This section requires the Department of Health Services to pay hospitals that serve a disproportionate share of low-income patients an additional $30,000,000 GPR and associated federal match in each year of the 2019-21 biennium only for Disproportionate Share Hospital supplemental payments, and increases the maximum allotment any one hospital may receive under this program to $9,600,000 in the 2019-21 biennium only.
While I am supportive of funding hospitals for uncompensated care, I object to using the Disproportionate Share Hospital supplemental payment mechanism as a primary way to do so without the infusion of federal tax dollars and resulting state savings from Medicaid expansion that would have allowed us to make these investments. Expanding Medicaid to individuals up to 138 percent of the poverty line not only ensures access to affordable, quality healthcare for Wisconsinites, it would have allowed a robust investment in our provider networks here in Wisconsin. However, in the absence of these critical federal dollars and resulting state savings, the Department of Health Services will need flexibility to prioritize the needs of patients.
I am, therefore, partially vetoing this section to allow an increase to the maximum per hospital payment under this program and broaden the language to allow the Department of Health Services the flexibility to determine the amount of additional funding under the Disproportionate Share Hospital supplemental payments to hospitals that serve low-income individuals. In addition, my partial veto will give the Department of Health Services additional flexibility in determining other potential supplemental payments to hospitals that serve low-income individuals as limited resources may allow. Further, I am directing the Department of Health Services to develop a methodology which ensures that after the new, higher cap is applied, eligible hospitals will receive no less under the Disproportionate Share Hospital supplemental formula than they would have under the current law cap.
43. Mendota Juvenile Treatment Center
Sections 9104 (6) (a) and 9319 (1)
This provision increases authorized general fund supported borrowing for the project identified as "Expansion of the Mendota Juvenile Treatment Center — Madison" from $15,000,000 to $43,994,000.
I am partially vetoing this provision because I object to the Legislature not providing sufficient borrowing authority for the building of an appropriately-sized facility. The Department of Health Services has indicated the need for $59 million to complete the project, and the Legislature's proposal provides only $44 million. Insufficient borrowing authority would result in a reduction in the number of beds the department is able to construct for juvenile treatment and impede the department's ability to provide the Mendota Juvenile Treatment Center's mental health treatment services by not providing adequate space to accommodate juveniles who are at different stages in their treatment progression. This veto results in total of $58,994,000 of general fund supported borrowing being available for this project.
44. Medicaid Reestimate
Section 126 [as it relates to s. 20.435 (4) (b)] Broadly, this provision increases funding under the Medical Assistance program.
I am partially vetoing section 126 [as it relates to s. 20.435 (4) (b)] by lining out the amounts under s. 20.435 (4) (b) and writing in smaller amounts that reduce the appropriation by $15,000,000 in each fiscal year. I object to the appropriation of these funds as it is no longer necessary based upon updated expenditure projections from the Department of Health Services. This partial veto is part of a larger write-down of the department's Medical Assistance appropriation. I am requesting the Department of Administration secretary not to allot these funds.
45. Physician and Behavioral Health Funding
Section 126 [as it relates to s. 20.865 (4) (a)] This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $5,000,000 GPR in both fiscal years for Medicaid reimbursement rate increases for physicians and behavioral health providers.
I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amounts under s. 20.865 (4) (a) and writing in smaller amounts that reduce the appropriation by $5,000,000 GPR in each fiscal year. Wisconsin is facing a behavioral health provider shortage, and I object to the removal of funding from the Department of Health Services to address this issue while the Legislature retains the funding to potentially use for other purposes. I am directing the department to proceed as soon as is practical with vital rate increases for physicians and behavioral health professionals from its base level resources.
This partial veto is part of larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds.
46. Crisis Intervention Services
Section 681
This provision allows the Department of Health Services to reimburse counties for crisis intervention services provided to Medical Assistance recipients, if the county delivers crisis intervention services on a regional basis and provides a maintenance of effort payment. This provision defines crisis intervention services as services for the treatment of mental illness, intellectual disability, substance abuse and dementia. Under the provision, counties are required to maintain a maintenance of effort equal to 75 percent of the annual average of the county's expenditures for crisis intervention services in calendar years 2016, 2017 and 2018.
