Amendment ASA1-AB718

AB718-ASA1,23,21 (4m) (a) The county hospitals and county sanatoriums of a county with a population of 500,000 750,000 or more shall be devoted to hospital service and the treatment of patients upon such terms and conditions as the county board of supervisors or, in matters of mental health, the Milwaukee County mental health board establishes. The hospitals and sanatoriums may be utilized for instruction of medical students, physicians and nurses and for scientific and clinical research that will promote the welfare of the patients and assist the application of science to the alleviation of human suffering.

AB718-ASA1,23,25 (b) Professional staff responsible for the care of patients under this subsection may submit bills for professional services under policies adopted by the county board of supervisors or under mental health policies adopted by the Milwaukee County mental health board.

AB718-ASA1,24,11 (6) Reports; expenditures. The director and the administrator shall submit annually to the county board of supervisors, or to the Milwaukee County mental health board in matters of mental health, reports, including itemized statements of receipts and disbursements, at the times and in the manner that the county board of supervisors or Milwaukee County mental health board specifies and as are required to comply with applicable federal statutes and regulations and state statutes and rules. Disbursements shall be made in the manner that the county board of supervisors or Milwaukee County mental health board, as applicable, adopts, consistent with sound accounting and auditing procedure and with applicable federal statutes and regulations, state statutes and rules and requirements of the county auditor and county department of administration.

AB718-ASA1,27 Section 27. 46.56 (1) (a) of the statutes is amended to read:

AB718-ASA1,24,15 46.56 (1) (a) "Administering agency" means a department designated by a county board of supervisors, by the Milwaukee County mental health board in Milwaukee County, or by a tribe to administer an initiative.

AB718-ASA1,28 Section 28. 46.56 (2) (a) of the statutes, as affected by 2013 Wisconsin Act 20, is amended to read:

AB718-ASA1,24,24 46.56 (2) (a) Except as provided in par. (b), if a county board of supervisors or the Milwaukee County mental health board establishes an initiative under s. 59.53 (7) or if a tribe establishes an initiative, the county board, Milwaukee County mental health board, or tribe shall appoint a coordinating committee and designate an administering agency. The initiative may be funded by the county or tribe or the county board of supervisors, Milwaukee County mental health board, or tribe may apply for funding by the state in accordance with sub. (15).

AB718-ASA1,29 Section 29. 46.56 (2) (b) of the statutes, as created by 2013 Wisconsin Act 20, is amended to read:

AB718-ASA1,25,14 46.56 (2) (b) A county may enter into an agreement with one or more other counties or tribes to establish an initiative and a tribe may enter into an agreement with one or more counties or tribes to establish an initiative. The parties to the agreement shall designate in the agreement a single lead administrative county or lead administrative tribe. The county board of the lead administrative county, the Milwaukee County mental health board, if Milwaukee County is the lead administrative county, or the lead administrative tribe shall appoint a coordinating committee and designate an administering agency. The initiative may be funded by the participating entities, or the county board of supervisors of the lead administrative county, the Milwaukee County mental health board, if Milwaukee County is the lead administrative county, or the lead administrative tribe may apply for funding by the state in accordance with sub. (15).

AB718-ASA1,30 Section 30. 46.56 (3) (b) 11. of the statutes is amended to read:

AB718-ASA1,25,18 46.56 (3) (b) 11. Representatives of the county board or, in Milwaukee County, the Milwaukee County mental health board or, for an initiative established by a tribe, representatives of the elected governing body of the tribe.

AB718-ASA1,31 Section 31. 46.56 (4) (d) of the statutes, as affected by 2013 Wisconsin Act 20, is amended to read:

AB718-ASA1,25,23 46.56 (4) (d) If the county board of supervisors, Milwaukee County mental health board, or tribe or a multi-entity initiative decides to seek state funding under sub. (15), develop the application in cooperation with the coordinating committee.

