The budget as passed by the Legislature assumes annual IGT revenues will be significantly less than $115,200,000. Counties would receive an increased supplemental payment only if revenues are more than $115,200,000, yet if even slightly less revenue is available, the counties would receive no increase in the supplement. At the same time, the Legislature appropriated IGT revenues to pay fully for the increased payment, which is inconsistent with maintaining this $115,200,000 threshold in state statutes.
With respect to the new appropriation for unanticipated IGT revenues, this provision will create significant pressure to expend these revenues in the 2001-03 biennium, exacerbating a cost-to-continue problem. The intent of the administration was to dedicate the vast majority of unanticipated IGT revenues to county and other nursing home payments for use in future years. With the Medical Assistance budget facing a $220 million structural deficit at the start of fiscal year 2003-04, any IGT revenues received above what have already been appropriated should not be expended unless an unforeseen problem arises.
Therefore, I am digit vetoing sections 1776m and 1778, eliminating the $115,200,000 threshold and thus removing this inconsistency from the budget. Also, I am partially vetoing sections 395 [as it relates to s.
20.435 (4) (wm)] and 717bd to remove language specifying this new appropriation for unanticipated IGT funds as a sum sufficient appropriation. By default, as outlined in s.
20.001 (3) (a), this appropriation will operate as an annual appropriation which can only be increased by an act of the Legislature or by an emergency action as specified under s.
13.10. Furthermore, I direct the department, working cooperatively with the county and other nursing homes, to pursue separate legislation clarifying that the vast majority of any unanticipated IGT funds will be dedicated to future county and other nursing home payments.
3.
Supplemental Hospital Payment
Section 395 appropriates a supplemental payment to hospitals participating in the Medical Assistance (MA) managed care initiative. Although there is no language in the budget bill authorizing this supplement, the Legislature passed a motion and an amendment during its deliberations to authorize the increases in this area.
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All hospitals serving MA or BadgerCare recipients received a rate increase in the 2001-03 biennial budget using intergovernmental transfer funds. I see no reason to retain an additional supplement for facilities participating in the MA managed care initiative. Therefore, I am vetoing this provision and decreasing the Department of Health and Family Services' appropriation under s.
20.435 (4) (w) by $71,000 SEG in fiscal year 2001-02 and by $74,500 SEG in fiscal year 2002-03. I am requesting the Department of Administration secretary not to allot these funds.
4.
Joint Committee on Finance Authority to Supplement BadgerCare
Sections 1836g and 1836r
These sections authorize the Joint Committee on Finance to supplement the BadgerCare benefits appropriation under s.
13.10 from any other appropriation after the administration has submitted a proposal to reduce or stop program enrollment in the event of a projected funding shortfall. Under current law, the Department of Health and Family Services is required to limit enrollment in the program if the program is projected to exceed its budget, and BadgerCare may be supplemented only through an act of the full Legislature, signed by the Governor into law.
In its first two years, the BadgerCare program experienced rapid caseload growth which left the program facing budget shortfalls. Fully funding BadgerCare required separate legislation in fiscal year 2000-01 as well as additional increases in the 2001-03 biennial budget. However, caseload growth in the program has stabilized, and the need for future supplements is less likely.
If, however, there is unanticipated growth in the BadgerCare program, it is appropriate to consider reducing or stopping program enrollment. If both the Legislature and administration agree that sufficient funds exist to supplement the program, then separate legislation can still remedy any shortfall. Therefore, I am vetoing these sections, to eliminate the Joint Committee on Finance's authority to supplement the BadgerCare program from any other state appropriation because it is unnecessary.
5.
BadgerCare Funding Study
Section 9123 (9wo)
This provision requires the Department of Health and Family Services to produce a report for the Joint Committee on Finance on the potential for long-term savings under the BadgerCare program, to be completed by January 1, 2002.
I support finding ways to reduce program costs in BadgerCare and other health care programs, but this provision does not provide the department sufficient time to complete a comprehensive review of the program. Therefore, I am partially vetoing this provision and am directing the department to complete its review of the BadgerCare program by January 1, 2003. Furthermore, I direct the department to submit a copy of the report to the secretary of the Department of Administration as a cost-containment proposal to be considered during the 2003-05 biennial budget process.
