LRB-4178/1
TJD:cjs:jf
2013 - 2014 LEGISLATURE
February 5, 2014 - Introduced by Senator Vukmir, cosponsored by Representative
Sanfelippo. Referred to Committee on Health and Human Services.
SB565,2,2 1An Act to amend 15.07 (1) (cm), 46.031 (2), 46.031 (2g) (a), 46.031 (2g) (b), 46.031
2(2r) (b), 46.031 (3) (a), 46.031 (3) (b), 46.031 (3) (c), 46.034 (3), 46.175, 46.18 (1),
346.18 (3), 46.18 (4), 46.18 (11), 46.18 (12), 46.18 (13), 46.18 (14), 46.18 (15), 46.19
4(4), 46.21 (2) (a), (j), (k), (m) and (q), (2m) (a) and (b) 1. (intro.), (3), (3g), (3r), (4),
5(4m) (a) and (b) and (6), 46.56 (1) (a), 46.56 (2) (a), 46.56 (2) (b), 46.56 (3) (b) 11.,
646.56 (4) (d), 46.56 (15) (b) (intro.), 51.08, 51.20 (18) (a), 51.42 (1) (b), 51.42 (3)
7(a), 51.42 (3) (ar) 8., 51.42 (3) (ar) 14., 51.42 (3) (b), 51.42 (4) (a) 2. (intro.), 51.42
8(6m) (intro.), 51.42 (6m) (c), 51.42 (6m) (i), 51.42 (6m) (m) 3., 51.423 (11), 51.44
9(4), 51.61 (1) (e), 51.61 (1) (f), 55.001 and 59.53 (7); and to create 13.94 (1) (mg),
1015.07 (1) (b) 24., 15.07 (3) (bm) 7., 15.195 (9), 17.07 (3r), 20.435 (5) (kf), 51.41
11and 59.53 (25) of the statutes; relating to: Milwaukee County mental health

1functions, programs, and services, creation of the Milwaukee County Mental
2Health Board, and making an appropriation.
Analysis by the Legislative Reference Bureau
This bill creates the Milwaukee County Mental Health Board (MCMHB)
attached to the Department of Health Services (DHS) for limited purposes. The
MCMHB is comprised of 11 voting and 2 nonvoting members nominated by the
governor and with advice and consent of the senate appointed to serve for four-year
terms. The bill specifies procedures for suggesting individuals for nominations and
creates limitations on those who may serve as a member of the MCMHB and also sets
criteria for removal of MCMHB members. The Milwaukee County board of
supervisors (county board) must arrange for payment from the Milwaukee County
mental health budget of expenses of the MCMHB under an agreement between the
Milwaukee County board and DHS.
The bill requires the MCMHB to fulfill duties including the following:
overseeing the provision of mental health programs and services in Milwaukee
County; making the final determination on mental health policy in Milwaukee
County; replacing the Milwaukee County board of supervisors (county board) in all
mental health functions typically performed by a county board; and attempting to
achieve costs savings in the provision of mental health programs and services in
Milwaukee County. The MCMHB must facilitate delivery of mental health services
in an efficient and effective manner by committing to community-based,
person-centered, recovery-oriented, mental health systems; maximizing
comprehensive community-based services; prioritizing access to community-based
services and reducing reliance on institutional and inpatient care; 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; providing
early intervention to minimize the length and depth of psychotic and other mental
health episodes; diverting people experiencing mental illness from the corrections
system when appropriate; and maximizing use of mobile crisis units and crisis
intervention training. Under the bill, 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 MCMHB does not vote to reject the contract within 14 days after the contract
is signed or countersigned by the county executive.
Under the bill, the MCMHB must allocate moneys for mental health functions,
programs, and services in Milwaukee County within a total budget amount which
is incorporated into the Milwaukee County budget by the county board. The bill sets
the total budget amount for each fiscal year to be the sum of a base budget amount
equal to $177,425,000 and any amount of unexpended moneys held by the
Milwaukee County treasurer in a mental health reserve fund mandated by the bill,
subject to the following adjustments:
1) The bill requires the Milwaukee County treasurer to hold in a mental health
reserve fund any moneys that were appropriated, but not expended, in a fiscal year

for mental health functions, programs, and services in Milwaukee County, and
specifies that moneys in the reserve fund may be expended only for such functions,
programs, and services. If in the fiscal year previous to the fiscal year for which the
budget is being determined, the county treasurer is holding any such unexpended
moneys in the mental health reserve fund, the base budget amount for the fiscal year
for which the budget is being determined is decreased by the amount of those
unexpended moneys.