AB718-ASA1,32 Section 32. 46.56 (15) (b) (intro.) of the statutes, as affected by 2013 Wisconsin Act 20, is amended to read:

AB718-ASA1,26,5 46.56 (15) (b) (intro.) In order to apply for funds under this subsection, the county board of supervisors, Milwaukee County mental health board, or tribe or, for a multi-entity initiative, the county board of the lead administrative county, the Milwaukee County mental health board, if Milwaukee County is the lead administrative county, or the lead administrative tribe shall do all of the following:

AB718-ASA1,33 Section 33. 51.08 of the statutes is amended to read:

AB718-ASA1,26,17 51.08 Milwaukee County Mental Health Complex. Any county having a population of 500,000 or more may, pursuant to s. 46.17, establish and maintain a county mental health complex. The county mental health complex shall be a hospital devoted to the detention and care of drug addicts, alcoholics, chronic patients and mentally ill persons whose mental illness is acute. Such hospital shall be governed pursuant to s. 46.21. Treatment of alcoholics at the county mental health complex is subject to approval by the department under s. 51.45 (8). The county mental health complex established pursuant to this section is subject to rules promulgated by the department concerning hospital standards. The county board may not sell the county mental health complex under this section without approval of the Milwaukee County mental health board.

AB718-ASA1,34 Section 34. 51.20 (18) (a) of the statutes is amended to read:

AB718-ASA1,26,22 51.20 (18) (a) Unless previously fixed by the county board of supervisors or the Milwaukee County mental health board in the county in which the examination is held, the examiners shall receive a fee as fixed by the court for participation in commitment proceedings, and reasonable reimbursement for travel expenses.

AB718-ASA1,35 Section 35. 51.41 of the statutes is created to read:

AB718-ASA1,26,25 51.41 Milwaukee County mental health; Milwaukee County mental health board.

AB718-ASA1,27,2 (1) Duties of the board. The Milwaukee County mental health board shall do all of the following:

AB718-ASA1,27,4 (a) Oversee the provision of mental health programs and services in Milwaukee County.

AB718-ASA1,27,6 (b) Allocate moneys for mental health functions, programs, and services in Milwaukee County within the budget amount set in sub. (4) (a).

AB718-ASA1,27,7 (c) Make the final determination on mental health policy in Milwaukee County.

AB718-ASA1,27,9 (d) Replace the Milwaukee County board of supervisors in all mental health functions that are typically performed by a county board of supervisors.

AB718-ASA1,27,11 (e) Facilitate delivery of mental health services in an efficient and effective manner by making a commitment to all of the following:

AB718-ASA1,27,13 1. Community-based, person-centered, recovery-oriented, mental health systems.

AB718-ASA1,27,14 2. Maximizing comprehensive community-based services.

AB718-ASA1,27,16 3. Prioritizing access to community-based services and reducing reliance on institutional and inpatient care.

AB718-ASA1,27,19 4. Protecting the personal liberty of individuals experiencing mental illness so that they may be treated in the least restrictive environment to the greatest extent possible.

AB718-ASA1,27,21 5. Providing early intervention to minimize the length and depth of psychotic and other mental health episodes.

AB718-ASA1,27,23 6. Diverting people experiencing mental illness from the corrections system when appropriate.

AB718-ASA1,27,24 7. Maximizing use of mobile crisis units and crisis intervention training.

AB718-ASA1,28,2 (f) Attempt to achieve costs savings in the provision of mental health programs and services in Milwaukee County.

AB718-ASA1,28,5 (g) Cooperate and consult with the department on recommendations for and establishing policy for inpatient mental health treatment facilities and related programs in Milwaukee County.

AB718-ASA1,28,11 (2) Powers of the board; limitations. (a) The Milwaukee County mental health board may request information from the Milwaukee Mental Health Complex, a county department under s. 46.21 or 51.42 or any other Milwaukee County governmental unit that possesses mental health information in order to fulfill its duties of overseeing mental health functions, programs, and services in Milwaukee County.

AB718-ASA1,28,19 (b) The Milwaukee County mental health board may not establish policies that change general audit, bill paying, payroll, and human resource procedures for Milwaukee County government or for the county department under s. 46.21 for divisions, branches, or functions other than those related to mental health. The Milwaukee County mental health board may change payroll and human resource procedures for the divisions, branches, and functions of the county department under s. 46.21 that relate to mental health only as authorized in this section and ss. 46.18, 46.21, and 51.42.

AB718-ASA1,28,21 (3) Public hearing. Annually, the Milwaukee County mental health board shall hold a public hearing in Milwaukee County as one of its required meetings.

