SB565: Bill Text

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 Section 1. 13.94 (1) (mg) of the statutes is created to read:

SB565,7,7 13.94 (1) (mg) No later than January 1, 2017, and biennially thereafter, perform a financial and performance evaluation audit of the Milwaukee County mental health board and of mental health functions, programs, and services in Milwaukee County including a review of the effectiveness of the Milwaukee County mental health board and new policies implemented under that board in providing mental health services, a review of the expenditures of the Milwaukee County mental health board, a review of Milwaukee County's expenditures for mental health functions, programs, and services and the outcomes of those programs and services in the period after the formation of the Milwaukee County mental health board. The legislative audit bureau shall file a copy of the audit report under this paragraph with the distributees specified in par. (b) and the Milwaukee County executive and the Milwaukee County board of supervisors. The audit under this paragraph does not count toward the limit of audits of a county in a calendar year in par. (m).

SB565,2 Section 2. 15.07 (1) (b) 24. of the statutes is created to read:

SB565,7,10 15.07 (1) (b) 24. The Milwaukee County mental health board, subject to s. 15.195 (9).

SB565,3 Section 3. 15.07 (1) (cm) of the statutes is amended to read:

SB565,7,24 15.07 (1) (cm) The term of one member of the government accountability board shall expire on each May 1. The terms of the 3 members of the land and water conservation board appointed under s. 15.135 (4) (b) 2. shall expire on January 1. The term of the member of the land and water conservation board appointed under s. 15.135 (4) (b) 2m. shall expire on May 1 of an even-numbered year. The terms of the appraiser members of the real estate appraisers board and the terms of the auctioneer and auction company representative members of the auctioneer board shall expire on May 1 in an even-numbered year. The terms of the members of the cemetery board shall expire on July 1 in an even-numbered year. The term of the student member of the Board of Regents of the University of Wisconsin System who is at least 24 years old shall expire on May 1 of every even-numbered year. The terms of 6 of the members of the Milwaukee County mental health board appointed under s. 15.195 (9) (b) shall expire on May 1 of an even-numbered year.

SB565,4 Section 4. 15.07 (3) (bm) 7. of the statutes is created to read:

SB565,8,3 15.07 (3) (bm) 7. The Milwaukee County mental health board shall meet 4 times each year and may meet at other times on the call of the chairperson or a majority of the board's members.

SB565,5 Section 5. 15.195 (9) of the statutes is created to read:

SB565,8,7 15.195 (9) Milwaukee County mental health board. (a) There is created a Milwaukee County mental health board, which is attached to the department of health services under s. 15.03.

SB565,8,9 (b) Subject to par. (d), the board shall consist of the following 11 voting members appointed for 4-year terms except for the members under subds. 10. and 11.:

SB565,8,17 1. A psychiatrist or psychologist who is suggested by the Milwaukee County board of supervisors. The Milwaukee County board of supervisors shall solicit suggestions for psychiatrists and psychologists from organizations including the Wisconsin Medical Society, the Medical Society of Milwaukee, the Wisconsin Psychological Association, and the Wisconsin Association of Family and Children's Agencies for individuals who specialize in a full continuum of behavioral health services for children. The Milwaukee County board of supervisors shall suggest to the governor 4 psychiatrists and psychologists for this board membership position.

SB565,8,25 2. A psychiatrist or psychologist who is suggested by the Milwaukee County board of supervisors. The Milwaukee County board of supervisors shall solicit suggestions for psychiatrists and psychologists from organizations including the Wisconsin Medical Society, the Medical Society of Milwaukee, the Wisconsin Psychological Association, and the Milwaukee Co-occurring Competency Cadre for individuals who specialize in a full continuum of behavioral health services for adults. The Milwaukee County board of supervisors shall suggest to the governor 4 psychiatrists and psychologists for this board membership position.