6.
Medical Assistance Estate Recovery Audit
Section 9132 (3w)
This section requests that the Joint Committee on Audit direct the Legislative Audit Bureau to study the estate recovery program administered by the Department of Health and Family Services. The Joint Committee on Audit currently has the authority to request such a study if it deems an evaluation is needed, making this budget provision unnecessary. Therefore, I am vetoing this provision.
7.
Provider Fraud and Abuse Administrative Rules
Section 9123 (15k)
This provision requires the Department of Health and Family Services to craft proposed administrative rules for new Medical Assistance fraud and abuse provisions within nine months of the budget bill's effective date. I feel nine months is not sufficient time for the department to develop proposed administrative rules. Therefore, I am vetoing section 9123 (15k) and am directing the department to submit its proposed rules to the Joint Legislative Council staff by January 1, 2003.
8.
Grants for Case Management Services for Children with Asthma
These sections authorize a $150,000 GPR annual grant to Milwaukee County to provide case management services to children with asthma. I am vetoing this provision because the Department of Health and Family Services is investing significant resources into Medical Assistance (MA) services for asthma treatment. Furthermore, asthma is a statewide medical issue and its treatment and control is not well served through geographic earmarks. Therefore, I am vetoing these sections and eliminating this special grant to Milwaukee County.
Medical Assistance as well as the BadgerCare program currently cover case management services for children with asthma, including comprehensive assessments of the child's needs, the development of an individualized case plan and on-going monitoring of the child. The department also encourages health maintenance organizations (HMOs) to report on the asthma care received by MA and BadgerCare recipients in their respective areas of service and will begin including performance measures tracking asthma care in the department's contracts with HMOs. These initiatives represent just a few of several state programs that address asthma issues.
9.
Standards for Health Maintenance Organizations
Sections 1787m, 1787mg, 9323 (15k) and 9423 (12p)
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These sections require all health maintenance organizations (HMOs) serving Medical Assistance (MA) and BadgerCare recipients within a specific zip code to have a sufficient number of primary care providers available within thirty miles of that zip code. This provision was intended to broaden the number of primary care providers to which MA or BadgerCare recipients have access. While I support ensuring recipients have sufficient access to care, this policy item will not have any measurable effect on access issues.
The Department of Health and Family Services currently requires these HMOs to have a sufficient number of primary care providers within twenty miles of the zip code in which they serve recipients. I feel that a narrower radius is more beneficial to participants in that it ensures more providers are available closer to an individual's home. Furthermore, by specifying a radius in state statute, the department's authority to administratively respond to unique geographical access issues would be limited. Therefore, I am vetoing these sections and retaining the department's current authority to address primary care access issues through its administrative authority.
10.
Medical Assistance Income Limit for Medically Needy Recipients
Sections 1797g, 1797j, 1798g, 1800m, 1804g, 1804m, 1805d, 1815g, 1815j, 9323 (10d) and 9423 (6d)
These provisions provide $500,800 GPR in fiscal year 2002-03 in order to expand Medical Assistance (MA) eligibility by increasing the income limit for medically needy recipients by the annual increase in the consumer price index. This change would not be effective until January 1, 2003.
Under current law, individuals who are not categorically eligible for MA can "spend down" their incomes to the medically needy limit to qualify for assistance. Some families have difficulty obtaining and maintaining coverage under this provision because the spend down threshold is capped at 133 percent of the Aid to Families with Dependent Children income limit in 1996, which is $596 for a family of two. While I am sympathetic to families who have difficulty obtaining services under the medically needy criteria, the tight fiscal constraints faced by the state make additional expansions of the MA program problematic. Since these annual adjustments will be only partially implemented in fiscal year 2002-03, they will add approximately $500,000 GPR to the structural deficit facing the state at the start of the 2003-05 biennium. Therefore, I am vetoing these provisions to maintain the current income threshold for those seeking MA under the medically needy eligibility category. Furthermore, I am requesting that the Department of Administration secretary place $500,800 GPR in fiscal year 2002-03 in unallotted reserve in appropriation s.