I am partially vetoing this provision to remove the reference to calendar years 2016, 2017 and 2018. I object to specifying the maintenance of effort calculation in statute, and I am directing the Department of Health Services to set the county maintenance of effort for crisis intervention services in a manner it determines is appropriate and equitable.
47. Qualified Treatment Trainee Grants
Sections 126 [as it relates to s. 20.435 (1) (be)], 187m and 1763m This provision requires the Department of Health Services to distribute a total of $500,000 GPR in each fiscal year to a hospital, or affiliate of a hospital, or an entity qualified under 42 USC 1395x (aa) (4) that establishes and maintains a qualified treatment trainee program. A qualified treatment trainee program must provide clinically supervised practice for qualified graduate students seeking licensure or certification as a social worker, counselor, marriage and family therapist, or psychologist. The grant recipient must match the grant amount. The grant recipient shall use the awarded funding for clinical supervision, training, and salaries and benefits for trainees and clinical supervisors. I am partially vetoing this provision to remove the overly prescriptive requirements for these funds. I am broadly supportive of measures to increase qualified health care providers in the state. However, I object to the specificity outlined in the provision. I am directing the Department of Health Services to develop grant criteria, seek applicants and award the grants.
48. Telehealth Expansion
Section 126 [as it relates to s. 20.865 (4) (a)] This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $1,088,200 GPR in fiscal year 2019-20 and $1,692,900 GPR in fiscal year 2020-21 to fund anticipated increases in the use of Medicaid services rendered through telehealth technology.
I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amounts under s. 20.865 (4) (a) and writing in smaller amounts that reduce the appropriation by $1,088,200 GPR in fiscal year 2019-20 and by $1,692,900 GPR in fiscal year 2020-21. I object to the Legislature placing this funding in the Joint Committee on Finance's supplemental appropriation and thereby delaying progress in moving forward with this important improvement in health service delivery. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds, and I am directing the Department of Health Services to move forward with investments in telehealth from existing resources. 49. Physical Health Service Provider Reimbursement
Section 126 [as it relates to s. 20.865 (4) (a)] This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $500,000 GPR in both fiscal years for Medicaid reimbursement rate increases for physical health providers.
I am partially vetoing section 126 [as it relates to s. 20.865 (4) (a)] by lining out the amounts under s. 20.865 (4) (a) and writing in smaller amounts that reduce the appropriation by $500,000 GPR in each fiscal year. I object to the appropriation of these funds without the infusion of federal tax dollars and resulting state savings from Medicaid expansion that would have allowed us to make investments like this. Expanding Medicaid to individuals up to 138 percent of the poverty line not only ensures access to affordable, quality coverage for Wisconsinites, it would have allowed a robust investment in our providers in Wisconsin. However, in absence of these critical federal dollars and resulting state savings, the limited resources that remain must be invested in expanding patient care first before we can increase payments to health providers. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds. 50. Hub-and-Spoke Mental Health and Substance Abuse Treatment Model
Section 126 [as it relates to s. 20.865 (4) (a)] This provision requires the Department of Health Services to develop a hub-and-spoke treatment model for substance abuse using the Medicaid home health benefit. However, the funding was placed in the Joint Committee on Finance GPR supplemental appropriation and the Department of Health Services must request the funding under s. 13.10. I am partially vetoing section 126 [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 $89,900 GPR in fiscal year 2020-21. I object to the Joint Committee on Finance restricting the use of these funds. I am directing the Department of Health Services to develop a hub-and-spoke treatment model for substance abuse using the Medicaid home health benefit with $89,900 GPR of existing funds. The crisis facing many Wisconsin families because of substance use disorders is too important to delay with an additional step in the process to be able to move forward with this critical program. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds. 51. Racine County Nursing Home Labor Region
Section 664r
This provision would move Racine County from its current labor region to the Milwaukee labor region, which includes Milwaukee, Ozaukee, Washington and Waukesha counties, for purposes of calculating Medical Assistance reimbursement to nursing homes. It would require the Department of Health Services to adjust Medical Assistance payments to nursing homes so that the direct care cost targets of facilities in Milwaukee, Ozaukee, Washington and Waukesha counties are not reduced as a result of including facilities in Racine County in this labor region.