SB565,9,8 3. A representative of the community who is a consumer of mental health services and who is suggested by the Milwaukee County board of supervisors. The Milwaukee County board of supervisors shall solicit suggestions for individuals who have experienced mental illness or substance abuse from organizations including Warmline, the Milwaukee Mental Health Task Force, and the Milwaukee Co-occurring Competency Cadre. The Milwaukee County board of supervisors shall suggest to the governor 4 representatives of the community for this board membership position.

SB565,9,16 4. A medical director who is suggested by the Milwaukee County executive. The Milwaukee County executive shall solicit suggestions from organizations including the Wisconsin Hospital Association for individuals who specialize in a full continuum of behavioral health and medical services including emergency detention, inpatient, residential, transitional, partial hospitalization, intensive outpatient, and wraparound community-based services. The Milwaukee County executive shall suggest to the governor 4 medical directors for this board membership position.

SB565,9,24 5. An individual specializing in finance and administration who is suggested by the Milwaukee County executive. The Milwaukee County executive shall solicit suggestions from organizations including the Wisconsin Hospital Association, the Wisconsin County Human Services Association, and the Public Policy Forum for individuals with experience in analyzing healthcare operating expenses, revenues, and reimbursement and expertise in financial restructuring for sustainability. The Milwaukee County executive shall suggest to the governor 4 individuals specializing in finance and administration for this board membership position.

SB565,10,7 6. A health care provider with experience in the delivery of substance abuse services who is suggested by the Milwaukee County executive. The Milwaukee County executive shall solicit suggestions from organizations including the Milwaukee Co-occurring Competency Cadre for health care providers specializing in providing substance abuse services. The Milwaukee County executive shall suggest to the governor 4 health care providers with experience in the delivery of substance abuse services for this board membership position.

SB565,10,13 7. An individual with legal expertise. The governor shall solicit suggestions from organizations including the Legal Aid Society of Milwaukee, Legal Action of Wisconsin, Community Justice Counsel, and Disability Rights Wisconsin for 4 individuals who have legal expertise specializing in emergency detention regulatory requirements including policies, procedures, provider responsibilities, and patient rights.

SB565,10,19 8. A health care provider representing community-based mental health service providers. The governor shall solicit suggestions from organizations including the Milwaukee Health Care Partnership, the Milwaukee Mental Health Task Force, and the Milwaukee Co-occurring Competency Cadre for 4 health care providers specializing in community-based, recovery-oriented, mental health systems.

SB565,10,25 9. An individual who is a consumer or family member representing community-based mental health service providers. The governor shall solicit suggestions from organizations including the Milwaukee Health Care Partnership, the Milwaukee Mental Health Task Force, and the Milwaukee Co-occurring Competency Cadre for 4 consumers and family members representing community-based mental health service providers.

SB565,11,5 10. An employee of the department of health services, as designated by the secretary of health services, who has direct knowledge of funding and systems, oversees the state mental health institutes, and is the official contact for the federal government on behavioral health issues or, if this individual is unavailable to serve on the board, the secretary of health services or his or her designee.

SB565,11,7 11. The chairperson of the Milwaukee Mental Health Task Force, or his or her designee.

SB565,11,9 (c) Subject to par. (d), the board shall consist of the following 2 nonvoting members appointed for 4-year terms:

SB565,11,20 1. A health care provider who is on the academic staff at a higher education institution. The governor shall solicit suggestions from the Medical College of Wisconsin for individuals specializing in community-based, 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 from the corrections system, when appropriate, or maximizing the use of mobile crisis units and crisis intervention training.

SB565,12,6 2. A health care provider who is on the academic staff at a higher education institution. The governor shall solicit suggestions from the University of Wisconsin—Madison for individuals specializing in community-based, 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 from the corrections system, when appropriate, or maximizing the use of mobile crisis units and crisis intervention training.

SB565,12,8 (d) 1. The governor shall ensure that one of the members under par. (b) 1. and 2. is a psychologist.