20.435 (4) (b) to lapse to the general fund.
11.
Transfer of Medical Assistance Funds to Community Options Program
Sections 1778d, 1778h, 1778p and 1778r
These sections require the Department of Health and Family Services to submit annually a report to the Joint Committee on Finance on the utilization of nursing home beds funded by Medical Assistance (MA) program benefits. These provisions further require the department to submit an annual proposal to the Joint Committee on Finance, under 14-day passive review, to transfer MA funds to the Community Options Program (COP) if the report shows decreasing MA nursing home bed utilization. The specific amount the department must transfer to COP is equal to the decrease in nursing home bed utilization over the prior two fiscal years multiplied by the average cost of a nursing home bed in the most recently completed fiscal year. This provision does not require the Joint Committee on Finance to consider the overall fiscal condition of the MA program before approving this transfer.
Under current law, the department may transfer surplus MA funds budgeted for nursing homes to COP, but such transfers may occur only if there is an overall surplus in the MA benefits appropriation. While I support community-based strategies for providing long-term care services, I object to this requirement to transfer MA funds to COP even if the MA budget is in deficit. Such a transfer would simply worsen a deficit which can only be filled by appropriating additional general purpose revenue. Transfers made in one fiscal year should not be dictated by occurrences in prior years, because the factors contributing to the situation in the past may not recur or persist in the present.
Therefore, I am vetoing these provisions, reinstating the Department of Health and Family Services' current authority to transfer MA nursing home funds to COP if a surplus in the entire MA program exists.
12.
Health Insurance Supplement for Community Disability Service Providers
Sections 395 [as it relates to s.
20.435 (4) (bu)], 707r, 707s, 9123 (13q) and 9423
(15r)
These sections provide a $250,000 GPR supplement in fiscal year 2001-02 to providers under the home- and community-based waiver programs to meet the costs of providing employee health insurance. While I acknowledge that health insurance costs can be significant for these facilities, such costs are not unique to these providers. Any health care provider, company or small business faces similar cost pressures, and I see no justification for providing a special supplement only to community-based waiver program providers. Therefore, I am vetoing these sections and eliminating the supplement.
13.
Medical Assistance Speech Therapy Services
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This provision includes a 76 percent increase in rates paid for speech therapy services, costing $250,000 GPR and $354,000 FED in fiscal year 2002-03. Although there is no language in the budget bill that authorizes these increases, the Legislature passed a motion and an amendment during its deliberations to authorize funding increases in this service area.
Although I understand and appreciate the value of speech therapy services, I cannot justify a rate increase of this magnitude, given the fiscal constraints of the budget. Rates for noninstitutional providers, which includes speech therapy services, were already increased in the budget by 2.5 percent in each year. Further rate increases cannot be justified given the current fiscal situation of the state. Thus, I am decreasing the Department of Health and Family Services' appropriations under s.
20.435 (4) (b) by $246,000 GPR in fiscal year 2002-03 and s.
20.435 (4) (bc) by $4,000 GPR in fiscal year 2002-03. This veto is part of a larger write-down of the Medical Assistance appropriation. I am requesting the Department of Administration secretary not to allot these funds.
14.
Adult Day Care Certification Fee
Section 1791i
This section removes the Department of Health and Family Services' authority to change the fee for the certification of adult day care facilities through administrative rule. Under current law, the department charges a fee equal to a flat rate of $89 plus a variable rate of $17.80 multiplied by the number of clients the facility serves. The department's practice is to multiply this variable rate by the maximum number of individuals a facility is capable of serving, not necessarily the actual number of persons receiving adult day care services. The budget bill changes this fee to a flat rate of $100 per facility.
While I support changing the fee, I object to removing the department's authority to change the fee through administrative rule. By setting the fee at a flat rate per facility, the revenue received by the department for administering this license will be reduced from approximately $31,600 PR per year to $5,000 PR per year. This reduction leaves the department with virtually no funds to monitor these facilities. While I understand that the current fee may be considered excessive by facilities equipped to serve large numbers of individuals, I maintain the department should have the ability to reasonably increase its fees so that it may respond to future program needs.