I am vetoing this provision in its entirety because I object to including a provision that would result in reductions in direct care funding to nursing homes in all other labor regions in the state. The department has worked with nursing home providers across the state to develop a labor region methodology and will continue to review labor regions and recommend changes when necessary.
52. Suicide Prevention Grant
Section 9119 (6f)
This provision requires the Department of Health Services to award a one-time grant of $100,000 GPR in fiscal year 2019-20 to the Wisconsin United Coalition of Mutual Assistance Association, Inc., to support suicide prevention activities conducted by the coalition.
I am partially vetoing this provision to remove the Wisconsin United Coalition of Mutual Assistance Association, Inc., as the recipient because I object to the Legislature earmarking a specific recipient. The experts at the Department of Health Services are best positioned to develop a grant program and ensure that recipients provide evidence-based care and treatment. I am directing the Department of Health Services to seek applicants for this grant and award funding to the most qualified applicant.
53. FoodShare Employment and Training Administrative Funds
Section 126 [as it relates to ss. 20.435 (4) (bn) and 20.435 (4) (nn)] This provision increases funding available for the FoodShare Employment and Training program and Medicaid administration of eligibility requirements. Specifically, it includes income maintenance funding related to the FoodShare Employment and Training drug screening requirement, the work requirement for able-bodied adults with school age dependents, provisions of the Medicaid childless adult waiver and the Medicaid health savings account.
I am partially vetoing this provision because I object to the burdensome requirements the Legislature has imposed on the state's low-income individuals. In addition, in so imposing these requirements, the Legislature has set unrealistic timelines for implementation of these provisions and does not give the Department of Health Services sufficient time to complete the required systems changes.
I am, therefore, partially vetoing section 126 [as it relates to ss. 20.435 (4) (bn) and 20.435 (4) (nn)] in the following ways: by lining out the amount under s. 20.435 (4) (bn) and writing in a smaller amount that reduces the appropriation by $547,800 GPR in fiscal year 2019-20; and by lining out the amount under s. 20.435 (4) (nn) and writing in a smaller amount that reduces the appropriation by $1,229,600 PR-F in fiscal year 2019-20. This partial veto is part of a larger write-down of the Income Maintenance appropriations. I am requesting the Department of Administration secretary not to allot these funds.
54. FoodShare Employment and Training Cost-to-Continue
Section 126 [as it relates to s. 20.435 (4) (bp)] This provision increases funding available for FoodShare Employment and Training program services for childless adults in the Medicaid program.
I am partially vetoing section 126 [as it relates to s. 20.435 (4) (bp)] by lining out the amounts under s. 20.435 (4) (bp) and writing in smaller amounts that reduce the appropriation by $1,000,000 GPR in both fiscal years. I object to burdensome requirements imposed on Medicaid recipients in order to receive health insurance. I am requesting the Department of Administration secretary not to allot these funds. 55. Authority to Reallocate Positions
Section 9119 (10)
This provision directs the Department of Health Services to utilize 5.0 FTE existing positions to create an infant mortality prevention program. The department shall report the reallocation of these positions in its 2021-23 budget request.
I object to the Legislature directing the reallocation without accounting for the need for staffing of other priority health programs, such as oral health. I am partially vetoing this provision to allow the department to reallocate positions to create the infant mortality prevention program and provide positions to the oral health program. I am directing the department to reallocate from existing positions sufficient FTE position authority to create and staff an infant mortality prevention program, sufficient FTE position authority to expand services provided by the oral health program, and sufficient FTE position authority to staff other programs within the department. I am directing the Department of Health Services to submit a plan for any reallocations under this section to the Department of Administration for review and approval prior to implementing any reallocation.
56. Birth to 3 Program
Section 9219 (1p)
This section requires the Department of Health Services to transfer $2,250,000 GPR allocated to the Children's Community Options Program to the Birth to 3 Program in fiscal year 2019-20. This section also requires a transfer of $2,250,000 GPR from the Community Options Program to the children's Community Options Program in fiscal year 2019-20.