SB565,12,12 2. When submitting suggestions for nominations of members under par. (b) the Milwaukee County executive and Milwaukee County board of supervisors shall attempt to ensure that individuals suggested are among the most-qualified and experienced in their field.

SB565,12,15 3. Members under par. (b) who are health care providers shall have experience in providing services to the population that is serviced by the Milwaukee County mental health system.

SB565,12,17 4. No member of the board may be an employee or contractor of Milwaukee County at the time of nomination.

SB565,12,24 5. No member of the board may be a lobbyist, as defined in s. 13.62 (11). No member of the board may directly or indirectly solicit or receive subscriptions or contributions for any partisan political party or any political purpose while appointed to the board. No member of the board may engage in any form of political activity calculated to favor or improve the chances of any political party or any person seeking or attempting to hold partisan office. No member of the board may hold an elected office. Any violation of this subdivision is adequate grounds for dismissal.

SB565,13,8 6. No member under par. (b) may serve more than 2 consecutive terms in a membership position for which suggestions for nomination are made by the same individual or entity, except that a member may serve 3 consecutive terms in a membership position for which suggestions for nomination are made by the same individual or entity if one of those 3 terms is for less than 2 years. An individual who has served 2 consecutive 4-year terms or 3 consecutive terms totalling less than 10 years is eligible to be suggested for nomination as a member under par. (b) after the individual has not served on the board for 12 months.

SB565,6 Section 6. 17.07 (3r) of the statutes is created to read:

SB565,13,11 17.07 (3r) (a) Notwithstanding sub. (3), a member of the Milwaukee County mental health board may be removed by any of the following:

SB565,13,12 1. The governor, for cause.

SB565,13,17 2. If the Milwaukee County executive suggested the member for nomination, the Milwaukee County executive, for neglect of duty, misconduct, malfeasance in office, failure to attend 4 board meetings in one year, or failure to attend 2 board meetings within one year without providing advance notice to the chairperson of the board.

SB565,13,22 3. If the Milwaukee County board of supervisors suggested the member for nomination, the Milwaukee County board of supervisors, for neglect of duty, misconduct, malfeasance in office, failure to attend 4 board meetings in one year, or failure to attend 2 board meetings within one year without providing advance notice to the chairperson of the board.

SB565,13,25 (b) Notwithstanding sub. (3), a member of the Milwaukee County mental health board shall be removed by the governor for engaging in an activity under s. 15.195 (9) (d) that disqualifies an individual from board membership.

SB565,7 Section 7. 20.435 (5) (kf) of the statutes is created to read:

SB565,14,4 20.435 (5) (kf) Milwaukee County mental health board. All moneys received under s. 51.41 (5) (b) for the general program operations of Milwaukee County mental health board.

SB565,8 Section 8. 46.031 (2) of the statutes is amended to read:

SB565,14,10 46.031 (2) Assessment of needs. Before developing and submitting a proposed budget to the county executive or county administrator or the county board or the Milwaukee County mental health board, the county departments listed in sub. (1) shall assess needs and inventory resources and services, using an open public participation process.

SB565,9 Section 9. 46.031 (2g) (a) of the statutes is amended to read:

SB565,15,4 46.031 (2g) (a) The department shall annually submit to the county board of supervisors in a county with a single-county department, the Milwaukee County mental health board in Milwaukee County for matters related to mental health, or the county boards of supervisors in counties with a multicounty department a proposed written contract containing the allocation of funds and such administrative requirements as necessary. The contract as approved may contain conditions of participation consistent with federal and state law. The contract may also include provisions necessary to ensure uniform cost accounting of services. Any changes to the proposed contract shall be mutually agreed upon. The county board of supervisors in a county with a single-county department, the Milwaukee County mental health board in Milwaukee County for matters related to mental health, or the county boards of supervisors in counties with a multicounty department shall approve the contract before January 1 of the year in which it takes effect unless the department grants an extension. The county board of supervisors in a county with a single-county department, the Milwaukee County mental health board in Milwaukee County, or the county boards of supervisors in counties with a multicounty department may designate an agent to approve addenda to any contract after the contract has been approved.

