This provision requires the Department of Health Services to submit a plan to achieve the unspecified Medicaid savings by August 1, 2009, for approval by the Joint Committee on Finance by September 1, 2009.
I am vetoing this provision because it creates an excessive delay in the implementation of actions required to reduce Medicaid expenditures and the realization of savings during the biennium. The report is unnecessary since the department has established an open and collaborative process and is working with providers to determine the changes that will be made to Medicaid reimbursement. Public information regarding the final plan will be readily available.
7.
Medicaid Transportation Broker
Section 9122 (4f) (a)
This provision requires the Department of Health Services to report to the Joint Committee on Finance prior to contracting with an entity to provide transportation management services. The report is to include the steps taken by the department to guarantee the entity under contract will coordinate with existing local transit services and provide adequate access throughout the state, including in rural counties.
I am vetoing this provision because I object to the limitation on the department's ability, in collaboration with a wide array of stakeholders, to manage the Medicaid program in a manner that is in the best interest of providers, recipients and the state. I am retaining the language requiring the department to report to the Joint Committee on Finance by January 31, 2010, on the savings and other efficiencies achieved in the delivery of transportation services, whether the manager enabled the state to claim additional federal funding and how the manager affected access to services for recipients statewide.
8.
Delivery of Medicaid Dental Services in Southeast Wisconsin
Section 1317n
This provision requires the Department of Health Services to use a fee-for-service dental delivery model in Kenosha, Milwaukee, Racine and Waukesha counties beginning on January 1, 2010.
While I support the intent of improving and expanding access to dental services, I am vetoing this provision because it is overly restrictive regarding the administration of the benefit and will prevent the department from exploring options and developing innovative strategies to improve the quality and provision of dental services in Southeast Wisconsin.
9.
Quality of Care Improvement Implementation
Sections 1301c, 1313h, 1313p, 1315n, 9122 (10q), 9322 (3f) and 9422 (14g)
A322
These sections require the Department of Health Services, beginning on January 1, 2010, to impose mandates on managed care organizations serving Medicaid recipients. These mandates include requirements to provide prenatal care coordination programs and require all pregnant Medicaid recipients to enroll in the program; assign a primary care provider to every Medicaid recipient; provide a monthly per patient payment to primary care physicians for care coordination services; and have a chronic disease management and case coordination program in place for all patients diagnosed with diabetes, asthma, congestive heart failure, coronary artery disease, and a primary or secondary behavioral health diagnosis, including substance abuse and depression. These sections also require the department to expand the use of special needs programs to provide case management services for children with medically complex conditions. Finally, these sections require the department to submit a report to the Legislature regarding six initiatives intended to improve the quality of care provided under Medicaid and reduce costs within the program.
I am vetoing these sections because these mandates are excessively prescriptive and provide insufficient flexibility for the department to manage and administer the Medicaid managed care program using quantifiable health outcomes. While I support the goal of improving the quality and cost-effectiveness of care provided through the Medicaid program, designating the operations of managed care organizations in statute limits the program's ability to develop new initiatives as best practices emerge and advance and it does not reward health care providers based on patient outcomes, which is contrary to the goals of the department.
10.
County Nursing Home Supplements
These provisions require the Department of Health Services to increase annual Medicaid supplemental payments to county and municipal nursing homes by $2,000,000 in each year of the biennium from the Medical Assistance Trust Fund.
I am partially vetoing these provisions because I object to increasing these payments during this fiscal crisis. I am lining out the Medical Assistance program benefits appropriation under s.
20.435 (4) (b) and am writing in a smaller amount that deletes $1,000,000 GPR in fiscal years 2009-10 and 2010-11. I am also lining out the Federal Aid Medical Assistance appropriation under s.
20.435 (4) (o) and am writing in a smaller amount that decreases the dollar amount for fiscal year 2009-10 by $704,500 FED and decreases the dollar amount for fiscal year 2010-11 by $655,500 FED. The intent of this veto is to provide an additional $1,000,000 per year of Medicaid supplemental payments to county and municipal nursing homes, for a total payment of not more than $38,100,000 in each fiscal year. I am also requesting the Department of Administration secretary not to allot these funds.
11.
Patient Health Care Records Access and Fees
Sections 2433b, 2433d, 2433f, 2433r and 9322 (9c)
This provision repeals the Department of Health Services' authority to prescribe fees in administrative rule, sets fees for copies of patient health care records in statute and limits fees that can be charged for electronic copies of records. Further, this provision specifies deadlines for the provision of copies and access to records, and prescribes penalties for failure to meet the requirements.
