I am requesting that the Department of Administration secretary place $1,722,500 GPR in fiscal year 1999-2000 and $2,277,500 GPR in fiscal year 2000-2001 in unallotted reserve in appropriation s. 20.435 (4) (b) to lapse to the general fund.
13. Supplemental Outpatient Hospital Payments
Section 1384g
This section directs the Department of Health and Family Services (DHFS) to distribute not more than $2,451,000 (all funds) in each fiscal year, beginning on July 1, 2000, as a supplemental payment to hospitals for which Medical Assistance (MA) revenues were at least 8% of the hospital’s total revenues in the hospital’s most recent fiscal year prior to the year of the payment. I am partially vetoing this provision to make this a one-time payment in fiscal year 2000-2001. The intent of the payment is to offset a portion of hospitals’ increasing costs related to providing uncompensated care to patients without health insurance coverage. With the BadgerCare program in place, these costs are likely to decline, therefore reducing the need for an on-going supplemental payment.
I am also partially vetoing this section to correct a technical error in the statutory language outlining the distribution methodology. The methodology contained in this section would result in each hospital’s supplemental payment being equal to the hospital’s total amount of MA revenues in the previous year. I am partially vetoing the section to correct the methodology so that each qualifying hospital would receive the percentage of the supplemental funds available that is equal to that hospital’s percentage share of total MA revenues of all qualifying hospitals.
Finally, I am also partially vetoing this section to allow DHFS to calculate payments based on data from the prior state fiscal year, as opposed to calculating the payments based on each hospital’s fiscal year. Not all hospitals operate on the same fiscal year. Requiring DHFS to calculate payments over differing time periods is needlessly burdensome. This partial veto will standardize the time period over which all payments are calculated.
14. Medical Assistance Asset Test
Sections 1433t, 1433tm, 1433u, 1437m, 1437n, 1437p, 1437q, 1439g and 1439q
These sections eliminate the asset test for AFDC-related Medical Assistance (MA) eligibility. No funding was provided for this provision based on the assumption that all adults who do not meet the current AFDC-related categorically needy MA test would be BadgerCare eligible. I am vetoing this provision because I disagree with this assumption. BadgerCare will not cover the following individuals: (1) nonlegally responsible relative caregivers; (2) adult parents and their spouses with access to an employer-subsidized family group health plan where the employer pays at least 80% of the premium; and (3) adult parents and their spouses with health insurance coverage in the last three months that meets the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard plan definition. The Department of Health and Family Services estimates that the elimination of the asset test will increase MA program costs by approximately $1,723,900 GPR and $2,460,000 FED per year.
15. Irrevocable Burial Trusts and Medical Assistance (MA) Eligibility
Sections 2923mn and 9442 (2c)
Under the budget bill, the amount of an irrevocable burial trust that may be excluded from assets when calculating MA eligibility increases from $2,000 to $2,500 on January 1, 2001, and to $3,000 on July 1, 2001. Because funding has only been provided for the last six months of the 1999-2001 biennium, this provision creates a significant cost-to-continue problem for the next biennium, which is unacceptable.
I am vetoing section 2923mn and partially vetoing section 9442 (2c) to eliminate the second increase from $2,500 to $3,000 because it commits the state to increased general purpose revenue expenditures in the next biennium.
16. Medical Assistance (MA) School-Based Services
Sections 1427j and 9123 (13d)
Section 1427j directs the Department of Health and Family Services (DHFS) to reimburse school districts, cooperative educational service agencies and the Department of Public Instruction (DPI) (on behalf of the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf) for 90% of the federal share of allowable administrative costs on a quarterly basis. I am partially vetoing this section to eliminate the requirement that DHFS reimburse these entities on a quarterly basis. Reimbursement on a quarterly basis does not coincide with the nine-month school year and this requirement would be administratively cumbersome to DHFS and to school districts. The reimbursement schedule currently in place, under which school districts receive reimbursement twice per year, is sufficient to ensure regular participation in the program.
Section 9123 (13d) specifies that DHFS shall reimburse school districts, cooperative educational service agencies and DPI (on behalf of the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf) for 90% of the federal share received for school-based services in excess of $16,100,000 annually. Under this provision, participating entities would receive 60% of the federal reimbursement for school medical services provided and 90% of federal reimbursement for administrative costs until federal reimbursement exceeds $16,100,000, at which point participating entities will receive 90% of federal reimbursement for both school medical services and administrative costs. The section further directs DHFS to submit, as part of its 2001-2003 biennial budget request, an increase in the percentage of the federal share received by educational entities for the provision of school-based services to reflect the total percentage of the federal share for which these educational entities were reimbursed in state fiscal year 1999-2000. I am vetoing this directive because it replaces the two-tiered reimbursement system aimed at encouraging participation in the program, with a flat, blended rate. I am directing DHFS to monitor participation based on the new rates and, if it is determined that improvements are needed, to propose a different rate structure in the next biennial budget.