AB718-ASA1,28,22 (4) Milwaukee County mental health budget. (a) In this subsection:

AB718-ASA1,28,24 1. "Community aids amount" means the amount of the mental health budget that is funded from the community aids allocation received under s. 46.40.

AB718-ASA1,29,3 2. "Mental health budget" means the part of the budget for Milwaukee County for a fiscal year that covers mental health functions, programs, and services in Milwaukee County.

AB718-ASA1,29,5 3. "Tax levy amount" means the amount of the mental health budget that is funded from revenues from the tax levy.

AB718-ASA1,29,10 (b) 1. The Milwaukee County mental health board shall propose to the Milwaukee County executive the total amount of the mental health budget, the community aids amount, and the tax levy amount. The Milwaukee County mental health board may not propose a tax levy amount that is less than $53,000,000 or more than $65,000,000, except as provided in subds. 5. and 6.

AB718-ASA1,29,15 2. The county executive, in his or her proposed budget for Milwaukee County for a fiscal year, may include a tax levy amount that is different than the tax levy amount proposed under subd. 1., but the county executive may not include a tax levy amount that is less than $53,000,000 or more than $65,000,000, except as provided in subds. 5. and 6.

AB718-ASA1,29,21 3. The county board of supervisors shall allocate to mental health functions, programs, and services an amount from the county's community aids allocation received under s. 46.40 that maintains or increases the expenditures for mental health functions, programs, and services paid from the county's community aids allocation in the previous fiscal year to the extent of the availability of community aids funds from the state.

AB718-ASA1,29,24 4. Except as provided in subds. 5. and 6., the county board of supervisors shall incorporate into the budget for Milwaukee County for a fiscal year all of the following:

AB718-ASA1,30,2 a. The tax levy amount as proposed by the county executive under subd. 2. and the amount of the community aids allocation determined under subd. 3.

AB718-ASA1,30,5 b. An amount equal to the total amount of the mental health budget proposed under subd. 1., less the community aids amount proposed under subd. 1 and the tax levy amount proposed under subd. 1.

AB718-ASA1,30,16 5. If the Milwaukee County mental health board transfers to itself jurisdiction of a function, service, or program under sub. (5) (b) that it did not have jurisdiction over on the effective date of this subdivision .... [LRB inserts date], the tax levy amount proposed under subd. 2. is increased by an amount equal to the amount derived from revenue from the tax levy that was expended by Milwaukee County for the transferred function, service, or program in the fiscal year before the fiscal year in which the function, program, or service is transferred. The $65,000,000 limit imposed under subds. 1. and 2. upon the tax levy amount may be exceeded by the amount of the increase under this subdivision in any fiscal year in which the Milwaukee County mental health board has jurisdiction over the transferred function, service or program.

AB718-ASA1,30,20 6. If a majority of the Milwaukee County mental health board and a majority of the Milwaukee County board of supervisors approves and the Milwaukee County executive agrees the tax levy amount may be less than $53,000,000 or more than $65,000,000 for a fiscal year.

AB718-ASA1,31,2 (c) Except as allowed under pars. (b) 2., 3., 4., 5., and 6. and (d), the Milwaukee County board of supervisors may not in a fiscal year provide funding, and the Milwaukee County executive may not in a fiscal year approve funding, for mental health functions, services, and programs that is less than or more than the total amount of the mental health budget proposed under par. (b) 1. for that fiscal year for those mental health functions, services, and programs.

AB718-ASA1,31,10 (d) The treasurer in Milwaukee County shall hold any moneys that at the end of a fiscal year have not been expended or encumbered from the amount budgeted for mental health functions, programs, and services in a mental health reserve fund. Moneys in the reserve fund may be used at any time to cover deficits in the Milwaukee County mental health budget. If the amount in the reserve fund exceeds $10,000,000, the amount exceeding $10,000,000 may be used at any time for any mental health function, program, or service in Milwaukee County. Moneys in the reserve fund may be used only for the purposes described in this paragraph.