I am partially vetoing this provision to eliminate the deadlines and the associated penalties for providing copies of and access to records, with the intent of maintaining current law requirements provided under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). The impact on health care providers of creating state regulations that are significantly more restrictive than federal requirements has not been adequately analyzed. Further, this partial veto will eliminate the $5 fee limit on electronic record copies with the intent that providers may charge a reasonable fee rate for providing copies in an electronic or digital format that is no more than the paper copy rate. The fee limitation is a deterrent to providers adopting electronic health records. Because the impact of these changes requires further study, I am directing the department, in collaboration with the Wisconsin eHealth Care Quality and Patient Safety Board, to evaluate alternatives and to make recommendations on appropriate fees and effective penalties to ensure appropriate and timely access to records that can be adopted in future legislation.
12.
Milwaukee Income Maintenance Investigation
Section 9130 (1q)
This provision requires the Department of Justice to investigate whether county administrative fraud was committed before May 1, 2009, in connection with the administration of any income maintenance program in Milwaukee County.
I am vetoing this section because it is inappropriate for the Legislature to direct a law enforcement agency to conduct a specific investigation. The Legislature has other resources, such as the Legislative Audit Bureau, that are more appropriate for an investigation of this nature.
13.
Medicaid Physician Pilot Project
Section 1301e
This section requires the Department of Health Services to develop and submit a proposal within 60 days of the effective date of the bill to the Joint Committee on Finance regarding increasing reimbursement to providers recognized as patient-centered medical homes or determined to be performing well based on specified criteria. The section also requires the department to implement the proposal by January 1, 2010, if approved under passive review by the Joint Committee on Finance and the U.S. Department of Health and Human Services, and report to the Joint Committee on Finance 39 months after the effective date of the bill on the net cost reductions and provide a recommendation on the continuation of increased reimbursement.
I am partially vetoing this section because the 60 day deadline is too short to develop a proposal of this scope. I support the goal of improving the quality and cost effectiveness of care provided to Medicaid recipients and am retaining the remaining language in this section. I am requesting that the Department of Health Services secretary submit this proposal to the Joint Committee on Finance within a reasonable time frame.
A323
14.
Income Maintenance Allocation
Section 1371r
This section directs the department to allocate $76,000 to Milwaukee County and $4,550,000 to the remaining Wisconsin counties and tribal governing bodies from funds received through the American Recovery and Reinvestment Act.
I am partially vetoing this section to correct the over-allocation of funds between Milwaukee County and the remainder of the state by deleting the limit on Milwaukee County. The legislative intent was to allocate $400,000 of this funding to Milwaukee County for Income Maintenance services and, therefore, I am directing the department to allocate $400,000 to Milwaukee County and $4,226,000 to the remaining counties and tribal governing bodies.
15.
Coverage of Podiatry Services for BadgerCare Plus Childless Adults
Section 1353n
This provision mandates coverage of services provided by podiatrists under the childless adults demonstration project.
I am vetoing this provision because I object to the limitation on the department's ability, in collaboration with medical experts, to prioritize benefit coverage in the most cost-effective and medically appropriate way. The Department of Health Services, through its Clinical Advisory Committee on Health and Emerging Technology (CACHET), has developed an open, evidence-based process to determine coverage of specific services based on cost effectiveness and medical necessity. I agree with the intent of ensuring proper and adequate preventive care is provided to recipients and am therefore directing the department to consider the inclusion of podiatric services under the childless adults demonstration project at a future CACHET meeting.
INSURANCE
16.
Motor Vehicle Insurance
Sections 2962t, 2963r, 3147, 3172, 3172k, 9326 (6) and 9426 (2)
These sections make changes to motor vehicle insurance requirements related to liability coverage limits, prohibitions on insurer limitations of coverage and premium rate setting.
I proposed changes to vehicle insurance requirements to ensure that policyholders obtained the full benefit of the coverage they have purchased and to increase the minimum amounts of liability insurance required for proof of financial responsibility. Liability insurance minimums have not been increased in over 25 years while, during that same period, the cost of health care has grown substantially. The liability insurance increase and other reforms are necessary to protect consumers and to ensure that people injured in accidents are shielded from excessive financial loss due to insufficient coverage.
The bill also mandates all drivers maintain vehicle liability insurance. I support this provision as Wisconsin is one of only two states that do not require drivers to carry liability insurance. However, with the implementation of this mandate, it is more essential than ever to ensure that insurance premiums remain affordable for all drivers required to purchase coverage. For that reason, I have revisited the liability limit increases and other reforms contained in the bill and have made several modifications through vetoes.