17. BadgerCare Outreach
Section 1476f
This provision directs the Department of Health and Family Services (DHFS) to coordinate with the Department of Public Instruction (DPI) to develop and implement an outreach mailing targeted at families of children enrolled in the federal school lunch program to inform them of the BadgerCare program.
I am vetoing this provision because a similar effort is already underway. DPI recently sent a letter to every school district in the state encouraging them to inform families of the BadgerCare program. As a result, the Milwaukee Public Schools created a flyer about BadgerCare which was distributed to students. Several other school districts have included BadgerCare information with applications for the federal school lunch program. In addition, it is my understanding that President Clinton has initiated a similar campaign at the federal level. I am directing DHFS to continue to coordinate with DPI to conduct BadgerCare outreach activities in Wisconsin schools.
18. Nocturnal Enuresis Feasibility Study
Section 9123 (7t)
This section directs the Department of Health and Family Services (DHFS) to conduct a study on the cost and efficacy of urine alarms used in conjunction with behavior modification therapy and case management, including bimonthly visits with a specialist, as a treatment for nocturnal enuresis (commonly referred to as bedwetting).
I am vetoing this study because the Wisconsin Medical Assistance (MA) program currently covers a number of methods and services that parents can use to address this problem, including case management, counseling and urine alarms. DHFS has concluded the successful use of urine alarms is best achieved when supervised by the child’s primary care physician as part of a comprehensive care plan. In addition, current literature and recommendations from the Nocturnal Enuresis Society do not indicate the need for outside supervision in conjunction with the use of urine alarms. Finally, the vast majority of MA recipients with this diagnosis are children who are enrolled in managed care plans. Health maintenance organizations routinely evaluate the effectiveness of such treatments and choose what they believe to be the most effective option.
Sections 30d, 172 [as it relates to s. 20.436 (1) (tb) and (tc)], 717t, 2486g, 9101 (20c) and 9158 (11mg)
These sections create the Tobacco Control Board (board) to develop a state plan for spending the funds received under the tobacco settlement and set aside $25,992,000 of those funds in a separate segregated fund. The board is attached administratively to the Department of Health and Family Services (DHFS). The sections also define the duties of the board, identify the activities on which the funds can be spent and provide 2.0 FTE SEG positions. An annual report is required each year evaluating the success of the grant program and audits are required of the University of Wisconsin Center for Tobacco Research and Intervention and the Medical College of Wisconsin. Finally, the Department of Administration (DOA) is required to study the possibility of selling and transferring the state's rights to the monies to establish a permanent endowment fund.
Prior to outlining my vetoes, I want to underscore the importance of investing dollars in worthy and effective programs to prevent smoking, as well as further research on both the health-effects of smoking and medical care for those who suffer from tobacco's ill effects. I fully expect this funding, which provides more than ample resources, will enable Wisconsin to be a bold leader in an aggressive battle to tackle smoking.
First, I am partially vetoing section 30d [as it relates to the board members, terms and number of meetings] because I am dissatisfied with the board's composition. My concern with the board as statutorily constituted stems from what I believe is an unbalanced composition that keeps important constituencies, such as retailers and parents of teenagers, from having a place at the table. I am also vetoing section 9158 (11mg) which specifies the expiration dates of certain members because it is no longer necessary if the specific membership of the board is not set statutorily.
Second, I am partially vetoing section 30d [as it relates to DHFS sending the board's budget to DOA without changes] because it is inconsistent with language which governs all attached boards. Under s. 15.03, "budgeting, program coordination and related management functions shall be performed under the direction and supervision of the head of the department" to which the board is attached. The agency that is responsible for the state's tobacco control program should have input into the board's budget, and my partial veto ensures this input will occur.
Third, while I recognize there was substantial compromise in reconciling the funding level proposed by each house, I still believe the final, agreed upon amount is too high. As a result, I am partially vetoing section 717t so that a total of $23,500,000 SEG will be available for the biennium, which will save $2,492,000. As a result, I am writing down the amounts in s. 20.436 (1) (tb), the administrative appropriation, by $200,000 SEG in fiscal year 1999-2000 and in s. 20.436 (1) (tc), the grants appropriation, by $2,292,000 SEG in fiscal year 2000-2001 to what I believe are more reasonable funding levels. I am requesting the Department of Administration secretary not to allot these funds. I am retaining the full amount of funding for administration in fiscal year 2000-2001 in order to ensure that the board has sufficient funding to reimburse DHFS for the cost of services, such as accounting or personnel, provided to the board.