Therefore, I am vetoing the section to retain the department's authority to change the fee through administrative rule. Under this veto, any increase to the fee must be approved through the rules process which is overseen by the Legislature.
15.
Licensure for Respite Facilities
Sections 1877g, 1877h, 1877i, 1894r, 1897g, 1900b, 1900c, 1900d, 1900e, 1900f, 1900g, 1900h, 1900i, 1900j, 1900k, 1900L, 1900m, 9123 (18f) and 9423 (18f)
These sections would require the Department of Health and Family Services to create a new type of licensure for facilities serving individuals with similar disabilities over the age of two. Facilities receiving this license would be allowed to provide respite, residential care to both children and adults, serving up to ten individuals under a single license. Under current law, a facility seeking to provide these services would need to obtain licenses both as a group or foster home and as a Community-Based Residential Facility.
The intent of these sections was to allow a provider to serve both adults and children under only one license. However, since these provisions do not extend coverage to children under Chapter
48 of state statutes, which provides legal rights for children in out-of-home placement settings, a facility seeking this new respite licensure would still have to obtain a group foster home license in order to legally provide respite care for children.
While I support efforts to improve the access to respite care for both adults and children, I object to this provision because it replaces one form of dual licensure with a new dual licensure. This new licensure category is not likely to result in any additional flexibility to providers than available under current law and administrative rules. Furthermore, the department has the authority to waive portions of current license rules in order to accommodate providers demonstrating a unique need.
Therefore, I am vetoing these sections, eliminating this new form of respite licensure. I am further directing the department to develop a waiver process for facilities seeking to serve individuals with similar disabilities over the age of two, in order to find new strategies to improve the supply of respite care in Wisconsin.
16.
Fees for Health Care Records
Sections 2850bg, 2850bh, 2850bi, 3872x, 3872y, 9123 (14g) and 9423 (16f)
These provisions require the Department of Health and Family Services to develop uniform rules by January 1, 2003, on fees to be charged for providing copies of health care records. The language identifies all of the items to be considered in establishing such charges.
I am vetoing these provisions because they are duplicative. Current law already provides the department with the authority to develop such rules. I am directing the department to develop these rules in conformance with the intent of the provisions being vetoed and submit these rules to the Department of Administration secretary for review and, with his concurrence, forward the rules to the standard rule-making process.
17.
Acquired Immunodeficiency Syndrome (AIDS) Funding
Sections 3140c and 3140m
Section 3140c requires that all funding for life care services and early intervention be granted to the AIDS services organizations throughout the state. I am partially vetoing this section to ensure that the Department of Health and Family Services can continue to provide grants to a variety of organizations including, but not limited to, the AIDS services organizations. This section also includes housing assistance as an eligible service. I am partially vetoing this provision to retain the current allowable services because housing assistance can be funded from other sources.
S332
Section 3140m authorizes funding for an African-American family resource center in Milwaukee targeting AIDS prevention efforts to families. I am vetoing funding in fiscal year 2002-03 so that an ongoing commitment is not made to this organization and requesting that the Department of Administration secretary place $62,500 GPR in fiscal year 2002-03 in unallotted reserve in the Department of Health and Family Services' appropriation s.
20.435 (5) (am) to lapse to the general fund.
18.
Statewide Trauma System
Sections 174p, 670, 2850ag, 9123 (12r), 9123 (12s) and 9152 (2t)
These provisions require the Department of Transportation to provide federal highway safety funds to the Department of Health and Family Services to fund two project positions to develop the statewide trauma system and to provide grants to regional trauma councils as established through these provisions. Although I support the statewide trauma system, I am vetoing provisions relating to this transfer of funds because I believe these federal funds are more appropriately used to improve highway safety. Dedication of these funds to the trauma system program would also result in reductions in other highway safety grants, which is counterproductive. I am also vetoing the requirement that regional trauma advisory councils be established because there will not be funding to support these councils.