SB565,10 Section 10. 46.031 (2g) (b) of the statutes is amended to read:

SB565,15,14 46.031 (2g) (b) The department may not approve contracts for amounts in excess of available revenues. The county board of supervisors in a county with a single-county department, the Milwaukee County mental health board in Milwaukee County for matters related to mental health, or the county boards of supervisors in counties with a multicounty department may appropriate funds not used to match state funds under ss. 46.495 (1) (d) and 51.423. Actual expenditure of county funds shall be reported in compliance with procedures developed by the department, and shall comply with standards guaranteeing quality of care comparable to similar facilities.

SB565,11 Section 11. 46.031 (2r) (b) of the statutes is amended to read:

SB565,16,5 46.031 (2r) (b) If the department withholds a portion of the allocable appropriation under par. (a), the county department affected by the action of the department may submit to the county board of supervisors in a county with a single-county department or to its designated agent, to the Milwaukee County mental health board if related to mental health in Milwaukee County, or to the county boards of supervisors in counties with a multicounty department or their designated agents a plan to rectify the deficiency found by the department. The county board of supervisors or its designated agent in a county with a single-county department, the Milwaukee County mental health board if related to mental health, or the county boards of supervisors in counties with a multicounty department or their designated agents may approve or amend the plan and may submit for departmental approval the plan as adopted. If a multicounty department is administering a program, the plan may not be submitted unless each county board of supervisors which participated in the establishment of the multicounty department, or its designated agent, adopts it.

SB565,12 Section 12. 46.031 (3) (a) of the statutes is amended to read:

SB565,17,2 46.031 (3) (a) Citizen advisory committee. Except as provided in par. (b), the county board of supervisors of each county, the Milwaukee County mental health board, as applicable, or the county boards of supervisors of 2 or more counties jointly shall establish a citizen advisory committee to the county departments under ss. 46.215, 46.22, 46.23, 51.42, and 51.437. The citizen advisory committee shall advise in the formulation of the budget under sub. (1). Membership on the committee shall be determined by the county board of supervisors in a county with a single-county committee, the Milwaukee County mental health board, as applicable, or by the county boards of supervisors in counties with a multicounty committee and shall include representatives of those persons receiving services, providers of service and citizens. A majority of the members of the committee shall be citizen and service consumers. The committee's membership may not consist of more than 25% county supervisors, nor of more than 20% service providers. The chairperson of the committee shall be appointed by the county board of supervisors establishing it or by the Milwaukee County mental health board, if it establishes the committee. In the case of a multicounty committee, the chairperson shall be nominated by the committee and approved by the county boards of supervisors establishing it. The county board of supervisors in a county with a single-county committee or the county boards of supervisors in counties with a multicounty committee may designate an agent to determine the membership of the committee and to appoint the committee chairperson or approve the nominee.

SB565,13 Section 13. 46.031 (3) (b) of the statutes is amended to read:

SB565,17,11 46.031 (3) (b) Alternate process. The county board of supervisors, the Milwaukee County mental health board, as applicable, or the boards of 2 or more counties acting jointly may submit a report to the department on the open public participation process used under sub. (2). The county board of supervisors or the Milwaukee County mental health board may designate an agent, or the boards of 2 or more counties acting jointly may designate an agent, to submit the report. If the department approves the report, establishment of a citizen advisory committee under par. (a) is not required.

SB565,14 Section 14. 46.031 (3) (c) of the statutes is amended to read:

SB565,17,18 46.031 (3) (c) Yearly report. The county board of supervisors or its designated agent, the Milwaukee County mental health board, as applicable, or the boards of 2 or more counties acting jointly or their designated agent, shall submit to the department a list of members of the citizen advisory committee under par. (a) or a report on the open public participation process under par. (b) on or before July 1 of each year.

