_Hlk493082827These sections establish and fund the statutory per diems of each of the elections and ethics commissioners at $227 per meeting. Under current law, each commissioner receives a per diem equivalent to a reserve judge sitting in circuit court for each day the commissioners were actually and necessarily engaged in performing their duties. In fiscal year 2016-17, this was equivalent to $454 per day.
I object to this provision because I believe that a $227 per meeting statutory per diem paid to ethics and elections commissioners is still out-of-line with per diems paid to members of comparable boards and commissions.
I am exercising the digit veto in section 17 in order to decrease the statutory per diem from $227 per meeting to $27 per meeting. Further, I am partially vetoing section 183 by lining out the amounts under s. 20.510 (1) (a) and s. 20.521 (1) (a) and writing in smaller amounts that reduce each appropriation by $9,600 in each year of the biennium. I am requesting the Department of Administration secretary to not allot these funds. With these vetoes, the statutory per diems paid to ethics and elections commissioners will be better aligned with the statutory per diems paid to members of other state boards and commissions.
Department of Employee Trust Funds
54. Group Insurance Program Changes and Group Insurance Board Directives
Sections 17n, 39d, 39f, 39g, 39h, 39j, 39k, 707f, 709g, 9114 (1c), 9114 (1t), 9114 (2p), 9114 (2w), 9129 (2w), 9314 (3c), 9314 (3p) and 9314 (4p)
These sections make the following changes to the state group health insurance program and the Group Insurance Board:
Section 9114 (2w) directs the Group Insurance Board to attempt to ensure that state group health insurance costs paid from GPR are reduced by $63,900,000 over the 2017‑19 biennium through a combination of provider negotiation savings, utilization of state group health program reserves, increased use of health plan tiers and health plan design changes, with an emphasis on consumer-driven health care, that do not exceed a 10 percent increase to total employee costs for the lowest tier plans in each of calendar years 2018 and 2019. Premiums, copays, deductibles, coinsurance and out-of-pocket-maximums are subject to the 10 percent limitation.
Section 9114 (1c) directs the Department of Employee Trust Funds to submit a plan and request for related funding to conduct an educational campaign for consumer-driven health plans before and during the annual enrollment period for the state health insurance plan for calendar year 2019 to the Joint Committee on Finance for its approval no later than January 1, 2018. The educational campaign shall provide the following information: (a) the advantages of high-deductible health plans and health savings accounts, (b) examples of individuals or families that may benefit from high-deductible health plans and health savings accounts, and (c) any consumer-driven health plan design changes or initiatives approved by the board. The department cannot conduct the campaign without the approval of the Committee.
Section 9114 (1t) requires the Group Insurance Board to submit a report to the Joint Committee on Finance by March 1, 2018, detailing: (a) the amount of state group health program reserves as of December 31, 2017, (b) the amount of state program reserves that will be used during calendar year 2018 to reduce state program costs, (c) a projection of 2018 year-end state program reserves by the board's consulting actuary, and (d) the board's planned utilization of state program reserves during calendar year 2019. The board may not implement the plan if, within 21 working days, the cochairpersons of the Joint Committee on Finance notify the board that a meeting has been scheduled to review the plan.
Section 9114 (2p) requires the Group Insurance Board to use $68,800,000 of the state group health program reserves during the 2017-19 biennium to reduce program costs. The board is also directed to review its policies related to maintaining reserves for fully insured health plans. In conducting the review, the board is required to review: (a) the history of changes in the participation of fully insured health plans in the group health insurance program, (b) the number of members affected by the discontinuation of fully insured health plans from year to year, and (c) the dollar amount of claims or premiums associated with members that are affected by the discontinuation of fully insured health plans from year to year.
Sections 709g and 9314 (3c) establish five, rather than three, health plan tiers in statute.
Sections 707f and 9314 (3p) require the Group Insurance Board, in consultation with the Division of Personnel Management within the Department of Administration, to submit any proposed changes to the state group health insurance program in the following program year to the Joint Committee on Finance by April 1 of each year under a passive review approval process. Proposed changes for calendar year 2018 that would have a financial impact or affect covered benefits are also subject to the passive review requirement. If the Committee notifies the board within 21 working days that a meeting has been scheduled for the purpose of reviewing the changes, the changes may not be implemented unless approved by the Committee.