2) If there are no moneys in the mental health reserve fund, the MCMHB
requests a mental health budget increase from the Milwaukee County executive, and
the Milwaukee County executive approves the mental health budget increase, the
base budget amount, together with any increase under item 3), below, is increased
to reflect the percentage change in a certain consumer price index during the
calendar year preceding the fiscal year for which the budget is being determined or,
if that percentage change is positive and if there is a smaller positive percentage
change in the property tax levy between the two calendar years preceding the fiscal
year for which the budget is being determined, to reflect that smaller positive
percentage change.
3) If the MCMHB is transferred jurisdiction of a function, service, or program,
under a procedure specified in the bill, that it did not have jurisdiction over initially,
the base budget amount is increased by the amount expended by Milwaukee County
on that function, service, or program in the fiscal year before the fiscal year in which
the function, program, or service is transferred. The increase applies for every fiscal
year for which the MCMHB has jurisdiction over the function, service, or program.
Under the bill, the Milwaukee County board may not provide funding and the
Milwaukee County executive may not approve funding, in any fiscal year, for mental
health functions, services, and programs that is less than or more than the total
budget amount calculated for that fiscal year, as described above.
The bill removes the jurisdiction over any mental health policy, functions,
programs, or services, from the Milwaukee County board. The bill prohibits the
Milwaukee County board from creating new mental health functions, programs, or
services that are under its jurisdiction. Disputes between the Milwaukee County
board and the MCMHB over whether a function, program, or service is a mental
health function, program, or service are resolved by the secretary of DHS.
Under the bill, the Milwaukee County executive must nominate an individual
to be the administrator of any division of the county department of human services
that administers behavioral health for Milwaukee County. The administrator may
be hired only upon approval of the MCMHB. The Milwaukee County executive
determines the salary and benefits and job duties of this administrator, but the
county executive may not assign the administrator any duties that are not related
to mental health functions, programs, and services in Milwaukee County. The
administrator may be removed by the MCMHB on its own by a vote of 8 of the
members or, if the Milwaukee County executive has recommended removal, by a vote
of 6 members of the MCMHB. The bill prohibits the Milwaukee County board from
hiring, removing, or disciplining, setting the salary or benefits of, or assigning or
removing job duties of this administrator.

Under current law, a county board 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. The primary responsibility is limited,
under current law, to the programs, services, and resources that the county 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. Under the bill, in
Milwaukee County, the MCMHB has 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 emergency
services. Under the bill, the Milwaukee County board retains the primary
responsibility for the well-being, treatment, and care of developmentally disabled
citizens residing in Milwaukee County, except where the responsibility is delegated
explicitly to the MCMHB.
Under current mental health-related statutes, the county board has certain
powers and duties. The bill makes changes to some powers and duties of the county
board including the following:
1. Under current law, county departments of community programs among
others, submit budget for services first to DHS. DHS submits a model of the contract
containing the allocation of funds to the county board, which must approve the
contract. Currently, the county board may appropriate moneys not used to match
state funds. The bill requires the department to submit contracts related to mental
health in Milwaukee County to the MCMHB.
2. Current law allows DHS to withhold a portion of the appropriation allocated
to certain county departments, including the county department of community
programs, for certain reasons, including duplicative services, inconsistency with
federal statutes or regulations, and inconsistency with the contract with the county
department. Under current law the county department affected by the withholding
of the appropriation, may submit to the county board a plan to rectify the deficiency
that prompted the withholding. The county board may approve or amend the plan
and submit the plan to DHS. Under the bill, if the withholding is related to mental
health in Milwaukee County, the county department submits the report to the
MCMHB and the MCMHB approves or amends the plan for submittal to DHS.
3. Under current law the county board of supervisors must establish a citizen
advisory committee to the county departments, including the county department of
community programs, which advises the county department in the formation of the
budget. The county board determines membership on the board, which must include
representatives of persons receiving services, providers of services, and citizens, and
selects the chairperson of the committee. Under current law, the establishment of a
citizen advisory committee is not required if the if the county board of supervisors
submits a report to DHS on the open public participation process it used to obtain
advice on the budget. Under the bill, the MCMHB takes the actions of the county

board of supervisors, as applicable, in either the establishment of the citizen advisory
committee or the alternate open public participation report.