AB718-ASA1,31,19 (5) Jurisdiction of Milwaukee County board. (a) The Milwaukee County board of supervisors has no jurisdiction over any mental health policy, functions, programs, or services. The Milwaukee County board of supervisors may not create new mental health functions, programs, or services that are under the jurisdiction of the board of supervisors. Any dispute between the Milwaukee County board of supervisors and the Milwaukee County mental health board over whether a function, program, or service is a mental health function, program, or service under the jurisdiction of the Milwaukee County mental health board shall be resolved by the secretary of health services.

AB718-ASA1,31,25 (b) The Milwaukee County mental health board may transfer jurisdiction over a Milwaukee County function, service, or program to itself that pertains to mental health or is highly integrated with mental health services and that is not under its jurisdiction by statute or by agreement with the Milwaukee County board of supervisors, by an affirmative vote of 8 of the voting Milwaukee County mental health board members if the secretary of health services approves the transfer.

AB718-ASA1,32,5 (6) Payment of board expenditures. (a) The Milwaukee County board of supervisors and the department shall enter an agreement for the payment of expenses of the Milwaukee County mental health board and for the performance of the audit and the completion of the report under 2013 Wisconsin Act .... (this act), section 53 (4).

AB718-ASA1,32,9 (b) The Milwaukee County board of supervisors shall arrange for the payment of expenses from the mental health budget, as defined in sub. (4) (a) 2., according to the agreement under par. (a). All payments shall be credited to the appropriation account under s. 20.435 (5) (kf).

AB718-ASA1,32,13 (7) County department requirements. (a) A county department under s. 46.21 or 51.42 in Milwaukee County may not impede the Milwaukee County mental health board in performing its duties under this section or exercising its powers under this section.

AB718-ASA1,32,16 (b) A county department under s. 46.21 or 51.42 in Milwaukee County shall respond to any requests for information from the Milwaukee County mental health board.

AB718-ASA1,32,24 (8) Reports; studies. (a) By March 1, 2015, and annually by March 1 thereafter, the Milwaukee County mental health board shall submit to the Milwaukee County executive, the Milwaukee County board of supervisors, and the department a report including a description of the funding allocations for Milwaukee County's mental health functions, services, and programs and a description of any improvements and efficiencies in those mental health functions, programs, and services. The department shall provide access to the report under this subsection to the public including posting the report on the department's Internet site.

AB718-ASA1,33,8 (b) The Milwaukee County mental health board shall arrange for a study to be conducted on alternate funding sources for mental health services and programs including fee-for-service models, managed care models that integrate mental health services into the contracts with an increased offset through basic county allocation reduction, and other funding models. By March 1, 2016, the Milwaukee County mental health board shall submit to the Milwaukee County board of supervisors, the Milwaukee County executive, and the department a report of the results of the study.

AB718-ASA1,33,18 (9) Administrator. (a) The Milwaukee County executive shall nominate an individual to be the administrator of any division or branch of the department under s. 46.21 that administers behavioral health for Milwaukee County. The nominated individual may be hired as the administrator only upon approval of the Milwaukee County mental health board. If the county executive does not nominate an individual by June 1, 2015, the Milwaukee County mental health board may hire an individual to be the administrator. Upon a vacancy in the position of administrator, if the county executive does not nominate an individual within 12 months of the date the position becomes vacant, the Milwaukee County mental health board may hire an individual to be the administrator.

AB718-ASA1,33,22 (b) The Milwaukee County executive shall determine the salary and benefits and the job duties of the administrator. The county executive may not assign the administrator any duties that are not related to mental health functions, programs, and services in Milwaukee County.

AB718-ASA1,33,24 (c) 1. The administrator under this subsection may be removed by the Milwaukee County mental health board by a vote of 8 members of that board.

AB718-ASA1,34,5 2. The Milwaukee County executive may recommend removal of the administrator under this subsection to the Milwaukee County mental health board. If the county executive recommends removal under this subdivision, the Milwaukee County mental health board may remove the administrator upon a vote of 6 members of that board.

AB718-ASA1,34,8 (d) The Milwaukee County board of supervisors may not hire, remove, or discipline; set the salary or benefits of, or assign or remove any job duties of the administrator under this subsection.

AB718-ASA1,34,13 (10) Mental health contracts. Any contract related to mental health with a value of at least $100,000, to which Milwaukee County is a party may take effect only if the Milwaukee County mental health board votes to approve, or does not vote to reject, the contract within 28 days after the contract is signed or countersigned by the county executive.

