49.153(4)(b)1.1. Except as provided in
subd. 2., the Wisconsin works health plan shall cover the care and services specified under
s. 49.46 (2).
49.153(4)(b)1m.
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).
49.153(4)(b)1s.
1s. The Wisconsin works health plan shall cover insulin if it is prescribed by a physician.
49.153(4)(b)2.
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:
49.153(4)(b)2.d.
d. Treatment of alcoholism or other drug abuse problems in excess of the minimum coverage required under
s. 632.89 (2).
49.153(4)(bm)1.a.
a. "Abortion" means the intentional destruction of the life of an unborn child.
49.153(4)(bm)1.b.
b. "Unborn child" means a human being from the time of conception until it is born alive.
49.153(4)(bm)2.
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.
49.153(4)(bm)3.a.
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.
49.153(4)(bm)3.b.
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.
49.153(4)(bm)3.c.
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.
49.153(4)(bm)4.
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.
49.153(4)(bm)5.
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.
49.153(4)(c)
(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.
49.153(4)(d)1.1. An individual who receives the Wisconsin works health plan shall pay, in the manner prescribed in
subd. 3., the monthly premium that the department of health and family services specified.
49.153(4)(d)3.a.
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.
49.153(4)(d)3.b.
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).
49.153(4)(d)3.c.
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.
49.153(4)(d)4.
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.
49.153 History
History: 1995 a. 289.
49.155
49.155
Wisconsin works; child care subsidy. 49.155(1m)
(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:
49.155(1m)(a)
(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:
49.155(1m)(a)2.
2. Work in an unsubsidized job, including training provided by an employer during the regular hours of employment.
49.155(1m)(a)4.
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:
49.155(1m)(a)4.a.
a. The individual has been employed in unsubsidized employment for 9 consecutive months and continues to be so employed.
49.155(1m)(a)4.b.
b. The individual is a participant in a Wisconsin works employment position.
49.155(1m)(b)
(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.
49.155(1m)(c)
(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.
49.155(1m)(d)
(d) The individual satisfies other eligibility criteria established by the department by rule.
49.155(3)(a)(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.
49.155(3)(b)
(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:
49.155(3)(b)2.
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.
49.155(3)(b)6.
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.
49.155(4)
(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).
49.155(5)
(5) Liability for payment. An individual is liable for the percentage of the cost of the child care that the department specified.
49.155(6)
(6) Child care rates and quality standards. 49.155(6)(a)(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.
49.155(6)(b)
(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 certified family 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).
49.155(6)(c)
(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 certified family 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).
49.155(6)(d)
(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).
49.155(7)
(7) Refusal to pay child care providers. 49.155(7)(a)(a) 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:
49.155(7)(a)1.
1. The person has been convicted of a felony or misdemeanor that the department or county department determines substantially relates to the care of children.
49.155(7)(a)2.
2. The person is the subject of a pending criminal charge that the department or county department determines substantially relates to the care of children.
49.155(7)(a)3.
3. The person has been determined under
s. 48.981 to have abused or neglected a child.
49.155 History
History: 1995 a. 289.
49.157
49.157
Wisconsin works; transportation assistance. A Wisconsin works agency may provide transportation assistance in the manner prescribed by the department. The Wisconsin works agency shall limit any financial assistance granted under this subsection to financial assistance for public transportation if a form of public transportation that meets the needs of the participant is available.
49.157 History
History: 1995 a. 289.
49.159
49.159
Wisconsin works; noncustodial and minor and other custodial parents. 49.159(1)
(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 is subject to a child support order. The Wisconsin works agency may provide job search assistance and case management designed to enable eligible noncustodial parents to obtain and retain employment.
49.159(2)
(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.
49.159(3)
(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.
49.159(4)
(4) Pregnant women. A pregnant woman whose pregnancy is medically verified who would be eligible under
s. 49.145 except that she is not a custodial parent of a dependent child is eligible for employment training and job search assistance services provided by the Wisconsin works agency.
49.159 History
History: 1995 a. 289.
49.161
49.161
Wisconsin works; overpayments. 49.161(1)
(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 not exceed the amount that the department paid in wage subsidies with respect to that participant while the participant was ineligible to participate. The department shall promulgate rules establishing policies and procedures for administrating this subsection.
49.161(2)
(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%.
49.161(3)
(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:
49.161(3)(a)
(a) For intentional program violations resulting in an overpayment that is less than $300, 10% of the amount of the monthly benefit payment.
49.161(3)(b)
(b) For intentional program violations resulting in an overpayment that is at least $300 but less than $1,000, $75.
49.161(3)(c)
(c) For intentional program violations resulting in an overpayment that is at least $1,000 but less than $2,500, $100.
49.161(3)(d)
(d) For intentional program violations resulting in an overpayment that is $2,500 or more, $200.
49.161 History
History: 1995 a. 289.
49.185
49.185
Employment skills advancement program. 49.185(1)(c)
(c) "Family" means an individual who is a custodial parent, all dependent children with respect to whom the individual is a custodial parent and all dependent children with respect to whom the individual's dependent child is a custodial parent. "Family" includes any nonmarital coparent, as defined in
s. 49.141 (1) (i), or any spouse of the individual who resides in the same household as the individual and any dependent children with respect to whom the spouse or nonmarital coparent is a custodial parent. "Family" does not include any person who is receiving benefits under
s. 49.027 (3) (b).
49.185(2)
(2) Grants. A person contracting with the department under
sub. (4) may make an employment skills advancement grant of up to $500 to an individual eligible under
sub. (3) for tuition, books, transportation or other direct costs of training or education in a vocational training or education program.
49.185(3)
(3) Eligibility. An individual is eligible for an employment skills advancement grant only if all of the following eligibility requirements are met:
