I am vetoing section 9123(15s) because it directs DHFS to provide special treatment to the nursing facilities in Racine County. I am requesting the DHFS Secretary to review the recent revision of the labor regions to determine if a more broadly based technical adjustment is warranted.
Reestimate Cost of the Nursing Home Rate Increase. Section 169 [as it relates to s.
20.435 (5) (b), Medical Assistance Program Benefits] contains a reduction in s.
20.435 (5) (b) of $2,031,900 GPR in fiscal year 1997-98 and $2,169,800 GPR in fiscal year 1998-99 to reflect a reestimate of the cost of providing a rate increase to nursing homes. Section 1921 authorizes no more than a 5.4% increase over that paid for services in fiscal year 1996-97 in MA funds for nursing home care.
I am writing down the MA appropriation to reflect reductions of $1,922,300 GPR in fiscal year 1997-98 and $1,991,200 GPR in fiscal year 1998-99. I am also partially vetoing section 1921 to reduce the 5.4% increase to a 5% increase. The most recent information indicates that a rate increase of 5% will allow an adjustment of facility base rates and will meet appropriate industry cost increases.
By lining out the DHFS s.
20.435 (5) (b) appropriation and writing in a smaller amount that deletes a total of $2,690,600 GPR in fiscal year 1997-98 and $8,491,600 GPR in fiscal year 1998-99, I am vetoing the part of the bill which funds this program. I am also requesting the Department of Administration Secretary not to allot these funds.
3. Transfer of Medical Assistance Funds to COP
Section 1932m
This section provides for a potential transfer of funding from the Medical Assistance (MA) GPR appropriation to the community options program (COP), if the utilization of nursing home beds by MA recipients declines. Each year, the Department of Health and Family Services (DHFS) is required to submit a report by December 1st to the Joint Committee on Finance. Using the method specified in this section, the report must compare the use of beds in the most recently completed fiscal year to the use of beds in the prior fiscal year. Then, using the method specified in this section, the report must calculate the cost of that decline and propose a transfer of funds. The Joint Committee on Finance could approve and modify the proposal.
A344
This section would prescribe a method that could result in a transfer of funds that have never been budgeted, or it could result in transferring funds to COP that could not be sustained in the following fiscal year. I am partially vetoing this section to eliminate the overly prescriptive directives about this report and the potential transfer. This veto allows DHFS to develop a more fiscally prudent method for calculating any fiscal effect of decreased bed use and to determine the final dollar amount of any transfer. I am requesting the DHFS Secretary to consult with the Secretary of Administration in the development of this report and transfer amount.
4. Medical Assistance Dental Pilot Project
Section 1942m
This section directs the Department of Health and Family Services (DHFS) to develop a pilot project for the provision of Medical Assistance dental services under a managed care system. DHFS must seek any federal waivers necessary to implement this pilot. If these waivers are granted and if the pilot would be cost-effective, DHFS must implement the pilot project no later than January 1, 1998 and end it by June 30, 1999.
I am partially vetoing this section to delete the dates. The late passage of the 1997-99 budget will prevent DHFS from beginning such a project by January 1, 1998. This veto will allow DHFS to choose the starting and ending dates of this pilot project.
5. Badger Care
Section 1980p
This section creates a new health insurance program for low income families and requires the Department of Health and Family Services (DHFS) to promulgate all administrative rules required for the program no later than 60 days after receipt of the federal waivers that allow implementation of Badger Care.
I am partially vetoing this section to remove the requirement that DHFS promulgate these rules within 60 days because 60 days is not sufficient time to promulgate rules. I am requesting the DHFS Secretary to promulgate these rules as quickly as possible after receipt of the federal waivers and to use the emergency rules process if necessary.
6. Wisconcare
Sections 169 [as it relates to s.
20.435 (5)(gp) and
(5)(kp)], 554b, 594m, 3010m, 3010p, 3011, 3011m, 3012 and 9223
These sections restructure the Wisconcare program, which provides basic health care to individuals in 17 counties with high rates of unemployment. Under the bill, the program would be made into a statewide, competitive grant program with services to be provided by nonprofit, community-based corporations. Funding would remain at $1,500,000 PR per year except that in fiscal year 1997-98, an additional $150,000 in carryforward revenue would be used to serve persons previously served under the existing program. The sections also move the existing appropriation organizationally between programs one and five within the Department of Health and Family Services (DHFS), create a new appropriation in program 5 and direct a lapse from the moved appropriation to the general fund of $725,900.
