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.
Section 9123 (16rq) requires the department to determine whether any new federal waivers under the MA program are necessary to administer funding for MA services as described in section 9123 (16r). The department shall apply for any waivers of federal MA statutes and regulations that the department determines are necessary to administer funding for MA services as described in 9123 (16r).
I am vetoing sections 9123 (16r) and 9123 (16rq) because the department is in the best position to determine the organizational structure that will most efficiently strengthen the delivery system for individuals with long-term care needs, including the developmentally disabled. In addition, placing institutional and community-based funding in one appropriation and having administration of institutional and community-based services in a single subunit of the department will not necessarily improve services for the developmentally disabled.
Section 9123 (16rs) requires the department, as soon as possible before July 1, 2002, to seek waivers of federal MA statutes and regulations that are necessary to implement a pilot program for long-term care of children with disabilities. If the federal waivers are received, the department is required, as soon as possible before July 1, 2002, to seek enactment of statutory language to implement the pilot program.
While maintaining the language that requires the department to seek the waiver and enactment of statutory language, I am partially vetoing this section to remove the requirement that it do so as soon as possible before July 1, 2002. I am concerned that the department will not be able to have the federal waiver approved by July 1, 2002. I am directing the secretary of the Department of Health and Family Services, if the waiver is received, to submit enabling legislation to the Department of Administration for the 2003-05 biennial budget.
Section 9123 (16rs) also provides that, if the waivers are granted, that the pilot program do the following: expand eligibility under the MA community-based waiver, Birth to Three and Family Support programs to include children with severe disabilities and long-term care needs and children eligible for MA with high medical costs; expand MA coverage of services to include services focused on the needs of children with developmental disabilities and their families; and require the department to provide transitional services to families whose children with physical or developmental disabilities are preparing to enter the adult service system. I am partially vetoing this section to remove these provisions because I object to expanding the MA program and am concerned about the fiscal impact in the 2003-05 biennium if the department must provide the transitional services. However, I want children and families to receive the transitional planning needed to enter the adult system. I am therefore requesting the secretary of the Department of Health and Family Services to ensure that transitional planning is part of the federal waiver request.
29.
Family Care
S335
Section 395 [as it relates to ss.
20.432 (1) (k) and
20.435 (4) (b),
(bm) and
(bn) and
(8) (a)] appropriates $255,000 GPR in fiscal year 2001-02 and $4,012,100 GPR in fiscal year 2002-03 for the following: (a) $3,032,100 GPR in fiscal year 2002-03 for expansion of the Family Care pilot program to Kenosha County; (b) $700,000 GPR in fiscal year 2002-03 as start-up funds for expansion of Family Care to five additional counties in the 2003-05 biennium; (c) $5,000 GPR in each fiscal year for administrative costs associated with the Council on Long-Term Care; and (d) $250,000 GPR in fiscal year 2001-02 and $275,000 GPR in fiscal year 2002-03 for a Family Care external advocacy program that the Department of Health and Family Services contracts for with the Board on Aging and Long-Term Care and 1.0 FTE PR-S position to administer the program. 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 for these purposes.
Family Care is a pilot program designed to test a new model for the provision of long-term care services. It involves an extensive redesign of the current system, which is often fragmented and confusing. While preliminary evaluations appear to be quite positive, the program's significant costs compel me to delay further expansion until the full evaluation of the program is completed in September 2002. With this evaluation, we should have better information to understand the cost effectiveness of the program, both in terms of the cost per person served as well as the overall cost of the pilot compared to current programs, and the quality of services received by participants and their families.
To reflect the elimination of funding for Kenosha County and the funding for the expansion to five additional counties in the 2003-05 biennium, I am decreasing the following Department of Health and Family Services' appropriations: s.
20.435 (4) (b) appropriation by $2,963,700 GPR in fiscal year 2002-03, s.
20.435 (4) (bn) appropriation by $33,400 GPR in fiscal year 2002-03 and s.
20.435 (8) (a) appropriation by $735,000 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.
Sections 1520d, 1520e, 1520w and 4060c extend the sunset date for the Council on Long-Term Care from July 1, 2001, to July 1, 2003. I am vetoing these sections because
1999 Wisconsin Act 9 created the council primarily to advise the department on the development of the Family Care pilot program, and the development phase is complete. The secretary has the administrative ability to seek advice from groups and individuals interested in Family Care implementation and other long-term care issues. Thus, I am decreasing the department's s.
20.435 (8) (a) appropriation by $5,000 GPR in fiscal year 2001-02 and $5,000 GPR in fiscal year 2002-03. I am requesting the Department of Administration secretary not to allot these funds.
Finally, I object to funding for a separate external advocacy program for individuals applying for, or enrolled in, Family Care. The department has grievance procedures in place that individuals can utilize if they are not satisfied with their Family Care eligibility or level of services. Thus, I am decreasing the department's s.
20.435 (4) (bm) appropriation by $250,000 GPR in fiscal year 2001-02 and by $275,000 GPR in fiscal year 2002-03 and the Board on Aging and Long-Term Care's s.
20.432 (1) (k) appropriation by $500,000 PR-S in fiscal year 2001-02 and $550,000 PR-S in fiscal year 2002-03. I am requesting the Department of Administration secretary not to allot these funds. I am also requesting the Department of Administration secretary not to authorize the 1.0 FTE PR-S position for the Board on Aging and Long-Term Care.
30.
Elder Abuse Services
Section 395 [as it relates to s.
20.435 (7) (dh)] appropriates $1,500,000 GPR in each fiscal year for funding to counties for direct services for the elderly who have been determined to be abused or neglected. 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 the funding increase. I object to the funding increase in fiscal year 2001-02. The Department of Health and Family Services contracts with counties on a calendar year basis and I am willing to approve a $750,000 increase in fiscal year 2001-02. Thus, I am decreasing the department's s.
20.435 (7) (dh) appropriation by $750,000 GPR in fiscal year 2001-02. I am requesting the Department of Administration secretary not to allot these funds.
31.
Life Span Respite Care
Section 395 [as it relates to s.
20.435 (7) (br)] appropriates $112,500 GPR in each fiscal year for the Life Span Respite Care program. 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 the funding increase. I object to the funding increase for this program. A fifty percent increase in funding is unwise when the state faces a significant structural deficit in the 2003-05 biennium. In addition, an evaluation of this new program is to be completed by June 1, 2004, and it is prudent to wait for the results before considering additional funding. Thus, I am decreasing the Department of Health and Family Services' s.
20.435 (7) (br) appropriation by $112,500 GPR in fiscal year 2001-02 and $112,500 GPR in fiscal year 2002-03. I am requesting the Department of Administration secretary not to allot these funds.
32.
Mental Health Systems Change Grants
Section 1562
S336
This section details the requirements that the Department of Health and Family Services must meet in administering mental health systems change grants. I am partially vetoing this section to remove language that limits the awarding of these grants to a nonprofit, tax-exempt corporation or a county because I want the Department of Health and Family Services to have the flexibility to award grants to the best applicants, regardless of organizational structure.
33.
Community Support Program
Sections 395 [as it relates to s.
20.435 (7) (bL)] and 1971L appropriate $1,000,000 GPR in each fiscal year as the state share of Medical Assistance benefits for the Community Support Program. I object to the funding increase in fiscal year 2001-02. The Department of Health and Family Services contracts with counties on a calendar year basis and I am willing to approve a $500,000 GPR increase in fiscal year 2001-02. Thus, I am decreasing the department's s.
20.435 (7) (bL) appropriation by $500,000 GPR in fiscal year 2001-02. I am requesting the Department of Administration secretary not to allot these funds.