Section 2962t increases the minimum amounts of liability insurance required for proof of financial responsibility over a three-year period. I am partially vetoing this section, the related effective date in section 9426 (2), and a cross reference in section 2963r, to retain the increase in minimum liability coverage effective on January 1, 2010, but delete the additional increases in 2011 and 2012. This will balance the need to maintain affordability while addressing some of the concerns regarding the insufficiency of the current liability minimum. In order to ensure coverage remains adequate, I am retaining a separate provision that adjusts the minimum amounts every five years based on changes in the consumer price index.
Section 3172 prohibits insurers from denying coverage for an accident if the vehicle is not described in the policy under which a claim is made. I am vetoing this provision and cross references to this section under sections 3147 and 9326 (6), because it may increase the cost of premiums, but I am retaining separate provisions that prohibit insurers from categorizing people who have not previously had insurance in a high-risk category and that allow the stacking of coverage limits for up to three vehicles owned by the insured.
I am partially vetoing section 3172k to delete a provision prohibiting insurers from determining premiums based on where the vehicle is located. This provision is disruptive to the market and would increase premiums for policyholders in many locations. I am requesting that the Commissioner of Insurance study this issue to ensure fair treatment of citizens throughout the state.
While these proposals are well-intended, I am vetoing these provisions because they may raise the costs of vehicle insurance premiums and are contrary to the goal of ensuring that all drivers are able to purchase affordable motor vehicle liability insurance.
E.
STATE GOVERNMENT OPERATIONS
OFFICE OF STATE EMPLOYMENT RELATIONS
1.
Office of State Employment Relations Charges
Section 2483
This provision allows the director of the Office of State Employment Relations to provide services and materials to other state agencies and charge them for the services and materials provided. It also requires the director to establish a methodology for determining the costs and charges by administrative rule.
A324
I am partially vetoing this provision to eliminate the requirement to promulgate an administrative rule for this process. I object to this requirement because it is burdensome and inefficient.
2.
Collective Bargaining Rights for University of Wisconsin System Faculty, Academic Staff and Research Assistants
Sections 2254L and 2255
These provisions allow faculty, academic staff and research assistants of the University of Wisconsin System the right to enter into collective bargaining. Research assistants are defined as graduate students enrolled in the University of Wisconsin System who are receiving a stipend to conduct research which is independent or self-directed. Students on a student or exchange visa or those provided fellowships, scholarships and traineeships that are distributed through other titles such as fellow, scholar or trainee are excluded. In addition, this provision allows the Wisconsin Employment Relations Commission to assign faculty and academic staff to collective bargaining units.
I am partially vetoing this provision because it requires research assistants who have formed into collective bargaining units to be initially represented by the Teaching Assistant Association and allows the Wisconsin Employment Relations Commission (WERC) to assign faculty and staff to bargaining units. I object to these provisions because employees who form bargaining units should be allowed to select the labor organization that will represent them. This veto is consistent with the intent of the Legislature on this matter. The provision that allows WERC to assign faculty and staff to bargaining units is unnecessary since it is redundant with WERC authority under current law.
F.
TAX, TRANSPORTATION AND BUDGET DEVELOPMENT
BUDGET MANAGEMENT
Section 3412
This section removes the requirement in
2007 Wisconsin Act 20 that the Department of Administration secretary lapse or transfer $200 million to the general fund from the balances of appropriations of executive branch agencies.
I am vetoing this section to restore the secretary's authority and provide additional flexibility to manage the state's finances. I am concerned that there continues to be uncertainty in the economic outlook, and the restoration of this authority will assist the state in addressing any potential fiscal impacts of further weakness in the global and national economy.
2.
Agency Mission Statements and Performance Measures
Section 73L
This section requires the Department of Administration to submit copies of agency mission statements and performance measures to the Joint Committee on Finance and to the chief clerk of each house for distribution to the appropriate standing committees of the Legislature in January of each odd-numbered year.
I am vetoing this section because it is redundant and duplicative with existing law. This information is already included in the Executive Budget Book, which is distributed to all members of the Legislature and the public in each odd-numbered year.
PUBLIC SERVICE COMMISSION
3.