AB718-ASA1,34,21 (11) Transition liaison position. (a) The Milwaukee County executive shall nominate an individual who has knowledge of the services provided by and the mental health systems of Milwaukee County to be a transition liaison to assist the Milwaukee County mental health board in the transition of oversight functions. The transition liaison shall be assigned or hired to that position only upon approval of the Milwaukee County mental health board. The transition liaison shall be assigned to or employed in that position for no longer than 12 months, except that the county executive may grant extensions to the term of that position.

AB718-ASA1,34,23 (b) 1. The Milwaukee County executive shall determine the salary and benefits and the job duties of the transition liaison assigned or hired under par. (a).

AB718-ASA1,35,5 2. The Milwaukee County executive may remove the transition liaison assigned or hired under par. (a). If the Milwaukee County executive removes the transition liaison assigned or hired under par. (a) before the 12 months following the date of the assignment or hiring of the initial transition liaison have expired, the Milwaukee County executive shall nominate another transition liaison to serve for at least the remainder of the 12 months following the date of the assignment or hiring of the initial transition liaison.

AB718-ASA1,35,8 (c) The Milwaukee County board of supervisors may not hire, remove, or discipline; set the salary or benefits of; or assign or remove any job duties of the transition liaison assigned or hired under this subsection.

AB718-ASA1,36 Section 36. 51.42 (1) (b) of the statutes is amended to read:

AB718-ASA1,36,16 51.42 (1) (b) County liability. The county board of supervisors except in Milwaukee County, has the primary responsibility for the well-being, treatment and care of the mentally ill, developmentally disabled, alcoholic and other drug dependent citizens residing within its county and for ensuring that those individuals in need of such emergency services found within its county receive immediate emergency services. In Milwaukee County, the Milwaukee County mental health board has the primary responsibility for the well-being, treatment and care of the mentally ill, alcoholic, and other drug dependent citizens residing within Milwaukee County and for ensuring that those individuals in need of such emergency services found within Milwaukee County receive immediate emergency services. The county board of supervisors of Milwaukee County has the primary responsibility for the well-being, treatment, and care of the developmentally disabled citizens residing within Milwaukee County, except where the responsibility is delegated explicitly under this section to the Milwaukee County mental health board, and for ensuring that developmentally disabled individuals in need of such emergency services found within Milwaukee County receive immediate emergency services. This primary responsibility is limited to the programs, services and resources that the county board of supervisors, or, as applicable, the Milwaukee County mental health board, is reasonably able to provide within the limits of available state and federal funds and of county funds required to be appropriated to match state funds. County liability for care and services purchased through or provided by a county department of community programs established under this section shall be based upon the client's county of residence except for emergency services for which liability shall be placed with the county in which the individual is found. For the purpose of establishing county liability, "emergency services" includes those services provided under the authority of s. 55.05 (4), 2003 stats., or s. 55.06 (11) (a), 2003 stats., or s. 51.15, 51.45 (11) (a) or (b) or (12), 55.13, or 55.135 for not more than 72 hours. Nothing in this paragraph prevents recovery of liability under s. 46.10 or any other statute creating liability upon the individual receiving a service or any other designated responsible party, or prevents reimbursement by the department of health services for the actual cost of all care and services from the appropriation under s. 20.435 (7) (da), as provided in s. 51.22 (3).

AB718-ASA1,37 Section 37. 51.42 (3) (a) of the statutes is amended to read:

AB718-ASA1,37,2 51.42 (3) (a) Creation. Except as provided under s. 46.23 (3) (b), the county board of supervisors of any county except Milwaukee County, the Milwaukee County mental health board, or the county boards of supervisors of 2 or more counties, shall establish a county department of community programs on a single-county or multicounty basis to administer a community mental health, developmental disabilities, alcoholism and drug abuse program, make appropriations to operate the program and authorize the county department of community programs to apply for grants-in-aid under s. 51.423. The county department of community programs shall consist of a county community programs board, a county community programs director and necessary personnel.

