7/12/2015 State Budget Vetoes

Mental Health Task Force/ Make It Work Milwaukee Update on State Budget

Governor Walker signed the biennial budget today. It included a total of 104 vetoes. The Governor’s veto message and the full list of vetoes can be found online at: http://doa.wi.gov/Documents/DEBF/Budget/Biennial%20Budget/Governor%27s%20Veto%20Message/2015-17%20Veto%20Message.pdf

Here is a listing of vetoes of particular interest to the disability community – there may be additions as we continue to review the approved budget and the Governor’s vetoes.

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

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.

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.

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.

Family Care and IRIS Programs
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.

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; © 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.

Consolidate Community Mental Health Programs

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.

Barbara Beckert, Milwaukee Office Director: DISABILITY RIGHTS WISCONSIN
6737 W. Washington St., Suite 3230 Milwaukee, WI 53214
414–773–4646 Ext 15 Voice
414–773–4647 Fax
barbara.beckert@drwi.org

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Last edited by Tyler Schuster.   Page last modified on July 13, 2015

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