Section 1392u
This section requires the Department of Health and Family Services secretary to create a new Mental Health Medication Review Committee to advise the department on the implementation of prior authorization for antidepressant drugs, specifically selective serotonin reuptake inhibiters (SSRIs), as well as any other proposals to use prior authorization for prescription drugs for the treatment of individuals with mental illness. The secretary would be required to ensure that at least 50 percent of the committee's membership consists of advocates and consumers.
S314 I am vetoing this section because I object to this additional restriction on the secretary's authority to administer the Medical Assistance program. Current law concerning a prescription drug prior authorization advisory committee does not need to be revised in order for the secretary to create a special mental health medication review committee that includes effective consumer and advocate participation.
14. SeniorCare – Copayments for Brand Name Prescription Drugs
Sections 1446g and 9424 (11g)
These sections increase from $15 to $20 per prescription the copayment for brand name drugs charged to all participants in the SeniorCare program.
I am vetoing these sections because I object to this additional change to the SeniorCare program, and this legislative proposal adds yet another reduction in benefits for Wisconsin's low-income seniors. The SeniorCare program has been crucial in controlling the skyrocketing costs of prescription drugs for more than 91,000 seniors enrolled in the program. Based on current caseload projections, this veto will increase costs in the SeniorCare program above currently appropriated amounts. I am, consequently, requesting the Department of Health and Family Services secretary to develop a plan to address this concern by July 1, 2004.
15. SeniorCare – Long-Term Care Insurance and Spend-Down Requirements
Sections 1438h, 1445h, 1446h and 9324 (13d)
This provision permits individuals enrolled in SeniorCare who have "spend-down" requirements to apply the cost of long-term care insurance premiums to their spend-down amount. Currently, individuals are eligible for SeniorCare if their income is below 240 percent of the federal poverty line, and those with incomes between 160 percent and 240 percent of poverty face a deductible requirement before being eligible for full SeniorCare benefits. If individuals or couples have income over 240 percent of the federal poverty line, they may be eligible for SeniorCare benefits if they meet an additional deductible requirement equal to the difference between their annual income and the income eligibility threshold at 240 percent of the poverty level. State law specifies that only prescription drug expenses may be applied to this spend-down requirement.
I am vetoing this provision because I object to using a prescription drug benefit program as an incentive for the purchase of long-term care insurance. The intent in creating deductible requirements in SeniorCare was to allow individuals with higher levels of income who also have high drug costs to benefit from the program. It is unclear to me why long-term care insurance costs merit special exception from this intent and not other expenses, such as premiums for health insurance or for supplemental prescription drug insurance. This provision could increase costs in the SeniorCare program and benefits only higher income individuals. This new policy represents a significant change in the nature of the program and should be thoroughly analyzed and discussed through separate legislation.
This veto will maintain the current program structure of allowing only prescription drug costs to apply to the spend-down requirement.
16. Managed Care for Recipients of Supplemental Security Income
Section 1312n
This section requires the Department of Health and Family Services to submit proposed contracts with managed care organizations, which provide services under Medical Assistance to recipients of supplemental security income (SSI), to the appropria te legislative standing committees for review. It also requires the department work with advocacy organizations and managed care organizations to determine the service needs of SSI recipients.
I am vetoing this section because legislative review is unnecessary and the department is already engaged in the critical task of working with interested parties. No other contracts with Medical Assistance providers are subject to legislative review, and I see no reason why such a requirement should be created for these specific managed care contracts. While I support the goal of having the department work with managed care organizations and advocacy groups, I object to legislative mandates directing an agency to conduct tasks already being performed.
17. Drug Savings and Funding for Health Maintenance Organizations
Section 9124 (7c)
This section requires the Department of Health and Family Services to develop a plan to provide increases in capitation rates paid to managed care organizations serving Medical Assistance and BadgerCare recipients, using any unanticipated savings in prescription drug expenditures in these programs. This plan would be subject to review and approval by both the Department of Administration secretary and the Joint Committee on Finance under 14-day passive review.
I am vetoing this section because it restricts the department's administrative authority to reallocate resources within the Medical Assistance and BadgerCare programs for such needs. If there are additional savings in either prescription drug expenditures or other Medical Assistance budget items, the department needs the authority to best decide how to allocate these resources, taking into consideration the entire context of the Medical Assistance budget.