Fourth, I am partially vetoing section 2486g which describes the duties of the board to eliminate the provision that the plan for spending the tobacco settlement funds must conform to the model developed by the Centers for Disease Control and be modeled after successful tobacco control programs in other states. While I understand it is not effective practice to reinvent the wheel, I believe the board members should not be constrained by these limitations. I want to provide each member with greater flexibility and encourage creativity and forward-thinking as they develop and propose programs to meet the specific needs of Wisconsin residents.
Finally, section 9101 (20c) requires DOA to study the possibility of selling and transferring Wisconsin's rights to the tobacco settlement funds in order to create a permanent endowment fund. The study is to be completed by January 1, 2000. I am partially vetoing this section to eliminate the study due date in order to provide more time for the department to complete a thorough and comprehensive review.
20. Women, Infants and Children (WIC) Electronic Benefits Transfer
Sections 34b, 2435q and 9123 (8d)
These sections establish a WIC Council attached to the Department of Health and Family Services (DHFS) which will review the program and make recommendations on needed changes in policy and procedures to the DHFS secretary and the Legislature. They also require DHFS to study the feasibility of an electronic benefits transfer program for WIC and submit the study to the Joint Committee on Finance (JCF) by January 1, 2002. The study would specify the information systems requirements, the compatibility of such a system with existing electronic benefits transfer programs and the costs of such a system.
I am vetoing the provisions establishing a council because it is duplicative. DHFS already has an advisory council which addresses policies and procedures in the WIC program. I am also partially vetoing the specific topics to be addressed in the feasibility study. I am interested in the possibility of using the electronic transfer of benefits in the future and I would like to learn what other states are developing now. However, I believe it is premature to conduct the study as proposed given the difficulty several states are experiencing in trying to develop this type of system. I am also vetoing the provision requiring the submission of the study to JCF and the due date, to provide DHFS some additional flexibility.
_Toc40102816121. Community Health Centers and the Minority Health Program
Sections 172 [as it relates to s. 20.435 (5) (fh)] and 2400m
Section 2400m provides $3,500,000 GPR in fiscal year 1999-2000 and $4,000,000 GPR in fiscal year 2000-2001 for federally qualified health centers. Section 2400m also provides $100,000 GPR in each fiscal year for the Mary Mahoney Health Services Center in Milwaukee. Finally, section 172 [as it relates to s. 20.435 (5) (fh)] provides $300,000 GPR annually to support a minority health program which will provide grants to improve minority health and a minority health media campaign.
While the federally qualified health centers provide a valuable service, I believe the amounts appropriated are excessive. Therefore, I am vetoing section 2400m [as it relates to the federally qualified health centers' allocation language] in order to reduce funding for these centers to $2,500,000 in fiscal year 1999-2000 and $3,000,000 in fiscal year 2000-2001. I am also partially vetoing funding in fiscal year 2000-2001 in section 2400m [as it relates to the Mary Mahoney Center] and the minority health program to avoid building these costs into the next biennium's base spending. Instead, I am asking these programs to apply for additional funding through a grant from the Tobacco Control Board. I am requesting that the Department of Administration secretary place $1,000,000 GPR in fiscal year 1999-2000 and $1,100,000 GPR in fiscal year 2000-2001 into unallotted reserve in appropriation s. 20.435 (5) (fh) to lapse to the general fund. I am also writing in a smaller amount in s. 20.435 (5) (fh) to reflect the GPR reduction in funding for the minority health program which should seek support in the second year from tobacco settlement funds. I am requesting the Department of Administration secretary not to allot the $300,000 for the minority health program.
22. Consolidated Contracts
Sections 999m and 9323 (11m)
These sections require the Department of Health and Family Services (DHFS) to submit a plan to the Joint Committee on Finance (JCF) for approval under the 14-day passive approval process to consolidate a variety of public health contracts for such activities as lead poisoning prevention and family planning. This language was developed in response to concerns from many organizations and public health departments that the inclusion of the family planning funds in the consolidated contract would politicize the provision of these services, as it already had in two counties, if the contract had to be approved by the county board of supervisors. To ensure that these services continue to be provided statewide and to not impede the progress of the rest of the consolidated contract proposal, I have directed DHFS to remove family planning services from the consolidated contract. I am vetoing the language requiring JCF review since the primary problem it was designed to address has been resolved.