Section 9129 (2w) requests the Joint Legislative Audit Committee to direct the Legislative Audit Bureau to conduct a financial and performance audit of the state group health insurance programs, including a review of the Group Insurance Board's compliance with the state group health reserves policy, a review of the appropriateness of its policy regarding fully-insured program reserves and the circumstances that have created ongoing, frequent accumulation and use of reserves.
Sections 17n, 39d, 39f, 39g, 39h, 39j, 39k and 9314 (4p) require that the six members of the Group Insurance Board who are appointed by the Governor to two-year terms under current law be appointed with the advice and consent of the Senate. In addition, this provision would expand the board from 11 members to 15 members and specify the following new members: (a) one member appointed by the Speaker of the Assembly, (b) one member appointed by the Minority Leader of the Assembly, (c) one member appointed by the Majority Leader of the Senate, and (d) one member appointed by the Minority Leader of the Senate.
I am vetoing all of these sections in their entirety because I object to having the Legislature interfere with the responsibilities of the Group Insurance Board, which has set policy and overseen administration of the group health insurance plan for state and local employees, retirees and employers since 1959. The Legislature’s role is to approve the compensation plan and set overall funding for the state group health insurance program. In addition, last session, the Legislature passed, and I signed, 2015 Wisconsin Act 119, which established new authority for the Joint Committee on Finance to approve or reject contracts to provide self-insured group health plans to state employees. Thus, I believe that current law already provides a sufficient and appropriate oversight role for the Legislature. I do not believe that they should micromanage plan design, contract negotiations and the financial and programmatic management of the program. The provisions to be vetoed ensure that the Joint Committee on Finance have complete control over any change, no matter how small, to the program. This degree of oversight will not be workable, especially for a Committee that does not meet on a regular basis. _Hlk491256470Furthermore, some of these provisions are unnecessary and administratively burdensome. For example, the board has already approved the participating health plans and rates for the calendar year 2018 group health insurance program and is committed to achieving the biennial savings target established by the Legislature. Any changes to the 2018 program made by the Joint Committee on Finance would require problematic contract amendments. Submitting any future changes to the plan design to the Committee for approval will also be problematic and may encourage additional lobbying of the Legislature by providers and employees. In addition, statutorily increasing the number of health plan tiers from three to five does not make sense for counties where fewer than five plans are even offered. Furthermore, statutorily requiring reports and an audit by the Legislative Audit Bureau of the program reserves are unnecessary as the Group Insurance Board is already in the process of updating its reserve policies as part of its normal process.
Finally, direct involvement of legislators in the policy-setting and administration of the group health program could politicize a process that has worked effectively under Group Insurance Board oversight for the past 58 years. While the Legislature has a substantial role in setting statutory policy and establishing overall funding levels, the members of the board must develop significant expertise in health plan design and administration, while balancing the needs of the employers, employees and health plans. This is best achieved with the current composition of the board.
55. 100th Anniversary of the State Capitol
This provision creates an annual GPR appropriation for activities related to the celebration of the 100th anniversary of the State Capitol and appropriates $50,000 GPR in fiscal year 2017-18. Payments from the appropriation must be authorized by the cochairpersons of the Joint Committee on Legislative Organization. It also creates a PR continuing appropriation to receive revenues generated from activities related to the celebration. The first $50,000 of these funds received in each fiscal year lapses to the general fund. Any amounts above $50,000 are transferred to a new PR biennial appropriation for capitol restoration and relocation planning.
_Hlk492389581I am vetoing this provision in its entirety because the State Capitol and Executive Residence Board has already authorized the use of funds from the capitol restoration fund for this purpose.
56. State Capitol Basement Renovations
Section 9104 (1) (a)
This provision enumerates $1 million GPR-supported borrowing for the purpose of renovations of the State Capitol basement.
I am vetoing this provision to delete the enumeration for the State Capitol basement renovation. I believe that the State Capitol and Executive Residence Board should study the proposal and determine if renovations to the basement are the best use of funds or if renovations to other parts of the State Capitol would be a more beneficial investment.
Section 9437 (1t)
Section 1691c amends the definition of "public utility" to exclude, among other entities, a state agency, as defined in s. 20.001 (1) of the statutes, that may own, operate, manage or control all or any part of a plant or equipment for the production, transmission, delivery or furnishing of water either directly or indirectly for the public. Section 9437 (1t) provides an effective date for this change on the first day of the 13th month after the effective date of the budget bill.
In addition, for the purposes of awarding federal Community Development Block Grant funding in the 2017-19 biennium, section 9101 (10t) directs the Department of Administration to give priority to a project meeting all of the following: (a) the project would plan for or establish public or private facilities for the provision of water and sewer services primarily to residential users; (b) the new water service would replace services currently provided by an entity other than a public utility, a community water system, a cooperative association, or private groundwater wells; and (c) the new sewer service would replace services currently provided by an entity other than a public utility, private on-site wastewater treatment systems, or any other on-site forms of sewage disposal.
These provisions were added to allow the Department of Health Services’ Winnebago Mental Health Institute to discontinue providing water and sewer services to residents located near the facility without negatively impacting these individuals.
I am vetoing section 9437 (1t) to remove the effective date of the first day of the 13th month beginning after the effective date of the bill because I believe that the change to clarify that the department is not a public utility should be made immediately. I am, however, directing the department to continue to provide water and sewer services to these residents for 12 months after the effective date of the budget.
D. Health Services and Insurance
Department of Health Services
58. Supervised Release of Sexually Violent Persons
Sections 377h, 979p, 2230s, 2251y, 2257e, 2257f, 2257g, 2257h, 2257i, 2257j, 2257k, 2257L, 2257m, 2257n, 2257o, 2257p, 2261d, 2262L, 2262m, 2262n, 2262o, 2262p, 2262q, 2262r, 2262s, 2262t, 2262u, 2262v, 2262w, 2262x, 9120 (1t) and 9320 (1t)
These provisions make a series of changes to the supervised release of sexually violent persons and representation of sexually violent persons by the State Public Defender. The changes apply to all petitions for supervised release under Chapter 980 currently pending at the time of the effective date of the bill. The following details those changes.
Require the county of residence of the sexually violent person, as determined by the Department of Health Services, to create a temporary committee in order to prepare a report identifying an appropriate residential option in that county and demonstrate that the county has contacted the landlord and that the landlord has committed to enter the lease. The committee will consist of: (a) the county human services department, (b) a representative from the department, (c) a local probation or parole officer, (d) the county corporation counsel or his or her designee, and (e) a representative of the department of the county that is responsible for land conservation.
The county shall consider the following factors when identifying an appropriate residential option: (a) the distance between the person's placement and any school premises, child care facility, public park, place of worship or youth center; (b) if the person committed a sexually violent offense against an adult at risk or an elder at risk, the distance between the person's placement and a nursing home or assisted living facility; and (c) if the person is a serious child sex offender, the distance between the person's placement and a property where a child's primary residence exists.
The county must consult with a local law enforcement agency having jurisdiction over the residence and allow the law enforcement agency to submit a written report that provides information on the residential option that must be included in the report submitted to the department.
The county report must be submitted to the department within 120 days following the court order. If a county does not submit a report within 120 days, it is in violation of the person's rights and each day after the 120-day mark is a new violation. A new PR appropriation is created for fees recovered by the person for a violation. These funds would be used for costs associated with housing a person. Within the first 12 months of the bill's effective date, the 120-day limit is extended to 180 days.
Within 30 days after the court orders the county to prepare a report, the department is required to determine the identity and location of known and registered victims of the person's acts by searching its victim database and consulting with the Office of Victim Services in the Department of Corrections, the Department of Justice, and the county coordinator of victims and witness services in the county of intended placement, the county where the person was convicted and the county of commitment.
Require the department, within 30 days after the county submits its report, to use the report to prepare a supervised release plan for the person that would address the person's need for supervision, counseling, medication, community support services, residential services, vocational services and alcohol and other drug abuse treatment. An extension of 30 days may be granted for good cause. The current law provision that the department may not arrange placement in a facility that did not exist before January 1, 2006, is repealed.
If current law procedures are insufficient, the department shall find the county of residence is the county in which, on the date that the person committed the sexually violent offense that resulted in the sentence, placement or commitment, the person would have been a resident for the purpose of Social Security disability insurance eligibility.