I am vetoing sections 3010m, 3010p, 3011, 3011m and 3012 because the restructuring of the program dilutes the effectiveness of the current program by spreading the funds across the state rather than focusing health care services provision on the 17 counties currently served. Further, as constructed, an unfunded mandate is created to serve those who are treated under the current program in the future. While minimal one-time funding is available in fiscal year 1997-98, no additional funds are provided after that. Finally, the creation of a grant program will lose the efficiencies gained under the current program. Currently, the DHFS fiscal agent, EDS, processes claims payments and disallows unauthorized costs, freeing up more funding for legitimate claims. I believe the existing program is properly targeted to areas of high unemployment, works well and should continue as under current law.
I am vetoing sections 169 [as it relates to 20.435(5)(gp) and (5)(kp)], 554b and 594m in order to retain the current program appropriation language.
I am vetoing section 9223 because it directs a lapse from an appropriation, which is eliminated in this veto. However, since the Legislature and I intend that accumulated funds be lapsed from this program to the general fund, I am requesting the Department of Administration Secretary to lapse $725,900 from appropriation 20.435(1)(gp), which will be the appropriation that contains the funds, on the effective date of the bill.
7. HIRSP Program Conversion
Section 3026f
This section defines the parameters for the payment of plan costs under the Health Insurance Risk Sharing Plan (HIRSP) after the move of the program to DHFS on January 1, 1998. One provision requires DHFS to set premium rates, insurer assessments and provider payment rates for the period January 1, 1998 to June 30, 1998. I am vetoing this provision because it will not be possible for DHFS to complete the setting of these rates by January 1, 1998.
The other provisions in this section that redefine the HIRSP program are interpreted to mean that the new parameters need not be used until July 1, 1998, because the method of setting the rates will now not apply until the beginning of a plan year.
I am requesting DHFS to complete the rate setting procedure as quickly as possible. However, given the complexity added by the Legislature in not using the existing rates under Medical Assistance as I proposed and the late passage of the budget by the Legislature, the date of January 1, 1998 is unachievable.
8. County Support for County Residents
Section 2136
A345
This section allows the Department of Health and Family Services (DHFS) to bill a county for part of the cost of an individual's care at one of the state centers for the developmentally disabled if an independent review has shown that the person could be served appropriately in the community. This was created as an incentive for counties to support community placements in accordance with state and federal directives for deinstitutionalization. However, under the bill, a county can be charged $48 per day only if the guardian or the individual's parents do not object to a community placement. I am partially vetoing this section to remove the reference to the objection of the guardian or the parent in order to maintain the fiscal incentive to counties to accept community placements. While many parents or guardians are initially opposed to placing their child or their ward in the community, DHFS has been very successful in working closely with parents and guardians to develop community placements which are acceptable to the parent or guardian and appropriate to the level of care the individual needs. By removing the reference to the objection of the guardian or parent, DHFS can continue to charge counties for part of the cost of care for those who could appropriately be placed in the community but who remain in the institution.
9. Supervised Release Placements
Sections 5491d and 5491y
These sections prohibit the Department of Health and Family Services (DHFS) from releasing a sexual predator into a county which contains a facility in which a predator was previously placed. I am vetoing these sections because, as written, the language can be interpreted more broadly than was intended and would severely limit the department's ability to place these individuals under supervision in the community. Under current law, a predator is placed on supervised release in that person's county of residence unless that county declines in which case DHFS must find another county which will accept the person. Predators cannot be released to either one of the two counties which currently have facilities in which the predators are housed unless that county is the person's county of residence. A broader interpretation implies that the predator could not be released into any county which had a facility in which the person was ever placed including other Division of Care and Treatment facilities or correctional institutions. This would make the already difficult process of placing a predator in the community all that much harder.
