,10 (5) Liability for payment. (a) Subject to a modification made pursuant to par. (b), an individual is liable for the following percentages of the cost of child care received:

AB591-ASA3,100,12 1. For an individual with an income equal to or less than 75% of the poverty line, 7.5%.