4. Under current law, every county home, infirmary, hospital, or similar
institution must, subject to regulations approved by the county board, be managed
by a board of trustees chosen by ballot by the county board. Current law specifies
how the county board selects the trustees, fills vacancies on the board of trustees,
removes trustees, and sets other requirements related to those trustees. The bill
substitutes the MCMHB for the county board of supervisors in appointment,
removal, and other requirements for trustees of county homes, infirmaries,
hospitals, and similar institutions that provide mental health treatment in
Milwaukee County. Furthermore, the trustees, under current law, appoint a
superintendent of each institution, who must appoint and prescribe duties of
necessary additional officers and employees of the institution, subject to county civil
service law and approval of the trustees. Under current law, the salaries of the
superintendent, visiting physician, and all necessary additional officers are fixed by
the county board. Under the bill, in Milwaukee County, the salaries of any
superintendent of a mental health institution and the salaries of any visiting
physician and necessary additional officers and employees are fixed by the county
executive.
5. Under current law, a county board must maintain as a segregated cash
reserve an annual charge of 2 percent of the original cost of new construction or
purchase or of the appraised value of existing infirmary structures and equipment.
Under the bill, the MCMHB must ensure the maintenance of such a reserve for
mental health infirmary structures and equipment in Milwaukee County.
6. Current law vests the management, operation, maintenance, and
improvement of human services in Milwaukee County with a county department of
human services under the jurisdiction, as to policy, of the county board. The bill
assigns the jurisdiction of the Milwaukee County department of human services, as
to mental health policy, to the Milwaukee County mental health board.
7. The bill removes from the Milwaukee County board of supervisors and
assigns to the Milwaukee County mental health board certain powers and duties
including the following: the duty to adopt policies regarding mental health and
mental health institutions, programs, and services; the power to approve or
disapprove contracts relating to mental health and mental health institutions,
programs, and services; and the power to transfer any mental health-related human
services program and the duty to transfer certain duties such as the management,
operation, maintenance, and improvement of the county mental health complex to
the county department of human services.
8. Under current law, the director and administrator of the Milwaukee County
department of human services must submit certain annual reports to the county
board. The bill requires reports on matters of mental health to be sent to the
MCMHB. Disbursements applicable to mental health must be made in the manner
that the MCMHB, instead of the Milwaukee County board, adopts.
9. Under current law, a county board of supervisors has powers and duties
related to initiatives to provide coordinated services for children and families. The

bill substitutes, in Milwaukee County, the MCMHB for the county board in those
powers and duties.
10. The bill requires the MCMHB, instead of the county board, to establish a
county department of community programs 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. The bill gives to the MCMHB,
instead of the county board, authority of approval of the appointment by the
Milwaukee County executive of the county community programs board, which is a
policy-making body. The bill allows the MCMHB to exercise certain powers and
requires the MCMHB to perform duties that would normally be exercised or
performed by the county board related to the county department of community
programs and the county community programs board.
11. The bill requires the MCMHB, instead of the county board, to designate the
appropriate county department, the local health department of the county, or
another entity as the local lead agency to provide early intervention services.
The bill requires the MCMHB to submit annual reports to the Milwaukee
County executive, the Milwaukee County board, and DHS. The bill requires the
MCMHB to arrange for a study on alternate funding sources for mental health
services and programs with the results to be submitted by March 1, 2016, to the
Milwaukee County board, the Milwaukee County executive, and DHS. In addition,
the bill requires the Legislative Audit Bureau to perform a financial and
performance evaluation audit of the MCMHB and of the mental health functions,
programs, and services in Milwaukee County by January 1, 2017 and then biennial
audits.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB565,1 1Section 1. 13.94 (1) (mg) of the statutes is created to read:
SB565,7,72 13.94 (1) (mg) No later than January 1, 2017, and biennially thereafter,
3perform a financial and performance evaluation audit of the Milwaukee County
4mental health board and of mental health functions, programs, and services in
5Milwaukee County including a review of the effectiveness of the Milwaukee County
6mental health board and new policies implemented under that board in providing
7mental health services, a review of the expenditures of the Milwaukee County

1mental health board, a review of Milwaukee County's expenditures for mental health
2functions, programs, and services and the outcomes of those programs and services
3in the period after the formation of the Milwaukee County mental health board. The
4legislative audit bureau shall file a copy of the audit report under this paragraph
5with the distributees specified in par. (b) and the Milwaukee County executive and
6the Milwaukee County board of supervisors. The audit under this paragraph does
7not count toward the limit of audits of a county in a calendar year in par. (m).
SB565,2 8Section 2. 15.07 (1) (b) 24. of the statutes is created to read:
SB565,7,109 15.07 (1) (b) 24. The Milwaukee County mental health board, subject to s.
1015.195 (9).
SB565,3 11Section 3. 15.07 (1) (cm) of the statutes is amended to read:
SB565,7,2412 15.07 (1) (cm) The term of one member of the government accountability board
13shall expire on each May 1. The terms of the 3 members of the land and water
14conservation board appointed under s. 15.135 (4) (b) 2. shall expire on January 1.
15The term of the member of the land and water conservation board appointed under
16s. 15.135 (4) (b) 2m. shall expire on May 1 of an even-numbered year. The terms of
17the appraiser members of the real estate appraisers board and the terms of the
18auctioneer and auction company representative members of the auctioneer board
19shall expire on May 1 in an even-numbered year. The terms of the members of the
20cemetery board shall expire on July 1 in an even-numbered year. The term of the
21student member of the Board of Regents of the University of Wisconsin System who
22is at least 24 years old shall expire on May 1 of every even-numbered year. The terms
23of 6 of the members of the Milwaukee County mental health board appointed under
24s. 15.195 (9) (b) shall expire on May 1 of an even-numbered year.
SB565,4 25Section 4. 15.07 (3) (bm) 7. of the statutes is created to read:
SB565,8,3
115.07 (3) (bm) 7. The Milwaukee County mental health board shall meet 4
2times each year and may meet at other times on the call of the chairperson or a
3majority of the board's members.
SB565,5 4Section 5. 15.195 (9) of the statutes is created to read:
SB565,8,75 15.195 (9) Milwaukee County mental health board. (a) There is created a
6Milwaukee County mental health board, which is attached to the department of
7health services under s. 15.03.
SB565,8,98 (b) Subject to par. (d), the board shall consist of the following 11 voting members
9appointed for 4-year terms except for the members under subds. 10. and 11.:
SB565,8,1710 1. A psychiatrist or psychologist who is suggested by the Milwaukee County
11board of supervisors. The Milwaukee County board of supervisors shall solicit
12suggestions for psychiatrists and psychologists from organizations including the
13Wisconsin Medical Society, the Medical Society of Milwaukee, the Wisconsin
14Psychological Association, and the Wisconsin Association of Family and Children's
15Agencies for individuals who specialize in a full continuum of behavioral health
16services for children. The Milwaukee County board of supervisors shall suggest to
17the governor 4 psychiatrists and psychologists for this board membership position.
SB565,8,2518 2. A psychiatrist or psychologist who is suggested by the Milwaukee County
19board of supervisors. The Milwaukee County board of supervisors shall solicit
20suggestions for psychiatrists and psychologists from organizations including the
21Wisconsin Medical Society, the Medical Society of Milwaukee, the Wisconsin
22Psychological Association, and the Milwaukee Co-occurring Competency Cadre for
23individuals who specialize in a full continuum of behavioral health services for
24adults. The Milwaukee County board of supervisors shall suggest to the governor
254 psychiatrists and psychologists for this board membership position.
SB565,9,8
13. A representative of the community who is a consumer of mental health
2services and who is suggested by the Milwaukee County board of supervisors. The
3Milwaukee County board of supervisors shall solicit suggestions for individuals who
4have experienced mental illness or substance abuse from organizations including
5Warmline, the Milwaukee Mental Health Task Force, and the Milwaukee
6Co-occurring Competency Cadre. The Milwaukee County board of supervisors shall
7suggest to the governor 4 representatives of the community for this board
8membership position.
SB565,9,169 4. A medical director who is suggested by the Milwaukee County executive.
10The Milwaukee County executive shall solicit suggestions from organizations
11including the Wisconsin Hospital Association for individuals who specialize in a full
12continuum of behavioral health and medical services including emergency
13detention, inpatient, residential, transitional, partial hospitalization, intensive
14outpatient, and wraparound community-based services. The Milwaukee County
15executive shall suggest to the governor 4 medical directors for this board
16membership position.
SB565,9,2417 5. An individual specializing in finance and administration who is suggested
18by the Milwaukee County executive. The Milwaukee County executive shall solicit
19suggestions from organizations including the Wisconsin Hospital Association, the
20Wisconsin County Human Services Association, and the Public Policy Forum for
21individuals with experience in analyzing healthcare operating expenses, revenues,
22and reimbursement and expertise in financial restructuring for sustainability. The
23Milwaukee County executive shall suggest to the governor 4 individuals specializing
24in finance and administration for this board membership position.
SB565,10,7
16. A health care provider with experience in the delivery of substance abuse
2services who is suggested by the Milwaukee County executive. The Milwaukee
3County executive shall solicit suggestions from organizations including the
4Milwaukee Co-occurring Competency Cadre for health care providers specializing
5in providing substance abuse services. The Milwaukee County executive shall
6suggest to the governor 4 health care providers with experience in the delivery of
7substance abuse services for this board membership position.
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