Although I am vetoing this language because it is subject to misinterpretation, I appreciate the need to address the problem of community placement for sexual predators and encourage the Legislature to revisit this issue and to propose language which will not be subject to misinterpretation.
10. Runaway Services
Section 1500m
This section requires the distribution of $100,000 GPR in each fiscal year as grants to programs that provide services for runaways. I am partially vetoing this section to provide a total of $100,000 GPR during the biennium because organizations currently receive federal funding from the state for this program. I am requesting the Department of Administration Secretary to place $50,000 GPR in fiscal year 1997-98 and $50,000 GPR in fiscal year 1998-99 in unallotted reserve in appropriation s.
20.435 (7) (bc) to lapse to the general fund.
11. Milwaukee Child Welfare Services Site Selection
Section 9123 (1) (dz)
This section requires the Secretary of Administration, in consultation with the Department of Health and Family Services (DHFS), to submit a proposal for the selection of the five neighborhood-based child welfare service delivery sites planned for Milwaukee County to the Joint Committee on Finance (JCF) for the Committee's 14 day passive review. I am vetoing this section because the sites were already selected and the leases were signed prior to the motion action by JCF.
12. Alcohol and Drug Abuse Initiatives
Sections 169[as it relates to s.
20.435 (6) (gb)], 595m, 595n and 9423 (2g)
These sections change the alcohol and drug abuse initiatives appropriation from continuing to annual and specify that the Department of Health and Family Services (DHFS) must allocate at least $112,500 PR from the appropriation for grants to local organizations that conduct community based programs to prevent alcohol and other drug abuse. Section 595m also transfers $250,000 PR from this appropriation to Community Aids.
I am partially vetoing sections 169 [as it relates to s.
20.435 (6) (gb)], 595m and 9423 (2g) and vetoing section 595n to retain the appropriation as continuing. I want the department to have the flexibility available with a continuing appropriation, especially in light of the department's tight operating budget. Any increased funding from this appropriation must be approved by the Department of Administration.
I am also partially vetoing section 595m and vetoing section 595n to remove the stipulation that DHFS must allocate at least $112,500 PR from the appropriation for grants to local organizations that conduct community based programs to prevent alcohol and other drug abuse. While I am sensitive to the concerns that exist regarding the level of grants funded for the Alliance for a Drug Free Wisconsin, I want the department to have some flexibility in using the funds, especially for local technical assistance which is of equal importance to the grantees. However, I am requesting the DHFS Secretary to annually award a minimum of $94,000 PR in mini grants to local Alliances.
13. Compulsive Gambling Awareness Campaign
A346
Section 169 [as it relates to s.
20.435 (7) (kg)] provides $100,000 PRS annually to the Department of Health and Family Services (DHFS) for compulsive gambling awareness campaigns. Section 1410g requires DHFS to provide grants to individuals or organizations in the private sector for the campaigns. Section 1410g also requires DHFS to annually develop a plan for awarding the grants and to submit the plan to the Joint Committee on Finance for the Committee's 14 day passive review. I am partially vetoing section 169 [as it relates to s.
20.435 (7) (kg)] to provide $100,000 PRS in fiscal year 1998-99 for compulsive gambling awareness campaigns. Future funding will be part of my compact negotiations with the Native American tribes. I am also partially vetoing section 1410g to delete the requirement that DHFS annually develop a plan for awarding the grants and submit the plan to the Joint Committee on Finance for the Committee's 14 day passive review. No resources were given to DHFS for this project and the 14 day passive review places an additional burden on the department in administering the campaigns.
14. Benefit Specialist Program
Section 169 [as it relates to s.
20.435 (7) (dj)] appropriates $1,160,000 GPR in fiscal year 1997-98 and $1,160,000 GPR in fiscal year 1998-99 for the benefit specialist program. Although there is no language in the budget bill that authorizes this increase, the Joint Committee on Finance passed a motion during its budget deliberations to authorize increased funding this program. Of the funding appropriated, $150,000 GPR annually was intended for a full time attorney trained in Indian Law and half time specialists for ten Native American Tribes.
I object to the funding for the full time attorney since I believe the tribes have the resources to employ their own attorney if needed for this program. By lining out the DHFS s.