I am partially vetoing this section to eliminate the $2,250,000 GPR transfer from the Community Options Program to the Children's Community Options Program because I object to it as unnecessary. I am directing the Department of Health Services and Department of Administration to utilize the authority of s. 20.435 (7) (bt) as a continuing appropriation to split the $2,250,000 GPR transfer over both years of the biennium. This will avoid violating the federal maintenance of effort requirement that requires states to maintain the same level of state support compared to the prior year. I am also directing the Department of Health Services to request an annual increase of $1,125,000 GPR in the Birth to 3 Program appropriation in its 2021-23 agency biennial budget request. 57. Nitrate Testing for Private Wells
Section 126 [as it relates to ss. 20.435 (1) (ec) and 20.865 (4) (a)] This provision increases funding in the Joint Committee on Finance GPR supplemental appropriation by $3,000,000 GPR in fiscal year 2019-20. Initially the Joint Committee on Finance created language related to nitrate testing for private wells, which the Assembly later removed. The Assembly did not remove the funding.
I am partially vetoing section 126 [as it relates to ss. 20.435 (1) (ec) and 20.865 (4) (a)] by removing s. 20.435 (1) (ec) and by lining out the amount under s. 20.865 (4) (a) and writing in a smaller amount that reduces the appropriation by $3,000,000 GPR in fiscal year 2019-20. I object to the removal of programmatic language for critical testing efforts in the state while the Legislature retains the funding to potentially use for other purposes. These programs should be authorized and funded together, and the department should not have to go back to the Joint Committee on Finance to request release of the funds. In addition, the Legislature intended to remove s. 20.435 (1) (ec) from the Chapter 20 appropriation schedule, but it was erroneously included. This partial veto is part of a larger write-down of the Joint Committee on Finance GPR supplemental appropriation. I am requesting the Department of Administration secretary not to allot these funds. 58. Wisconsin Statewide Public Safety and Interoperable Communications System
Section 9144 (3)
This provision requires the Department of Transportation to issue a request for proposals for the Wisconsin Statewide Public Safety Interoperable Communications System (WISCOM) by June 30, 2020, in collaboration with the Department of Military Affairs, and it authorizes the Department of Transportation to spend up to $500,000 for related professional consulting services.
I am vetoing this provision in its entirety because I object to having the WISCOM program in the Department of Military Affairs while having the Department of Transportation issue a request for proposals related to the system. The Department of Administration has statutory authority over procurement in the state. This provision is legislative overreach into the procurement process.
E. TRANSPORTATION, TAX, LOCAL GOVERNMENT AND ECONOMIC DEVELOPMENT
59. Expansion of Auditing Activity
Section 9137 (1p)
This section advances the termination date of 38.0 FTE GPR audit and compliance project positions that were provided to the Department of Revenue under 2017 Wisconsin Act 59, to an effective date of September 30, 2023. I am partially vetoing the effective date language in section 9137 (1p) to extend the termination date of these positions to encompass the full 2023-25 biennium because I object to the early elimination of these positions that are needed to ensure tax fairness and equality. The new effective termination date will be June 30, 2025. This will allow the Department of Revenue to continue its tax enforcement and auditing activities without interruption.
60. Defining Vapor Products
Section 1754
This section defines a "vapor product" and the bill imposes an excise tax and inventory tax of 5 cents per milliliter on vapor fluids. The bill further amends current law regulating the sale and taxation of tobacco products to include vapor products.
I am partially vetoing the definition of "vapor product" in section 1754 because I object to the ambiguous language in the definition. Specifically, the language could be erroneously construed to exclude liquids or other substances that are used in electronic cigarettes, electronic cigars, electronic pipes or similar devices. Such an interpretation would be contrary to intent.
As a result of my partial veto of this definition, the vapor products tax will clearly apply to any device containing vapor fluid and to vapor fluid sold separately.
61. Tolling and Mileage-based Fee Study
Section 1082m
This section requires the Department of Transportation to spend not more than $2,500,000 to study tolling and mileage-based fees. It further requires the department to submit a report on its findings and include its recommendations in the department's next biennial budget request.
I am vetoing this section because I object to the financing of another study that will show, yet again, that the motor fuel tax is the most effective way to approximate a user fee of roadway use and the most cost-effective way to collect revenue. The Legislature has had more than enough evidence and enough time to study the issue. It is time for the Legislature to stop stalling and act to secure a long-term transportation funding solution.
62. Registration Fees by Weight Classification
Section 1988b
This section requires the Department of Transportation to charge truck owners the same registration fee of $100 per vehicle to register all trucks that weigh not more than 10,000 pounds.