19.
Assessment on Small Employer Insurers
Section 2850dm, 2850Ldc, 2850Ldm, 2850Le [as it relates to the small employer insurer assessment], 2850Lem, 2850Lj [as it relates to the small employer insurer assessment], 2850Ln [as it relates to the small employer insurer assessment] and 3766r
These provisions establish a penalty that would be assessed on small employer insurers that terminate health coverage and whose enrollees subsequently enroll in the Health Insurance Risk Sharing Plan (HIRSP). The penalty would be used to reduce the policyholders' premiums and the assessment on insurers that is currently part of the financial support for HIRSP. I am vetoing these provisions because they are directly counter to our efforts to encourage a broader market for health care policies sold to small businesses. It would also be administratively difficult to calculate the penalty, which could actually increase HIRSP program costs because the Department of Health and Family Services would have to contract for additional actuarial services.
Section 3766r eliminates the Commissioner of Insurance's ability to grant exceptions to certain regulations that pertain to the small employer insurers market. I am vetoing this section because I object to the limitation it places on the commissioner's ability to protect policyholders.
20.
Health Insurance Risk Sharing Plan Study
Section 9123 (16mn)
This section requires the Health Insurance Risk Sharing Plan (HIRSP) board of governors to study alternative funding sources for the HIRSP program and submit a report on its findings by January 1, 2002, to the standing committees of the Legislature that examine health-related issues and to the Joint Committee on Finance. I am vetoing this provision because another study of this issue is unnecessary. When this program was transferred from the Office of the Commissioner of Insurance to the Department of Health and Family Services, the Governor's Office, the Legislature, the board, service providers and insurers all worked together to establish funding that is equitable for all affected parties.
21.
Disease Aids Rebate
Section 1838c
This section establishes a rebate program for drug manufacturers that participate in providing drugs under the disease aids program similar to the rebate program under Medical Assistance (MA). However, unlike the MA rebate program, this rebate language would exempt manufacturers for a ten-year period from a penalty which is assessed when their drug prices are higher than the consumer price index. This would result in fewer dollars available to support the program and would be very difficult to administer. As a result, I am vetoing this section so that the rebate program is the same as the MA rebate program.
22.
Vital Records Fees
Sections 2095g, 2095h, 2095i and 2096c
These provisions change the fees charged for vital records for events that occurred before 1930. Marriage, divorce and death record charges would change from $7 to $3 and birth certificates would be reduced from $12 to $3. Additional copies of any of these records would be $1. While such a change would be beneficial to genealogists who conduct record searches, it reduces revenue to the vital records section which sets its rates to cover program expenses. More importantly, the change in fees would result in reduced revenue to the Child Abuse and Neglect Prevention Board which receives $7 from the $12 charged for a birth certificate to support its program. Because of the loss in revenue and the inequity of charging two sets of fees, I am vetoing these sections.
23.
Cash Accounting for Certain Appropriation
Section 248t
S333
This section exempts the conditional and supervised release appropriation, s.
20.435 (2) (bj), from state accounting standards that require state agencies to use accrual accounting so that a service provided in June of one fiscal year would be paid in July of the next fiscal year. This change allowed one month of the program's funding to be lapsed on a one-time basis. While the funds cannot be restored, I am vetoing this section so that funds can be properly accounted for as required under state accounting standards. Should program funding budgeted in fiscal year 2001-02 be insufficient, there are processes under which the Department of Health and Family Services can seek reallocation of base funds for use in this program.
24.
Sexually Violent Persons' Mail
Section 1993n
This section specifies that mail which is considered to be privileged, such as from an attorney, sent to sexually violent persons at the Sand Ridge Secure Treatment Center must be opened in the presence of the person. It also authorizes staff, if they have reason to suspect that the mail could cause a security problem, to open and read nonprivileged mail. I am partially vetoing this section to allow staff to open any mail outside the presence of the person and inspect it for contraband. Opening mail in the presence of the person could create security problems and interfere with the person's treatment program.
25.
Lie Detector Tests
Section 1967p