20.435 (7) (dj) appropriation and writing in a smaller amount that deletes $35,600 GPR in fiscal year 1997-98 and $35,600 GPR in fiscal year 1998-99, I am vetoing the part of the bill which funds this program. I am also requesting the Department of Administration Secretary not to allot these funds.
15. Income Augmentation Funds
Section 1486m
This section requires the Department of Health and Family Services (DHFS), in consultation with the Department of Administration, to submit to the Joint Committee on Finance a plan for the use of the portion of excess Title IV-E, Medicare or Medical Assistance funds that are not allocated to counties or used exclusively for the operational costs of augmenting federal income. The plan could be approved and modified by the Committee.
I am partially vetoing this section to permit DHFS to implement the plan for the use of these funds after approval is granted by the Department of Administration Secretary. Most changes to federal appropriations can be approved by the Department of Administration Secretary. This veto will allow for the same level of review and oversight of this appropriation as is provided for other similar federal appropriations.
16. Department of Health and Family Services Studies
Sections 9123 (4t), 9123 (5) and 9123 (11mp)
Section 9123 (4t) requires the Department of Health and Family Services (DHFS), in conjunction with other state agencies, to study the correlation between the presence of wetlands and an increase in the number of cases of blastomycosis, which is a fungus infection creating lesions on the skin and lungs. I am vetoing this study because, for medical and scientific reasons, there is no reliable way to analyze this issue and there have been only 12 outbreaks of this disease in the United States since 1954. First, because of the highly variable incubation period, there is no way to tell where a person became infected. Second, staff have already noted that there is no apparent correlation between reported cases of the disease and the number of acres of wetlands in the county. Such a study is unnecessary.
Section 9123 (5) requires DHFS to conduct in-depth studies on the requirements for a statewide health insurance program for uninsured families and school-age children. Among other requirements under this section would be an evaluation of current Medical Assistance outreach efforts, a study on the cost effectiveness of expanding the medical income standard for children and a cost-benefit study of three different approaches to providing health services to these populations.
I am vetoing this section because it is unnecessary. The problems that prompted the request for this study will be addressed in the Badger Care program. Much of the work of this study has already been done as preparation for the budget and for the application for federal waivers for Badger Care. This veto deletes the requirement for the study.
Section 9123 (11mp) requires DHFS to study the feasibility of offering family insurance coverage under the HIRSP program which is an insurance program for high-risk individuals who cannot otherwise get insurance. I am vetoing the study requirement because the creation of Badger Care in this budget will extend insurance coverage to a significant number of children and families and another study is unnecessary.
INSURANCE
17. Chiropractor Liens
Sections 5165c, 5165m, 5165o, 5165q, 5165s, 5165u, 5165x, 9356 (9h) and 9456 (4z)
These sections allow chiropractors to file liens for services rendered against settlements of personal injury suits. Under current law, only charitable institutions which operate hospitals are eligible to file a lien against a person's settlement which recognizes the fact that they provide services to people who are unable to pay their bills and should be able to recoup payment if possible. I am vetoing these provisions because chiropractic practices are not charitable institutions that serve persons regardless of their ability to pay.
A347
My administration has taken many steps to ensure that all health care providers are treated fairly by insurers and managed care organizations. On behalf of chiropractors and other health care providers, we continually review the activities of insurers to guarantee equitable treatment. This language would separate chiropractors from other providers, the opposite of our shared goal since 1987. I would welcome the opportunity to work with chiropractors to advance an alternative approach to help them accomplish their objectives.
18. Insurance Mandate for Dental Coverage
Section 4930t
This section creates a mandate for the coverage of the correction of temporomandibular disorders in insurance policies. I am partially vetoing this section to eliminate from this mandate the specific inclusion of coverage of medically necessary surgery for the correction of functional deformities of the maxilla or mandible, because this language expands the scope of legislative intent beyond the correction of temporomandibular disorders in providing this coverage.