HEALTH AND PUBLIC SAFETY Page 49
S315 18. Supplemental Nursing Home Payment Pilot Demonstration
Section 9124 (13k)
This section requires the Department of Health and Family Services to earmark $405,500 GPR in each year of the biennium from the Medical Assistance benefits appropriation for Milwaukee County to support a two-year demonstration project involving a facility with between 80 and 90 beds and with a population of residents of which 90 percent are Medical Assistance recipients. It is expected that the only facility meeting these requirements is the Kilbourn Care Center in Milwaukee.
I am vetoing this section because this pilot project has not been subject to the normal review of the Legislature nor been adequately justified. Earmarking these funds for this one facility would either mean that all other nursing homes throughout the state would receive less funding or the deficit in the Medical Assistance program would increase.
19. Food Stamp Retailer Transaction Fee
Sections 286 [as it relates to s. 20.435 (4) (bm)] and 1450m
These sections restore funding for a $0.08 fee paid to grocers by the food stamp program for every electronic benefit transfer (EBT) transaction processed on grocers' own point-of-sale terminals. These sections also amend current law to make this fee, which was originally established to aid in the transition of a coupon-based food stamp system to an electronic benefits system, permanent.
I am partially vetoing section 286 [as it relates to s. 20.435 (4) (bm)] and am vetoing section 1450m because I object to the continuation of this fee, which was originally authorized to temporarily reward grocers who use their own point-of-sale terminals (as opposed to terminals purchased and maintained by the state) to process EBT benefits. By lining out the appropriation under s. 20.435 (4) (bm) and writing in a smaller amount that deletes $250,000 GPR per fiscal year, 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.
Only seven other states pay such a transaction fee and, of the seven, Wisconsin's fee is the highest. Grocers incur transaction costs with every sale, regardless of whether the purchase is made using cash, credit cards or checks. Grocers do not get reimbursed for these transaction costs which, with the exception of cash, are more expensive than processing an EBT transaction. While I support efforts to ensure grocers offer access to EBT-based food stamps, I feel the benefits grocers receive from this fee are small compared to the over $200 million paid annually to grocers for the actual cost of food purchased through food stamps.
This veto maintains the Department of Health and Family Services' ability to eliminate the fee administratively, and will delete funding for this subsidy.
20. Hospital Data Collection
Sections 2092c, 2092e, 2092f, 2092i, 2092j, 2093bg, 2093bh, 2094c, 2094d, 2094e, 2094f, 2094g, 2094L, 2094x, 2095re, 2095rn and 9124 (10k)
These sections require that the Department of Administration enter into a contract with the Wisconsin Hospital Association to collect health care information from hospitals and ambulatory surgery centers.
I am partially vetoing this provision because I object to the composition of the oversight board, the time frame for the data transfer, the ability of the Wisconsin Hospital Association to approve requests to waive the data requirements and certain limitations placed on the Department of Health and Family Services relating to data collection analysis and distribution. The result of these vetoes will be provisions that more closely resemble the compromise agreement reached by the Department of Health and Family Services and the Wisconsin Hospital Association. That agreement was designed to make the contract process more workable and ensure full public access to timely, quality data.
Since the language was introduced by the Joint Committee on Finance, the department, which currently collects such data, has been negotiating with the Wisconsin Hospital Association to make the proposal more workable. For example, it was agreed to use the existing Board on Health Care Information as the oversight body rather than creating a new board as required in the bill. The Department of Health and Family Services and the Wisconsin Hospital Association also agreed to move the start date back six months. However, the compromise package did not get incorporated into the budget. The effect of this veto will be to have the Department of Administration contract with the Wisconsin Hospital Association for the collection of health care data. The timeframe for the transfer is improved and the Department of Health and Family Services will continue to provide some oversight of the data. The veto will also provide more flexibility in the types of data collected and allow the Department of Health and Family Services to continue sharing data with other state agencies.
21. Chronic Disease Program
Sections 1424, 1425, 1426, 1429, 1430, 1433 and 9324 (2)
S316 These sections require that people with renal disease or adult cystic fibrosis apply to all other existing governmental health care programs, specified by the Department of Health and Family Services by rule, before they can apply for assistance under the chronic disease program, but it exempts people with hemophilia from this application requirement.
I am partially vetoing these sections to eliminate this exemption because it is too broad. In order to maximize the use of scarce GPR funding, it is essential to require that the maximum possible number of participants apply to programs partially funded by federal funds and to have those participants use those federally funded programs if found to be eligible.