AB718-ASA1,38 Section 38. 51.42 (3) (ar) 8. of the statutes is amended to read:

AB718-ASA1,37,13 51.42 (3) (ar) 8. By September 30, submit for inclusion as part of the proposed county budget to the Milwaukee County mental health board in Milwaukee County, to the county executive or county administrator, or, in those counties without a county executive or county administrator, directly to the county board of supervisors in a county with a single-county department of community programs or the county boards of supervisors in counties with a multicounty department of community programs a proposed budget for the succeeding calendar year covering services, including active treatment community mental health center services, based on the plan required under subd. 5. The final budget shall be submitted to the department of health services.

AB718-ASA1,39 Section 39. 51.42 (3) (ar) 14. of the statutes is amended to read:

AB718-ASA1,37,18 51.42 (3) (ar) 14. If the county board of supervisors or, as applicable, the Milwaukee County mental health board establishes an initiative to provide coordinated services under s. 59.53 (7), participate in and may administer the initiative, including entering into any written interagency agreements or contracts.

AB718-ASA1,40 Section 40. 51.42 (3) (b) of the statutes is amended to read:

AB718-ASA1,38,2 51.42 (3) (b) Other powers and duties. The county board of supervisors of any county with a single-county department of community programs, the Milwaukee County mental health board, and the county boards of supervisors of counties with a multicounty department of community programs may designate the county department of community programs as the administrator of any other county health care program or institution, but the operation of such program or institution is not reimbursable under s. 51.423.

AB718-ASA1,41 Section 41. 51.42 (4) (a) 2. (intro.) of the statutes is amended to read:

AB718-ASA1,38,12 51.42 (4) (a) 2. (intro.) In any county with a county executive or county administrator and which has established a single-county department of community programs, the county executive or county administrator shall appoint, subject to confirmation by the Milwaukee County mental health board in Milwaukee County or the county board of supervisors, the county community programs board, which shall be only a policy-making body determining the broad outlines and principles governing the administration of programs under this section. A member of a county community programs board appointed under this subdivision may be removed by the county executive or county administrator under the following circumstances:

AB718-ASA1,42 Section 42. 51.42 (6m) (intro.) of the statutes is amended to read:

AB718-ASA1,39,9 51.42 (6m) County community programs director in certain counties with a county executive or county administrator. (intro.) In any county with a county executive or county administrator in which the county board of supervisors or the Milwaukee County mental health board has established a single-county department of community programs, the county executive or county administrator shall appoint and supervise the county community programs director. In any county with a population of 500,000 750,000 or more, the county executive or county administrator shall appoint the director of the county department of human services under s. 46.21 as the county community programs director. The appointment of a county community programs director under this subsection shall be on the basis of recognized and demonstrated interest in and knowledge of the problems of mental health, intellectual disability, alcoholism and drug addiction, with due regard to training, experience, executive and administrative ability, and general qualification and fitness for the performance of the duties of the director. The appointment of a county community programs director under this subsection is subject to confirmation by the county board of supervisors, except in Milwaukee County, unless the county board of supervisors, by ordinance, elects to waive confirmation or unless the appointment is made under a civil service system competitive examination procedure established under s. 59.52 (8) or ch. 63. The county community programs director, subject only to the supervision of the county executive or county administrator, shall:

AB718-ASA1,43 Section 43. 51.42 (6m) (c) of the statutes is amended to read:

AB718-ASA1,39,18 51.42 (6m) (c) Determine, subject to the approval of the county board of supervisors or the Milwaukee County mental health board, as applicable, and with the advice of the county community programs board, whether services are to be provided directly by the county department of community programs or contracted for with other providers and make such contracts. The county board of supervisors, except in Milwaukee County, or the Milwaukee County mental health board in Milwaukee County may elect to require the approval of any such contract by the county board of supervisors or the Milwaukee County mental health board.

AB718-ASA1,44 Section 44. 51.42 (6m) (i) of the statutes is amended to read:

AB718-ASA1,39,25 51.42 (6m) (i) Establish salaries and personnel policies of the programs of the county department of community programs subject to approval of the county executive or county administrator and county board of supervisors, except in Milwaukee County, or the Milwaukee County mental health board in Milwaukee County unless the county board of supervisors or the Milwaukee County mental health board elects not to review the salaries and personnel policies.