Police and Fire Protection Fee Sunset and Creation of 911 Grant Program
Sections 40w, 225d, 225L, 665su, 665w, 681i, 682L, 1835dr, 1836er, 1849w, 2454L, 2460f, 2460t, 2475L, 2572hb, 2572he, 2572hh, 2572hL, 2572ho, 2572hr, 2572hu, 2572hy, 2573b, 2573f, 2573h, 9141, 9341 and 9441 (1j) (b) and (2j)
These provisions sunset the police and fire protection fee on June 30, 2011, and implement a new 911 surcharge beginning July 1, 2011. Under these provisions, the 911 surcharge will be used to fund a 911 grant program for local governments and telephone service providers administered by the Public Service Commission. These provisions create a segregated 911 fund and a 911 council, permit adjustment of the amount of the 911 surcharge, and provide the commission with 1.0 FTE 911 state coordinator position and related funding.
I am vetoing sections 225L, 665w, 682L, 2454L and 9441 (1j) (b) to remove the sunset of the police and fire protection fee because I object to the loss of direct aid to local governments. I am also vetoing sections 40w, 225d, 665su, 681i, 1835dr, 1836er, 1849w, 2460f, 2460t, 2475L, 2572hb, 2572he, 2572hh, 2572hL, 2572ho, 2572hr, 2572hu, 2572hy, 2573b, 2573f, 2573h, 9141, 9341 and 9441 (2j) because the program will no longer have a funding source. While I agree that enhanced 911 capabilities are a significant part of public safety, we must protect funding for the fire and police personnel who provide local law enforcement and emergency response. My veto will ensure that the police and fire protection fee continues to be returned to local governments through the county and municipal aid program. I request that the commission work with interested parties to determine the best approach and revenue source to reimburse enhanced 911 costs, and to ensure that the public has the opportunity to be heard on this important issue.
4.
Intervenor Financing for a Nonprofit Corporation
A325
This provision permits grants to certain organizations to be made from the Public Service Commission's intervenor financing appropriation. The provision specifies that a $300,000 annual grant shall be made to a nonstock, nonprofit corporation with a history of advocating on behalf of residential ratepayers for affordable rates, and increases the appropriation accordingly. The provision also changes the intervenor financing appropriation from annual to biennial to accommodate the grants.
I am vetoing this provision because the grant is unnecessary. This provision was created in anticipation of an increased number of cases due to the permissive automatic utility rate adjustment. However, the automatic rate adjustment was not included in the final budget passed by the Legislature. I agree that while this is a meritorious idea, it requires further consideration and public hearing. Nonstock, nonprofit corporations will continue to be eligible for compensation through intervenor financing under current law, and any increases to intervenor financing can be considered should future changes result in an increased caseload.
By lining out the dollar amounts in the commission's appropriation under s.
20.155 (1) (j) and writing in a smaller amount that deletes $300,000 in each fiscal year, I am vetoing the funding for these grants. Furthermore, I am requesting the secretary of the Department of Administration not to allot these funds.
REVENUE
5.
Assessment of Leased Property
Sections 1520d and 9343 (4f)
This provision requires assessors to consider the actual rent and terms of a lease when determining the value of leased property using the income approach.
I am vetoing this provision because I object to changing valuation methodology through the legislative process. Currently, property assessment methods and standards are set forth in the Wisconsin Property Assessment Manual. The manual is developed in accordance with professionally accepted appraisal practices and is researched and reviewed thoroughly by experts working in the appraisal field. Changes to property assessment practices should be pursued as updates to the manual to ensure sufficient review by property appraisal experts.
6.
Financial Record Matching Program
Section 1804
This section establishes a financial institution data match program that partners financial institutions with the Department of Revenue to identify financial institution account holders with delinquent state taxes for the purpose of levying accounts to offset debts owed to the state. The section stipulates that financial institutions must match the delinquent taxpayer data against account holder records and provide the results to the department. In addition, the section exempts financial institutions with less than $5 million in assets from the program.
I am partially vetoing this section, as it relates to s.
71.91 (8) (a) 4. and
(c), to eliminate the requirement that financial institutions perform the data match because I object to the administrative burden this requirement imposes on the institutions. The effect of the veto will provide institutions the option to forward account holder data to the department for matching. The remaining language will allow the department to promulgate rules that provide program flexibility consistent with the administration of a similar program that partners financial institutions with the Department of Children and Families.
In addition, I am partially vetoing this section as it relates to a financial institution with less than $5 million in assets because it is unnecessary. These smaller institutions will be able to utilize the data match option provided above. As a result, all financial institutions in the state will be subject to the financial record matching program.
7.
Burnett County Temporary Sales Tax
