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)
S330
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
S331
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
This section allows staff at the Sand Ridge Secure Treatment Center to administer lie detector tests to sexually violent persons as part of their treatment plan. The language also specifically prohibits staff from asking the person about offenses committed for which the person was not convicted. One of the goals of treatment is for these people to take responsibility and acknowledge the sexual crimes they have committed. Not being able to question the predator about these past incidents is detrimental to achieving treatment goals. Patient advocates have expressed concerns about staff asking about specific details of a previously undetected crime that could result in new charges being brought. As part of a compromise with that group, the Department of Health and Family Services proposed that staff could question the predator about previous incidents but not about specific details such as the victim's name or the place the assault took place. As a result, I am partially vetoing this section and requesting the Department of Health and Family Services to seek legislation restoring the language in the original, agreed-upon proposal.
26.
Community-Based Waiver Programs
Section 395 [as it relates to s.
20.435 (4) (b)] appropriates $2,898,600 GPR in fiscal year 2001-02 and $6,796,800 GPR in fiscal year 2002-03 to fund: (a) 388 new placements in fiscal year 2001-02 and an additional 300 placements in fiscal year 2002-03 for the Community Integration Program for persons with developmental disabilities (CIP 1B); (b) a daily rate increase from $48.33 to $49.67 in fiscal year 2001-02 and from $49.67 to $50.33 in fiscal year 2002-03 for CIP 1B; and (c) a daily rate increase from $40.78 to $41.86 in fiscal year 2001-02 and from $41.86 to $42.23 in fiscal year 2002-03 for the Community Integration Program for persons relocated or meeting reimbursable levels of care (CIP II). Section 395 [as it relates to s.
20.435 (7) (bd)] appropriates $2,851,300 GPR in fiscal year 2001-02 and $7,147,300 GPR in fiscal year 2002-03 for 1,000 new placements in fiscal year 2001-02 and 960 additional new placements in fiscal year 2002-03 for the Community Options Program-Waiver (COP-W). 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 CIP 1B, CIP II and COP-W.
Given the future deficit created in this budget by unfunded commitments to program expansions, I cannot support the funding increases in these programs at the levels approved by the Legislature. However, because I understand the importance of providing alternatives to institutional care, I am approving an increase of $3,760,900 GPR in fiscal year 2001-02 and $7,394,100 GPR in fiscal year 2002-03 to fund: (a) 250 new CIP 1B placements in calendar year 2002; (b) a daily rate increase for CIP 1B from $48.33 to $49.67 in fiscal year 2002-03; (c) a daily rate increase for CIP II from $40.78 to $41.86 in fiscal year 2002-03; and (d) 1,000 new COP-W placements in calendar year 2002.
Wisconsin has made a significant investment in community-based programs and services and I want to continue that commitment. This increase will provide reasonable growth for the community-based waiver programs but at a level that is within the state's financial means. In addition, it is important to note that the budget includes a 2.5 percent annual increase for personal care and home health agencies who provide services to individuals in the CIP 1B and CIP II programs.
Thus, I am decreasing the Department of Health and Family Services' s.
20.435 (4) (b) appropriation by $1,989,000 GPR in fiscal year 2001-02 and $3,855,400 GPR in fiscal year 2002-03. This veto is part of a larger write-down of the Medical Assistance appropriation. I am also decreasing the department's s.
20.435 (7) (bd) appropriation by $2,694,600 GPR in fiscal year 2002-03. I am requesting the Department of Administration secretary not to allot these funds.
27.
Community-Based Residential Facilities
Section 1504r
This section repeals the provision allowing counties to establish more restrictive conditions for Community Options Program (COP) waiver funding in Community-Based Residential Facilities. I am vetoing this section because I want counties to retain the flexibility to administer the COP waiver program in a manner that meets their community needs and priorities.
S334
28.
Legislative Council on Developmental Disabilities Recommendations
Sections 174g, 174h, 9123 (16r), 9123 (16rq) and 9123 (16rs)
Section 174g adds four members of the Legislature, one each designated by the Assembly speaker, the Senate majority leader and the minority leader of each house of the Legislature and appointed by the Governor to the Council on Developmental Disabilities. I am vetoing section 174g because federal law requires that a minimum of sixty percent of the council's membership consist of persons with developmental disabilities, their parents or guardians. The addition of four legislators will require the appointment of an additional six individuals to meet federal requirements, which will decrease the effectiveness of the council by increasing its size from 26 to 36 members.
Section 174h requires that the Council on Developmental Disabilities, by January 31 of each year, submit a report to the Legislature on an evaluation of waiting lists compiled by the Department of Health and Family Services for services for persons with developmental disabilities. I am vetoing this section because the council currently evaluates the waiting lists and its evaluation is available to all interested parties.
Section 9123 (16r) requires the department to develop a plan to administer and fund services for people with developmental disabilities. The plan, which must be submitted to the Department of Administration for the 2003-05 biennial budget, must include the following provisions: (a) consolidate administration of both institutional and community-based services within the department's subunit responsible for community-based services for people with developmental disabilities; (b) combine funding under the Medical Assistance (MA) program for institutional services and community-based waivers for people with developmental disabilities into one appropriation, to the extent possible under federal law; and (c) ensure that funding in the MA appropriation not be tied to any specific program or service setting and be individually tailored to enable the person to live in the least restrictive environment appropriate to his or her needs and preferences.