23. Newborn Hearing Screening Program
Sections 172 [as it relates to s. 20.435 (5) (jk)], 368r, 368s, 434r, 434s, 434t, 1649r, 1649s, 2439r, 2439s and 9423 (11g)
These provisions establish a newborn hearing screening program under which grants would be made to hospitals to purchase equipment for hearing tests and to provide training. The program would be funded by a $2 increase in the cost of a birth certificate for the period October 1, 1999, (or on the first day of the month after publication, whichever is later) through December 31, 2001. The Department of Health and Family Services (DHFS) is required to collect data on the number of babies born in hospitals that test hearing. If, by August 5, 2003, DHFS determines that less than 88% of babies born in the state are delivered at hospitals which do not administer hearing tests, then DHFS must require all hospitals in the state to provide the tests.
I believe this program has merit, but I believe that funding the program with increased fees from birth certificates is inappropriate. As a result, I am vetoing the appropriation under s. 20.435 (5) (jk) and other sections related to the funding for this program. I am, however, retaining the programmatic language and asking the groups that support this program to work together to propose a more appropriate source of funding for the program.
24. Birth and Developmental Outcome Program
Section 172 [as it relates to s. 20.435 (1) (a)]
Section 172 [as it relates to s. 20.435 (1) (a)] provides $100,000 GPR in fiscal year 1999-2000 and $200,000 GPR in fiscal year 2000-2001 to purchase the services of a medical records abstractor to collect and study data on children with birth defects. I am reducing funding for this purpose by $100,000 in the second year because there was no justification to document the need for increasing the level of funding for this program in the second year. By lining out s. 20.435 (1) (a) and writing in a smaller amount, I am vetoing the part of the bill that funds this provision. I am also requesting the Department of Administration secretary not to allot these funds.
25. Health Insurance Risk Sharing Plan (HIRSP)
Sections 2277t and 2278g
Section 2277t allows the HIRSP Board or the Department of Health and Family Services (DHFS) to adjust the income eligibility brackets for the premium and deductible subsidies by the consumer price index. Prior to making these adjustments, the HIRSP Board and DHFS must obtain approval of the Joint Committee on Finance (JCF). I am partially vetoing the provision that requires JCF approval because the additional oversight provided by the committee is unnecessary.
Section 2278g requires DHFS to obtain approval from the HIRSP Board before developing rules on cost containment strategies such as prior authorization requirements. I am vetoing this provision to ensure that departmental staff have flexibility in establishing cost containment strategies. However, I am directing the DHFS secretary to consult with the HIRSP Board with respect to these policies prior to issuing any new rules.
26. Caregiver Background Checks Recidivism Study
Section 9111 (4xx)
This section directs the Department of Corrections (DOC), in conjunction with the University of Wisconsin-Madison (UW), to prepare a report on the correlation between prior convictions and the propensity to commit future acts of abuse, neglect or misappropriation. I am partially vetoing this section to delete DOC participation in the study. Many crimes of abuse, neglect and misappropriation are misdemeanors, and records of these crimes are kept at the county level. Court records, not DOC records, are a more appropriate and comprehensive source of data for this study. I am requesting the UW to submit the report to the Legislature in the manner provided under s. 13.172 (3) of the statutes no later than June 30, 2001.
27. Income Augmentation Contract
Sections 456r, 1091k and 9323 (13f)
These sections require the Department of Health and Family Services (DHFS) to perform activities to augment income received under 42 USC 670 to 679a, 42 USC 1395 to 1395ddd and 42 USC 1396 to 1396v (foster care, Medicaid and Medicare). Under these sections, DHFS is required to perform these activities itself and may not contract with any person to perform these activities. I am vetoing these sections because I want DHFS to have the flexibility to augment federal income in a manner that maximizes the amount of income the state receives from the federal government. The vendor currently under contract with DHFS has already documented $68.1 million in retroactive claims that the state has since collected.
28. Data Collection Proposals
Section 9123 (8mx)
This section requires that two proposals be developed regarding health care data collection. The first allows the Department of Health and Family Services (DHFS) to develop and submit a request by June 30, 2001, for expenditure and position authority to the Department of Administration (DOA) that would allow DHFS to collect health care data from physicians and would include recommendations regarding how that activity might be funded. DOA may submit the proposal, along with any legislation necessary to implement the proposal, to the Joint Committee on Finance (JCF) for approval under the 14-day passive review process. The second proposal is a joint effort of DHFS, the Office of the Commissioner of Insurance and the Department of Employe Trust Funds to develop a memorandum of understanding among the agencies regarding the consolidation of health care data collection activities. This proposal would be sent to DOA which would forward the proposal with any modifications and any needed language to JCF for approval under the 14-day passive approval process.