SB565,15 Section 15. 46.034 (3) of the statutes is amended to read:

SB565,18,19 46.034 (3) With the agreement of the affected county board of supervisors in a county with a single-county department, the Milwaukee County mental health board, as applicable, or boards of supervisors in counties with a multicounty department, effective for the contract period beginning January 1, 1980, the department may approve a county with a single-county department or counties participating in a multicounty department to administer a single consolidated aid consisting of the state and federal financial aid available to that county or those counties from appropriations under s. 20.435 (7) (b) and (o) for services provided and purchased by county departments under ss. 46.215, 46.22, 46.23, 51.42, and 51.437. Under such an agreement, in the interest of improved service coordination and effectiveness, the county board of supervisors in a county with a single-county department, the Milwaukee County mental health board, as applicable, or county boards of supervisors in counties with a multicounty department may reallocate among county departments under ss. 46.215, 46.22, 46.23, 51.42, and 51.437 funds that otherwise would be specified for use by a single county department. The budget under s. 46.031 (1) shall be the vehicle for expressing the proposed use of the single consolidated fund by the county board of supervisors in a county with a single-county department, the Milwaukee County mental health board, as applicable, or county boards of supervisors in counties with a multicounty department. Approval by the department of this use of the fund shall be in the contract under s. 46.031 (2g). Counties that were selected by the department to pilot test consolidated aids for contract periods beginning January 1, 1978, may continue or terminate consolidation with the agreement of the affected county board of supervisors in a county with a single-county department, the Milwaukee County mental health board, or county boards of supervisors in counties with a multicounty department.

SB565,16 Section 16. 46.175 of the statutes is amended to read:

SB565,19,5 46.175 County institutions: minimum standards. Notwithstanding any other provision of law, any county currently operating an institution established under s. 49.70, 49.71, 49.72, 51.08, or 51.09 may, by resolution of the county board or, in Milwaukee County for institutions providing mental health treatment, the Milwaukee County mental health board, designate such institution or distinct part of such institution as a facility to be operated under s. 50.02, 50.03 or 50.33. Any county institution or part thereof, where so designated, shall be required to meet those licensure standards established by the department for the type of facility designated by the county. Any designation under this section may be made only if such designation will not result in any additional cost to the state.

SB565,17 Section 17. 46.18 (1) of the statutes is amended to read:

SB565,19,24 46.18 (1) Trustees. Every county home, infirmary, hospital, or similar institution, shall, subject to regulations approved by the county board except in Milwaukee County for county homes, infirmaries, hospitals, or institutions providing mental health treatment, be managed by a board of trustees, electors of the county, chosen by ballot by the county board. In Milwaukee County, every county home, infirmary, hospital, or similar institution that provides mental health treatment shall, subject to standards and procedures adopted by the Milwaukee County mental health board, be managed by a board of trustees, electors of the county, chosen by ballot by the Milwaukee County mental health board. At its annual meeting, the county board or the Milwaukee County mental health board, if applicable, shall appoint an uneven number of trustees, from 3 to 9 at the option of the board, for staggered 3-year terms ending the first Monday in January. Any vacancy shall be filled for the unexpired term by the county board or the Milwaukee County mental health board, as applicable; but the chairperson of the county board may appoint a trustee to fill the vacancy until the county board acts except for boards of trustees appointed by the Milwaukee County mental health board for which the chairperson of the Milwaukee County mental health board may appoint a trustee to fill the vacancy until the entire Milwaukee County mental health board acts.

SB565,18 Section 18. 46.18 (3) of the statutes is amended to read:

SB565,20,4 46.18 (3) Removal of trustee. Any trustee may be removed from office for misconduct or neglect, by a two-thirds vote of the county board or of the Milwaukee County mental health board, as applicable, on due notice in writing and hearing of the charges against the trustee.