In any situation under Chapter 980 where the person has the right to be represented by counsel, the court is required to refer the person as soon as practicable to the State Public Defender, who would be required to appoint counsel. At the conclusion of any proceeding under Chapter 980, the court may inquire as to the person's ability to reimburse the state for the costs of representation. If the court determines that the person is able to make reimbursement, the court may order the person to reimburse the state. These reimbursements would be made to the clerk of courts where the proceedings took place, which would transmit payments to the county treasurer, who would be required to deposit 25 percent of the payment in the county treasury and transmit the remainder to the Department of Administration. Upon request, the State Public Defender must conduct a determination of indigency and report the results of the determination. Require the clerk of courts to report, by January 31 of each year, to the State Public Defender the total amount of reimbursements order for Chapter 980.
While I understand the importance of updating the process for placing sexually violent persons in the community, the issues the Department of Health Services and communities face in completing placement plans and how critical it is that these individuals be placed in appropriate settings for the health and safety of the citizens in those counties, I am vetoing these provisions as nonfiscal policy. This policy eliminates current law provisions requiring that residential options be a specific distance from any school premises, child care facility, public park, place of worship or youth center and should therefore be thoroughly vetted through the regular legislative process, with input from the public and counties.
59. FoodShare Employment and Training – Universal Referrals
This provision requires income maintenance workers to provide all FoodShare applicants and participants information about the FoodShare Employment and Training program at least two times per year.
I am vetoing this provision because there is no additional funding or positions included in the bill to implement this unfunded mandate. However, I am directing the Department of Health Services to develop a protocol for better informing all FoodShare applicants and participants about the FoodShare Employment and Training Program because I agree with the intent of the provision.
60. FoodShare Employment and Training – Cost to Continue
Section 9120 (2s)
This section requires the Department of Health Services to submit a report to the Legislature regarding the outcomes related to the FoodShare Employment and Training program before February 1, 2018. The report shall include any proposed program improvements and contract modifications necessary based on the reported outcomes.
I am vetoing this section because I object to this administratively burdensome requirement.
61. FoodShare Employment and Training Pilot
Section 9120 (2)
This provision modifies the provision in the Governor's budget to increase the amount of job training and employment assistance services provided to individuals receiving FoodShare benefits by requiring able-bodied adults with school-age children to participate in the FoodShare Employment and Training Program. The provision is modified in the following ways: (a) require the pilot region selected by the Department of Health Services to be composed of no more than two FoodShare Employment and Training vendor regions; (b) require a pilot of the work requirement be run from April 2019 through June 30, 2020; and (c) require an evaluation of the pilot program and make statewide expansion contingent on that evaluation.
Further, this provision reduces funding in fiscal year 2017-18 by $29,000 GPR and increases funding by $42,300 GPR in fiscal year 2018-19. This provision also transfers the biennial funding of $4,236,400 GPR provided in the bill to the Joint Committee on Finance supplemental appropriation and requires that the Department of Health Services seek release of the funds through s. 13.10 by submitting a detailed plan for implementation of the pilot.
I am partially vetoing this provision to remove the requirements that the regions be FoodShare Employment and Training vendor regions because I object to this arbitrary policy. I direct the department to determine which region or regions make the most sense for Wisconsin.
Second, I am partially vetoing the provision to remove the evaluation of the program because I object to requiring an evaluation of this provision before it can be expanded.
Lastly, I am partially vetoing the requirement that the department operate a pilot from April 2019 through June 30, 2020, because I object to this arbitrary and administratively burdensome timeline. The department requires flexibility in operating this program and an arbitrary timeline impedes on the administration's ability to successfully implement this provision.
62. Medical Assistance Coverage of Complex Rehabilitation Technology
Sections 926p, 931n and 9120 (5h)
This provision specifies that durable medical equipment that is considered complex rehabilitation technology is a covered service under the Medical Assistance program.