I am vetoing the provision under which DHFS may submit a proposal to collect health care data from physicians because it is no longer necessary. This provision was incorporated in the JCF version of the bill. However, in a later step in the legislative process, the staff and funding needed to collect the data were approved.
I am also vetoing the provision requiring the three agencies to develop a proposal for a consolidated data collection system because it, too, is unnecessary. All three agencies are currently members of the Interagency Coordinating Council whose charge is specifically to coordinate health care data collection activities among all state agencies.
29. Five-Year Age Increments
Section 2280c
This provision, which is part of a larger initiative on the confidentiality of health care records, describes the data elements which can be included in public use data files. It specifically indicates that a person's age must be included in 5-year increments up to age 80 and a category of 80 and over. Groups conducting research on geriatric health indicate there are significant health differences in people over 80 and would prefer to have data on that age group reported in 5-year increments as well. Therefore, I have partially vetoed this section to ensure that all data are reported in 5-year increments regardless of age.
30. Social Security Numbers on State Documents
Sections 936t, 944w, 2359tb, 9315 (1p), 9315 (2p) and 9317 (3p)
These sections prohibit the Departments of Employe Trust Funds and Employment Relations from using social security numbers as an identifier on state documents, including agency time sheets, deferred compensation statements and retirement system statements.
While I most definitely support efforts to protect people's identities, I do not believe that the fiscal impact of these provisions was clearly defined. Both agencies reported that they would need significant funding to completely overhaul their information systems which use the social security number as the primary link between payroll, time reporting and benefits accounting. For these reasons, I am vetoing the provisions related to the use of social security numbers on state documents.
I am asking these agencies to comply with the spirit of the language to the extent that they can and I am asking members of the Governor's Task Force on Privacy to address this issue and provide me with recommendations which can be included in the January legislative session.
INSURANCE
31. Point-of-Service Option
Sections 3036h, 9326 (4g) and 9426 (4g)
This provision, which is part of a larger initiative on point-of-service option insurance plans, exempts employers from having to offer such a plan if, after having offered this option and providing an opportunity to enroll, fewer than 25 employes express an interest in enrolling in this plan. I am partially vetoing these sections because I believe it is inequitable to employes who did express an interest in the plan, but were denied the opportunity to enroll in the point-of-service plan simply because fewer than 25 of their co-workers wanted to purchase this plan.
32. Obstetric Services Referrals
Section 3036r
This section prohibits managed care plans that offer obstetric and gynecologic services from requiring female enrollees to get a referral for these services. It further requires the plans to provide notification of this referral prohibition in the person's policy and in the literature provided during each enrollment period.
I am partially vetoing the provision requiring notice of the referral prohibition during the open enrollment period because it will unnecessarily increase plan costs. Managed care plans are already required to identify referral policies when they issue coverage to a person.
WORKFORCE DEVELOPMENT
33. W-2 Agency Profits – County Community Reinvestment
Sections 1330r and 1278g [as it relates to s. 49.175 (1) (d)]
These sections require the Department of Workforce Development (DWD) to distribute an amount equal to 4% of W-2 agencies’ contract amounts directly to county governments for purposes of community reinvestment. They also require DWD to establish by rule criteria for the use of community reinvestment funds.
I object to the treatment of community reinvestment funds in this section. My budget proposal made community reinvestment funds available to W-2 agencies as a bonus for agency performance. These provisions create a guaranteed distribution of community reinvestment funds to counties, not W-2 agencies, regardless of performance. While many county governments administer the W-2 program, under this provision those nonprofit and private organizations administering W-2 would not have access to community reinvestment dollars. Moreover, the proposal agreed to by the Conference Committee allocated an amount equal to 3% of contract amounts for community reinvestment, and allocations under s. 49.175 (1) (d) were calculated using the 3% community reinvestment proposal. Section 1330r, however, states that amounts for community reinvestment would equal 4% of the contract total, not 3%.
Finally, use of reinvestment funds has not been detailed in the statutes because I wanted each agency to have the flexibility to use the funds to benefit its own particular community. DWD already issues guidance for use of community reinvestment bonuses, and I feel requiring DWD to create administrative rules is unnecessary.