Section 1426 requires the Department of Health and Family Services to pay claims in this program at the lower of the Medicare or Medical Assistance rate. I am partially vetoing this section because it would be a very expensive undertaking to completely redo the claims processing system used by the fiscal agent and there is no estimate of potential savings associated with this action.
22. Tobacco Control Advisory Committee
Sections 2459x and 9124 (5x)
These sections require the Department of Health and Family Services to establish a tobacco control advisory committee, which would essentially recreate a Tobacco Control Board, with duties similar to that board, within the department. These sections also require external, independent evaluations of the success of tobacco control projects.
I am vetoing these sections because they are unnecessary. Public health staff, through their current tobacco prevention and control efforts, are already consulting with an extensive network of people and agencies to assist the department in its future efforts to control the use of tobacco. In addition, the department is already committed to using both internal and external evaluations, using existing resources, to evaluate the effectiveness of these projects.
23. Health Insurance Risk Sharing Plan
Section 9124 (10h)
This section requires the Department of Health and Family Services to prepare a request for proposal for bids to become the fiscal agent for the Health Insurance Risk Sharing Plan. It further specifies that the proposal should be ready to issue six months after the effective date of passage of the biennial budget and that the proposal be reviewed by the Joint Committee on Finance subject to the 14-day passive approval process.
I am vetoing this section because I object to the requirements it imposes on the department. These requirements are burdensome and unnecessary. The budget bill includes a provision allowing the department to prepare a request for proposal for bids to be the fiscal agent for the Health Insurance Risk Sharing Plan. Based on this provision, I request the Department of Health and Family Services secretary to prepare a request for proposal.
24. Multiple Sclerosis Screening
Section 2455r
This section requires that the Well-Woman Program earmark $60,000 GPR annually of its current appropriation for multiple sclerosis screening.
I am partially vetoing this section because the earmark is arbitrary and could reduce the Department of Health Family Services' ability to fund other needed services, such as breast and cervical cancer screening. This veto will remove the reference to "each fiscal year" and delete the word "screening" so that the department can use the $60,000 as needed to cover the actual annual costs of providing referrals to appropriate health care providers and for multiple sclerosis education. My intent is to give the department the flexibility to determine the level of spending needed in each fiscal year until a total of $60,000 has been expended for these services. If the level of multiple sclerosis spending over the biennium is insufficient to fully expend the $60,000 earmark, the commitment will carry forward into future fiscal years until it is fulfilled.
25. Northern Wisconsin Center
Sections 1490c and 1496c
These sections prohibit the Northern Wisconsin Center for the Developmentally Disabled from transferring residents and staff to other centers on an involuntary basis. I am vetoing section 1490c and partially vetoing section 1496c because they limit the center's flexibility in best meeting resident treatment needs and in best allocating staff to meet workload demands. Current law already provides adequate protection because residents may only be transferred to another center with the permission of the legally responsible county, or by court order. Transfers are done in consultation with residents' guardians, and are based on the best interests of the residents. The Department of Health and Family Services also requires flexibility to deploy positions to areas of need, consistent with current bargaining agreements. I am vetoing these sections to retain this flexibility and to ensure that individuals with developmental disabilities are placed in appropriate facilities.
26. Daily Rate for Community Placements
Section 1320
S317 This section identifies the daily placement rate for people moved from the centers for the developmentally disabled to placements in the community. The rate would increase from $225 per day to $325 per day beginning in fiscal year 2004-05. I am partially vetoing this section so that the new rate takes effect in fiscal year 2003-04 because the higher rate enables individuals to be placed in the community where they can be served well and in a cost-effective manner.
27. Bureau of Quality Assurance Surveyors
Section 1466d
This section requires that the bureau responsible for surveying community facilities, such as nursing homes, reduce the number of staff at the same percentage as the decrease in the number of facilities.
I am vetoing this section because it may result in less oversight of community facilities. Staffing demands may not decrease proportionately with the decrease in the nursing home population due to increased intensity of care required for the population that remains in such facilities.
28. Income Augmentation Plan
Sections 1154e, 1157b, 9224 (2c) and 9424 (10c)
These sections delete the authority of the Department of Health and Family Services to propose the use of income augmentation funds for purposes other than supporting costs exclusively related to augmenting federal income, or other uses provided for by law or in budget determinations, effective July 1, 2005. In addition, these sections would require the department to lapse all future income augmentation revenue received during the 2003-05 biennium that is not budgeted or lapsed elsewhere in this budget.