The provision defines a "complex needs patient" as an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation; "complex rehabilitation technology" as items classified within Medicare as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary; "individually configured" as having a combination of sizes, features, adjustments or modifications that a qualified complex rehabilitation technology supplier can customize to the specific individual by measuring, fitting, programming, adjusting or adapting as appropriate so that the device operates in accordance with an assessment or evaluation of the individual by a qualified health care professional and is consistent with the individual's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
The provision further defines "Medicare" as coverage under Part A or Part B of Title XVIII of the federal Social Security Act, 42 USC 1395 et seq. A "qualified complex rehabilitation technology professional" is defined as an individual who is certified as an assistive technology professional by the Rehabilitation Engineering and Assistive Technology Society of North America.
The provision defines "qualified complex rehabilitation technology supplier" as a company or entity that meets all of the following criteria: (a) is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology; (b) is an enrolled supplier for purposes of Medicare reimbursement that meets the supplier and quality standards established for durable medical equipment suppliers, including those for complex rehabilitation technology under Medicare; (c) is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology; (d) requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient; (e) has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells; and (f) provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology.
Further, the provision defines "qualified health care professional" as any of the following: (a) a licensed physician or physician assistant, (b) a licensed physical therapist, (c) a licensed occupational therapist, or (d) a licensed chiropractor.
The provision also requires the Department of Health Services to promulgate rules and other policies for the use of complex rehabilitation technology by recipients of Medical Assistance (MA). The provision stipulates that the rules shall include all of the following: (a) designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes and provisions allowing for quarterly updates to the designations; (b) establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers; (c) a requirement that MA recipients who need a manual wheelchair, power wheelchair, or other seating component to be evaluated by a qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier and a qualified complex rehabilitation technology professional; (d) establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients; (e) a requirement for contracts with the department that managed care plans providing services to MA recipients comply with statutory requirements related to the provision of complex rehabilitation technology and with the related administrative rules; and (f) protection of access to complex rehabilitation technology for complex needs patients.
Lastly the provision specifies that the proposed rules must designate certain healthcare common procedure system codes, which are used under the federal Medicare program and certain mixed complex rehabilitation technology product and standard mobility and accessory product codes. Require the department to specify, in the proposed rules, that procurement of these codes shall be exempt from any bidding or selective contracting requirements.
I am vetoing this provision because I believe there may be unanticipated costs to the MA program and that the language presented may inadvertently limit availability for this service in rural areas of the state. I object to this policy item being placed in the budget without giving the department, MA recipients, health care providers and the public an opportunity to publicly debate its merits. While this provision may have merit, the Legislature should review the impact further and forward legislation when the impacts have been analyzed and such issues have been resolved.
63. Exemption from the Nursing Home Bed Assessment
This provision creates an exemption for county-owned institutions for mental diseases and state licensed nursing homes, which are not certified to participate in Medicaid and Medicare, from the state nursing home bed assessment. The Department of Health Services is required to seek approval from the U.S. Department of Health and Human Services.
I am vetoing this provision because the practice would violate a Centers for Medicare and Medicaid Services requirement that the assessment be "broad based" in design and is therefore not allowable.
64. Childless Adult Employment and Training Waiver
This section requires the Department of Health Services to submit a report to the Joint Committee on Finance no later than three months following final approval of the proposed Medicaid Childless Adult waiver, including the following: (a) a description of each component of the approved waiver, including information on the department's plan to implement; and (b) an estimate of the impact on Medical Assistance enrollment and the Medical Assistance budget.
The section further specifies that that the department may not implement the waiver unless the Joint Committee on Finance meets under s. 13.10 of the statutes to review the report and approves the waiver. Lastly, the Joint Committee on Finance may modify the waiver by removing certain components. The department is required to implement the waiver as approved by the Joint Committee on Finance and the department must submit a waiver amendment to the federal government with any changes made by the committee.
I am vetoing this section because I believe these requirements will infringe on the Department of Health Services' ability to negotiate a successful waiver with the Centers for Medicare and Medicaid Services. Further, I object to the creation of unnecessary and burdensome reporting requirements that could delay approval of the waiver, jeopardizing these reforms from being implemented.
65. Family Care Funding
This provision provides funding in the Joint Committee on Finance supplemental GPR appropriation and requires the Department of Health Services to work with both the Centers for Medicare and Medicaid Services as well as Family Care Managed Care Organizations to develop a payment mechanism to increase the direct care and services portion of the capitation rates paid to the managed care organizations.