WORKFORCE DEVELOPMENT
19. Wisconsin Works (W-2) Participation in Technical College Courses
Section 1812w
This section allows a W-2 participant to count up to 15 hours of time spent attending technical college courses, including time spent traveling to and from classes, toward the work requirement of Community Service Jobs and W-2 Transition slots. This would be in addition to the 10 hours and 12 hours per week of education and training that are already allowed for Community Service Jobs and W-2 Transition positions, respectively.
I recognize the importance of education and training in an individual's move toward self sufficiency. In developing W-2, I ensured that opportunities for these activities were included in the participation requirements. I am vetoing this section because this change would significantly alter the focus of the W-2 program. The philosophy behind W-2 is that the first and best step that a person who applies for assistance can take is to obtain work experience. Immediate attachment to the workforce has proven to be a more successful approach to helping people obtain self-sufficiency than educational programs.
I do believe, however, that the technical colleges have an important role to play in W-2 and in helping people move forward in the labor market. By offering short-term, customized labor-training programs, technical colleges can help W-2 participants with little or no education or work experience get that "first" job. By offering flexible longer-term education and training programs that complement people's work experience and schedules, the technical colleges can help people take the next step, advancing their careers while supporting their families. This veto will retain W-2's focus on immediate workforce attachment for W-2 participants. As W-2 progresses, we will continue to examine the balance of work experience and education and training.
20. Grant for Second Parent
Sections 1820c and 1857p
These provisions require W-2 agencies to pay a grant of up to $555 per month for required work activities to the "second" parent in a two-parent family under certain circumstances. First, both parents have to reside with the dependent child. Second, the "first" parent must be in a W-2 subsidized employment position. Third, the family must be accessing federally funded child care. Fourth, neither adult in the family may be disabled or caring for a severely disabled child. Combined, the two parents must be participating in 55 hours of required work activities to meet the federal work requirements.
I am partially vetoing these provisions because under W-2, similar to the Aid to Families with Dependent Children (AFDC) program, only one grant or wage subsidy is provided to each family, while both parents have an obligation to help support their family. Therefore, if the second parent is not staying at home to take care of the children and is consequently accessing federally funded child care, he or she should also be making progress in work activities. This veto will eliminate the requirement that each parent receive a type of subsidized employment grant.
21. Suspension of the Work Requirement for Parents of Disabled Children
Sections 1812e, 1812j, 1812k, 1812p, 1812t and 1812u
These sections specify that the W-2 work and education requirement of the W-2 Transition placement is suspended if the participant is a single parent of a disabled child and if the W-2 agency determines that he or she is needed in the home for at least 40 hours per week to provide care for the disabled child.
I am vetoing these sections because they create a mandatory exemption from the W-2 Transition work and education requirement that is unnecessary. I understand an exemption may be appropriate under some circumstances. However, W-2 agencies already have the flexibility to determine appropriate activities for individuals in W-2 Transition positions. These activities may include caring for a disabled child in the home. These provisions are too broad and could prevent a W-2 agency from requiring a parent to participate in activities which could lead to self-sufficiency during hours that the child is in school.
22. W-2 Dispute Resolution
Section 1831g
This section defines the Department of Workforce Development's (DWD) role in the W-2 dispute resolution process. DWD is required to give an opportunity for a fair hearing to any individual who petitions for a review of a W-2 agency decision. DWD also must allow the individual to present evidence and testimony and to be represented by legal counsel at the hearing. The individual also has a right to have access to the records pertaining to their case prior to the hearing.
A348
I am partially vetoing this section because the department's role in the W-2 dispute resolution process was intended to primarily be a desk review of the case file. I believe a formal fair hearing for each contested case is duplicative of the W-2 agency's efforts and will unnecessarily lengthen the time it takes to resolve disputes. The W-2 agency is already required to convene a fact-finding session as the first level of review. At this level, a W-2 participant may appear with a representative, present his or her arguments and documents and ask questions of agency staff. If the department or its designee, the Department of Administration's Division of Hearings and Appeals, determines the file provided by the W-2 agency is inadequate, it has the authority to access additional information. This may be done informally or through a hearing. With this partial veto, I am preserving a dispute resolution process which is fair while less formal and legalistic than the AFDC "fair hearing" process.
23. Plan on State Funding of Tribal TANF Programs
Sections 627, 627b and 1857o