I am partially vetoing sections 1154e, 9224 (2c) and 9424 (10c) and vetoing section 1157b because the Joint Committee on Finance plan review process in current law provides for sufficient legislative oversight of proposals for the use of income augmentation revenue for purposes other than those specified in statute. In addition, I am vetoing these provisions because they unduly limit the department's ability to respond to unforeseen needs and effectively manage programs. The effect of these vetoes will be to maintain current law, giving the Department of Health and Family Services the authority to propose the use of income augmentation revenue for purposes other than those specified in statute.
Under current law the Department of Health and Family Services is required to submit a plan for the proposed use of income augmentation funds for purposes other than those specified in statute to the Department of Administration secretary. If the secretary approves the plan, it is submitted to the Joint Committee on Finance for review. The Department of Health and Family Services may then implement the plan only if approved by the Joint Committee on Finance.
29. Wisconsin Statewide Automated Child Welfare Information System
(WiSACWIS)
Sections 448t, 1104m and 9324 (15x)
These sections require counties to support 50 percent of the nonfederal portion of the ongoing costs of the Wisconsin Statewide Automated Child Welfare Information System (WiSACWIS). This would result in an increased cost to counties of approximately $268,700 annually.
I am vetoing these sections because I object to the unfunded mandate they impose on county governments, which have previously agreed in good faith to support 33 percent, not 50 percent, of the nonfederal, ongoing costs of WiSACWIS. Furthermore, the increased county costs may slow implementation of WiSACWIS, a situation that could force the state to return federal matching funds and pay noncompliance penalties.
JUSTICE
30. Consumer Protection Assessments
Sections 286 [as it relates to s. 20.115 (1) (km)], 287p and 1817d
These provisions create a new appropriation and require the Department of Administration secretary to transfer an amount equal to the unassessed consumer protection assessment from the Department of Justice's GPR state operations appropriations to the Department of Agriculture, Trade and Consumer Protection's PR consumer protection, assessments appropriation. This transfer is to occur whenever a court fails to impose a consumer protection assessment as required under current law.
I am vetoing these provisions to return to current law because the required transfer arbitrarily and unfairly penalizes the Department of Justice. District attorneys have significant discretion to prosecute statutory, rule and ordinance violations under Chapter 98 (Weights and Measures) and Chapter 100 (Marketing; Trade Practices), in collaboration with the Department of Justice. Most importantly, current law requires a Wisconsin court to impose a consumer protection assessment and credits the assessment amount to the Department of Agriculture, Trade and Consumer Protection's appropriation. I urge the Chief Justice, as the administrative head of the state judicial system, to ensure that Wisconsin courts impose this assessment. The action or inaction of district attorneys and courts with regard to these assessments should not be the basis for reducing funding for the law enforcement efforts of the Department of Justice.
31. Criminal History Searches; Fingerprint Identification Appropriation
Sections 286 [as it relates to s. 20.455 (2) (gm)] and 556r
S318 This provision converts the Department of Justice's criminal history searches and fingerprint identification appropriation from a continuing to an annual appropriation.
I am vetoing this provision because it unduly restricts the department's ability to maintain and increase fund balances in future years. The department should have the flexibility to monitor these fund balances, to plan for the long-term needs of the Crime Information Bureau and, thereby, avoid requesting supplementation from the Joint Committee on Finance appropriations.
32. Department of Justice Required Lapses
Section 9232 (2r)
Section 9232 (2r) requires the Department of Administration secretary to lapse $1,567,000 PR-O in fiscal year 2003-04 and $1,208,000 PR-O in fiscal year 2004-05 from the Department of Justice's crime laboratories and drug law enforcement assessment appropriation under s. 20.455 (2) (Lm).
I am vetoing this section because I object to imposing this excessive lapse requirement on the Department of Justice. Lapsing the amount required by the Legislature from the crime laboratories and drug law enforcement assessment appropriation could force the department to close the Wausau Crime Laboratory, and drastically reduce funding for the two remaining labs. The effect of my veto will be to allow the Department of Justice to retain this fee revenue, which will ensure that the department has the resources needed to continue providing the services local law enforcement agencies depend upon to solve cases and apprehend offenders.
OFFICE OF JUSTICE ASSISTANCE
33. Federal Homeland Security Funding
Sections 286 [as it relates to s. 20.465 (3) (mg)], 562m, 2111g and 2111j
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