SB565,19 Section 19. 46.18 (4) of the statutes is amended to read:

SB565,20,13 46.18 (4) Oath of office, bond, expenses, pay. Each trustee shall take and file the official oath and execute and file an official bond to the county, in the amount determined by the county board, or the Milwaukee County mental health board, as applicable, and the sufficiency of the sureties shall be approved by the chairperson of the board. Each trustee shall be reimbursed for traveling expenses necessarily incurred in the discharge of the duties, and shall receive the compensation fixed by the county board or the Milwaukee County mental health board, as applicable, unless otherwise provided by law.

SB565,20 Section 20. 46.18 (11) of the statutes is amended to read:

SB565,20,20 46.18 (11) County appropriation. The county board or, in Milwaukee County, the Milwaukee County mental health board, as applicable, shall annually appropriate for operation and maintenance of each such institution not less than the amount of state aid estimated by the trustees to accrue to said institution; or such lesser sum as may be estimated by the trustees to be necessary for operation and maintenance.

SB565,21 Section 21. 46.18 (12) of the statutes is amended to read:

SB565,20,25 46.18 (12) Additional duties. The county board or the Milwaukee County mental health board, as applicable, may provide that the trustees and superintendent of any institution shall be the trustees and superintendent of any other institution.

SB565,22 Section 22. 46.18 (13) of the statutes is amended to read:

SB565,21,19 46.18 (13) Building reserve fund. The Except in Milwaukee County, the county board shall maintain as a segregated cash reserve an annual charge of 2% of the original cost of new construction or purchase or of the appraised value of existing infirmary structures and equipment. In Milwaukee County, the Milwaukee County mental health board, for mental health infirmary structures and equipment, shall ensure the maintenance, as a segregated cash reserve, of an annual charge of 2 percent of the original cost of new construction or purchase or of the appraised value of existing mental health infirmary structures and equipment. If the infirmary or any of its equipment is replaced, any net cost of replacement in excess of the original cost is subject to an annual charge of 2%. No contributions to the cash reserve in excess of the amount required under this subsection may be included in the calculation under s. 49.726 (1). The county board, except the Milwaukee County board, may from time to time appropriate from such reserve sums to be expended solely for the enlargement, modernization or replacement of such infirmary and its equipment. In Milwaukee County, the Milwaukee County mental health board may require to be appropriated from reserve sums for mental health infirmaries to be expended for the enlargement, modernization, or replacement of a mental health infirmary and its equipment.

SB565,23 Section 23. 46.18 (14) of the statutes is amended to read:

SB565,22,4 46.18 (14) Incentive payments to patients in mental hospitals. The county board or, in Milwaukee County, the Milwaukee County mental health board may authorize the board of trustees of any county mental hospital to establish a program of incentive payments so as to provide incentive and encouragement to patients by the disbursement of small weekly payments but not restricted to work allowances. Incentive payments paid to inmates shall not be included as costs in arriving at the per capita rate for state aids or charges to other counties and the state for care of inmates. In counties having a population of 500,000 or more the county board of supervisors may establish a similar program.

SB565,24 Section 24. 46.18 (15) of the statutes is amended to read:

SB565,22,13 46.18 (15) Joint operation of health-related service. If the county board of supervisors, or the Milwaukee County mental health board, as applicable, so authorizes, the trustees of the county hospital may, together with a private or public organization or affiliation, organize, establish and participate in the governance and operation of an entity to operate, wholly or in part, any health-related service, may participate in the financing of the entity and may provide administrative and financial services or resources for its operation on terms prescribed by the county board of supervisors or the Milwaukee County mental health board, as applicable.

SB565,25 Section 25. 46.19 (4) of the statutes is amended to read:

SB565,22,20 46.19 (4) The salaries of the superintendent, visiting physician and all necessary additional officers and employees shall be fixed by the county board. 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 whose duties are related to mental health shall be fixed by the county executive.

SB565,26 Section 26. 46.21 (2) (a), (j), (k), (m) and (q), (2m) (a) and (b) 1. (intro.), (3), (3g), (3r), (4), (4m) (a) and (b) and (6) of the statutes are amended to read: