Section 9118 (9)
Broadly, this provision requires the Department of Health Services to submit two waiver requests to the federal Centers for Medicare and Medicaid Services. The first waiver expands Family Care statewide by January 1, 2017, or upon approval of the waiver, whichever is later. The second makes a variety of reforms to the Family Care and Include, Respect, I Self-Direct (IRIS) programs, including requiring integrated health agencies to offer to long-term care participants both acute care and long-term care services. Integrated health agencies are required to offer all of the services currently offered in the current IRIS program to maintain a self-direction program for consumers.
In addition, the provision requires the waiver to meet certain benchmark requirements and the department is required to hold a specified number of public hearings and to consult with stakeholders in the waiver development process. Further, the department is required to report to the Joint Committee on Finance with progress reports as well as for approval or disapproval of the final waiver package.
Further, the provision requires the department to include in its 2017-19 biennial budget request, any proposed statutory changes necessary to conform statutes to the approved waiver or state plan amendment.
I believe these reforms to our state's long-term care programs will help improve outcomes for the state's elderly and disabled residents by offering consumers integrated health, behavioral and long-term care under a single provider. These reforms not only improve outcomes for the state's most vulnerable residents, but help to ensure that these vital safety net programs are run in a more efficient, equitable and sustainable manner.
However, I am partially vetoing this provision to make several common sense changes in order to best serve the consumers of long-term care services. First, I am vetoing the requirement that there be no less than five long-term care regions because I object to creating a fixed number of regions. Allowing the department to define the number of long-term care regions in the state gives it the flexibility to create the number of regions that makes the most sense for consumers.
Secondly, I am vetoing the requirement that rates paid to integrated health agencies are set through a separate actuarial study because it is unnecessary. The state and federal government already require the rates paid through the long-term care programs be actuarially sound.
Lastly, I am partially vetoing the requirement that the open enrollment period coincide with the Medicare open enrollment period because I object to specifying the timing of the open enrollment period in the bill. The department will set an open enrollment period which makes the most sense for Wisconsin consumers as part of its waiver submission.
74. Labor Region Methodology Study
Section 9118 (4u)
This provision requires the Department of Health Services to study the labor region methodology used to assist with the determination of Medical Assistance reimbursement rates. The department is also required to propose, to the Legislature no later than July 1, 2016, any necessary changes to the methodology such that the proposed labor region methodology results in adjustments to direct care costs that reflect labor costs for nursing homes in each county. This section also prohibits the department from implementing any proposed changes to the methodology without enactment of legislation.
I am vetoing this provision to eliminate the labor region methodology requirements, as these requirements are administratively burdensome and duplicative. The department already regularly evaluates the labor region methodology and may recommend changes if needed.
75. Dispute Resolution Process Relating Health Insurance Coverage of Chiropractic Treatment
Sections 4590r and 9122
The provision requires the Commissioner of Insurance to promulgate rules that provide for an independent process for resolving disputes related to insurer conduct with respect to statutory requirements for chiropractic coverage, access and reimbursement. The provision also specifies the criteria that must be included in the rules and authorizes the Commissioner of Insurance to promulgate emergency rules for the period before the effective date of permanent rules without being required to provide evidence that an emergency rule is necessary for the preservation of public peace, health, safety or welfare, or being required to provide a finding of emergency.
I am vetoing this provision because it would establish a unique method for dispute resolution for a single profession, which may result in administrative challenges and consumer confusion.
76. FoodShare Employment and Training Drug Testing
Section 1833
This provision requires the Department of Health Services to promulgate rules to develop and implement a drug screening, testing and treatment program that incorporates the provisions of 2015 Assembly Bill 191, as passed by the Assembly, that relate to screening and testing of FoodShare Employment and Training participants who are able-bodied adults without dependent children and are subject to FoodShare work requirements.
The department is required to include the following elements in its administrative rules: (a) only participants for whom there is a reasonable suspicion of use of a controlled substance without a valid prescription may be subject to testing; (b) if a person tests negative for use of a controlled substance, or tests positive but possesses a valid prescription, the individual will have satisfactorily completed the requirements of the provision; (c) if a participant tests positive and does not have a valid prescription, the individual must participate in state-sponsored substance abuse treatment to remain eligible for the employment and training program; and (d) while participating in state- sponsored treatment, the individual must submit to random testing in order to remain eligible for the employment and training program, and if an individual tests positive, the individual may begin treatment again, one time, and remain eligible for the program.
Subject to the promulgation of rules, the department shall screen and, if indicated, test and treat participants in an employment and training program who are able-bodied adults for illegal use of a controlled substance without a valid prescription for the controlled substance.
I am partially vetoing this provision in two ways. First, I am partially vetoing the requirement that treatment be state-sponsored because I object to requiring the state to cover all treatment costs, if the person has other coverage. This partial veto provides access to treatment while ensuring that the state is the payer of last resort.
Further, I am vetoing the requirement that testing is based on reasonable suspicion because I object to limiting the department's ability to determine which program participants will be screened and, if indicated, tested for illegal use of a controlled substance.
77. Grants to an Organization that Provides Advanced Life Support Training
Sections 481 [as it relates to appropriation s. 20.435 (1) (ch)], 668r, 668s, 9118 (3q) and 9418 (7q) These provisions appropriate $20,000 GPR in each year of the 2015-17 biennium for a grant to an entity that provides or facilitates advanced life support training to doctors, physician's assistants, nurse practitioners, registered nurses and paramedics who work in rural areas in Wisconsin. The provisions specify that the funding is only to be provided in the 2015-17 biennium.
I am partially vetoing section 481 [as it relates to s. 20.435 (1) (ch)] and vetoing sections 668r, 668s, 9118 (3q) and 9418 (7q) because I object to earmarking these funds. By lining out the appropriation under s. 20.435 (1) (ch) and writing in smaller amounts that delete $20,000 in each 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. 78. Repeal Health Care Provider Fees for Data Collection and Dissemination
This provision establishes the funding level for the Joint Committee on Finance general purpose revenue funds general program supplementation appropriation under s. 20.865 (4) (a) for the 2015-17 biennium. Included in that amount is an unreserved amount of $1,000,000 in fiscal year 2015-16, which was placed in the appropriation through the Committee’s actions which required the Department of Health Services to lapse $1,000,000 from the program revenue balance of the general program operations; health care information appropriation to the general fund in fiscal year 2015-16. I am partially vetoing section 481 [as it relates to s. 20.865 (4) (a)] by lining out the amount under s. 20.865 (4) (a) and writing in a smaller amount that reduces the appropriation by $1,000,000 in fiscal year 2015-16 because I object to increasing the Committee’s supplemental appropriation without sufficient detail as to how these funds are intended to be used. I am also requesting the Department of Administration secretary not to allot these funds. 79. County-to-County Nursing Home Bed Transfers
Section 9118 (7g)
This section requires the Department of Health Services to develop a policy that specifies procedures for applying for, and receiving approval of, the transfer of available, licensed nursing home beds among counties and requires the department to report to the Joint Committee on Finance no later than July 1, 2016.
I am vetoing this section because it is unnecessary. Current law already specifies the requirements that must be met for a transfer of licensed beds. However, I am directing the department to review current procedures and prepare a plan to address any issues that arise from that review.
80. Exempt Institutions for Mental Disease and County-Operated Nursing Homes from Bed Assessment
Sections 481 [as it relates to s. 20.435 (2) (a)], 1875d, 1875e and 1875f This provision exempts county government-owned institutions for mental disease and state-only licensed facilities from the nursing home bed assessment, unless the Centers for Medicare and Medicaid Services determines that exempting these facilities would not be permissible under federal statutes or rules relating to state health care provider assessments.
I am vetoing this provision because I object to exempting county-owned and state-only licensed institutions for mental disease from the nursing home bed assessment. This provision creates an additional financial burden on private facilities, thus risking access to care for some of our most vulnerable citizens. By lining out s. 20.435 (2) (a) and writing in a smaller amount that reduces the appropriation by $320,300 in each 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. 81. Nonemergency Medical Transportation
Section 9118 (11f)
This provision requires the Department of Health Services, to the extent permitted by contract, to modify the current nonemergency medical transportation contract and exclude the following counties: Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington and Waukesha. In addition, the provision requires that, if the contract is modified, the department must make alternative arrangements with counties, health maintenance organizations or transportation providers to provide nonemergency medical transportation services to Medical Assistance recipients who reside in the excluded counties, no later than January 1, 2016.
I am vetoing this provision because I object to excluding specific counties from the current nonemergency medical transportation contract. All counties should be served by the same contract in order to provide uniform, equitable and cost-effective transportation services under the Medical Assistance program to all eligible program recipients.
82. Healthy Aging Grants
Sections 703r and 9118 (4f)
This provision provides one-time funding in each year of the 2015-17 biennium for grants to a private, nonprofit entity that will use these funds to conduct the following activities: coordinate the implementation of evidence-based health promotion programs in healthy aging; coordinate with academic and research institutes regarding research on healthy aging; serve as a statewide clearinghouse on evidence-based disease prevention and health promotion programs; provide training and technical assistance to the staff of county departments, administering agencies and other providers of services to aging populations; collect and disseminate information on disease prevention and health promotion in healthy aging; coordinate public awareness activities related to disease prevention and health promotion in aging; and advise the Department of Health Services on public policy issues concerning disease prevention and health promotion in aging. In addition, the provision creates an annual GPR appropriation, entitled "Healthy aging; evidence-based training and prevention" among the department's programs for disability and elder services.
I am partially vetoing this provision to remove the overly restrictive grant administration requirements. Instead, I am allowing the department more flexibility to best address healthy aging issues.
83. Enhanced Dental Services Reimbursement Pilot Program
Sections 1798 [as it relates to setting the rates in statute, specifying the length of the pilot program, and requiring an evaluation and report to the Joint Committee on Finance] and 9318 (2)
This provision requires the Department of Health Services to request a waiver from the federal government to conduct a pilot program to provide an enhanced Medicaid payment for pediatric and adult emergency dental services in Brown, Polk, Racine and Marathon counties. The reimbursement is specified at 80 percent of the median fee for each procedure, or the usual and customary charge, whichever is less. In addition, the department is required to work collaboratively with the American Dental Association's Health Policy Institute to prepare an evaluation of the pilot program on a quarterly basis, beginning at the end of the first quarter in which the pilot program becomes effective. Further, the department is required to submit a report to the Joint Committee on Finance regarding dental care utilization, the number of Medicaid participating dentists in the state, the fiscal impact of the pilot program, a comparison of the pilot program as administered under a fee-for-service system and under a health maintenance organization system, and the impact of the pilot program on oral health outcomes.
These requirements apply to claims by providers for services provided on or after the effective date of the waiver or state plan amendment. Lastly, the pilot program is discontinued on the first day of the 37th month after the enhanced reimbursement rates take effect.
While I believe this dental reimbursement pilot program will allow eligible Medicaid recipients to have greater access to vital dental care, I am partially vetoing the provision in several ways. First, I am vetoing the inclusion of specific rates in statute because I object to limiting the department's ability to negotiate the rate methodology with the federal government.
I am also vetoing the requirement that the department work collaboratively with the American Dental Association's Health Policy Institute and the requirement to submit quarterly evaluation reports to the Committee. While I understand the importance of program evaluation and ensuring the effectiveness of this pilot program, I object to the overly prescriptive requirement placed on the department. The department should have flexibility to determine the appropriate timing of reports and the appropriate entities with whom to consult on a review of the pilot program to ensure it is an effective use of taxpayer funding.
I am vetoing the discontinuation of the pilot program on the first day of the 37th month after the enhanced reimbursement rates take effect because I object to specifying the length of the pilot program in statutes.
Lastly, I am vetoing the requirement to apply these changes to claims by providers for services provided on or after the effective date of the waiver or state plan amendment because I object to limiting the department's ability to negotiate the parameters of this dental reimbursement pilot program with the federal government.
84. BadgerCare Plus Coverage for Childless Adults
Section 1797
This section requires the Department of Health Services to submit two reports to the Joint Committee on Finance regarding changes to the BadgerCare Plus coverage for childless adults. The first report must be submitted to the Committee prior to submitting a waiver amendment to the federal Centers for Medicare and Medicaid Services and must summarize the provisions of the waiver and estimate the fiscal impact of any changes. The second report is required to be submitted to the Committee summarizing any provision approved by the federal government and must estimate the fiscal impact of those approved provisions.
I am partially vetoing this section because I object to these administratively burdensome requirements. In addition, these requirements may have the unintended consequence of limiting the administration's ability to negotiate the waiver amendment with the federal government.
85. Consolidate Community Mental Health Programs
Section 9118 (1q)
This section requires the Department of Health Services to consult with the Wisconsin Counties Association and mental health stakeholders before developing a method for distributing community mental health services funds from a new consolidated community mental health program in 2016 and beyond. In addition, this provision requires the department to submit the proposed distribution to the Joint Committee on Finance under 14-day passive review and use the proposed distribution method as approved, or modified and approved by the Committee.
I am vetoing this section because it is overly prescriptive and unnecessarily limits the flexibility of the department to balance the interests of counties and other stakeholders while providing services in the most programmatically and financially sound manner.
86. Children's Community Options Program Technical Modification
Section 1535
This section defines which individuals are eligible for the newly created Children's Community Options Program as a person under 22 years of age who is not eligible to receive services in, or be on a waiting list for, an adult long−term care program.
I am partially vetoing this section because the language, as drafted, could lead to uncertainty regarding eligibility for the program. My partial veto clarifies that individuals up to 22 years of age, as long as they are not otherwise able to access services through the adult long-term care system, are eligible for the newly created Children's Community Options Program.
87. Division of Medicaid Services
Sections 3665r, 3665s and 9418 (7p)
These sections reduce the number of division administrator unclassified positions authorized for the Department of Health Services to reflect the newly created Division of Medicaid Services.
I am vetoing these sections because I object to reducing the current number of unclassified positions in the department at this time. Staffing levels will continue to be reviewed by the department as the new division is implemented and these changes to the unclassified position authority are premature.
F. PROTECTING WISCONSIN CITIZENS AND OUR MOST VULNERABLE
88. Pedestrians Crossing Railroads
Section 3527m
This section allows a person to walk directly across the tracks or right-of-way of any railroad without being considered to be trespassing on the railroad property.
I am vetoing this section because I am concerned that allowing people to walk across railroad tracks outside of a designated crossing impairs public safety.
89. Expanded Payday Lender Authority
Sections 3443f, 3443h, 3443j and 3443m
These sections expand the types of financial products and services a payday lending company may provide to include sales of insurance, annuities and related products, and any financial or consumer financial services subject to regulation by statute or rule. These sections also specify that a payday loan licensee may conduct, or permit others to conduct, at the place of business specified in its license, services commonly offered by a currency exchange. Finally, these sections allow a payday loan licensee to sell merchandise and conduct other business provided it possesses any applicable license, permit or other approval required by law.
I am vetoing these sections because the expanded scope of business provided for payday lenders is overly broad and significantly exceeds that of any other financial institutions. In addition, the expanded scope could create regulatory ambiguity and consumer uncertainty. Changes of this magnitude should be addressed as separate legislation where the implications can be more carefully explored.
90. Nonprofit Voluntary Host Families Report
Section 9106 (2e)
This section requires the Department of Children and Families to establish a plan for engaging and utilizing nonprofit volunteer programs to place, with temporary host families, children whose parents or guardians have agreed to participate as an alternative to foster care. The department must submit a report on this plan to the Joint Committee on Finance on or before November 1, 2015.
I am partially vetoing this section to remove the requirement that a report be submitted because it is unnecessary. The department will evaluate the proposal and determine how to best serve the children involved.
91. Increase Part-time District Attorneys to Full-time
Sections 481 [as it relates to s. 20.475 (1) (d)], 4735d, 4735r, 4740e, 4740n and 9410 (1c) This provision provides $83,500 GPR and 1.2 FTE district attorney positions for Florence, Buffalo and Pepin counties on January 2, 2017, which will be the first day of the new four-year term of office. Currently, Florence County has a 0.5 FTE district attorney position, Buffalo County has a 0.5 FTE district attorney position and Pepin County has a 0.8 FTE district attorney position.
I am vetoing sections 4735d, 4735r, 4740e, 4740n and 9410 (1c), and partially vetoing section 481 [as it relates to s. 20.475 (1) (d)] by lining out the amount under s. 20.475 (1) (d) and writing in a smaller amount that reduces the appropriation by $83,500 in fiscal year 2016-17 because I object to the inclusion of these positions when there is not a uniform demonstrated need across all three counties. With this veto, I am reducing the 1.2 FTE positions in the appropriation under s. 20.475 (1) (d) in each year of the biennium. I am requesting the Department of Administration secretary not to allot these funds or authorize the additional position authority. 92. Reference to the Department of Children and Families
