Kicking off the third week of executive sessions, on Tuesday, May 16 the Joint Finance Committee continued to take votes on pieces of Gov. Scott Walker’s proposed 2017-19 budget. The May 16 session included issues in Elections Commission, Ethics Commission, general items in the Department of Administration, care and treatment services in the Department of Health Services and programs under the Department of Children and Families.
Elections Commission: The governor’s budget provided for 16 positions for the Elections Commission. With federal funds projected to be exhausted by the first year of the biennium, the governor provided Federal (FED) funds in 2017-18 to support the 16 positions and General Purpose Revenue (GPR) in 2018-19. JFC opted to fund 21 Elections Commission positions, utilizing FED funds in 2017-18 and GPR in 2018-19. Democrats pushed for 22 positions, but the committee ultimately voted 12-4 to fund 21 positions.
DOA—General Agency Provisions: Under the Worker’s Compensation (WC) system, the governor proposed to eliminate the use of court reporters at a Division of Hearing and Appeals (DHA) hearing related to worker’s compensation. Both plaintiff and defense attorneys who practice in this space immediately shared concerns with this provision citing the lack of evidence showing that substituting technology for a live person saves costs in the system long-term.
JFC decided to maintain current law, which allows the use of live court reporters. In addition, the legislature required the DHA to conduct a study of the audio and video needs of worker’s compensation hearings that could allow for the use of such technologies in WC hearings. DHA must present their findings to the Worker’s Compensation Advisory Council by July 2018. The council may submit a recommendation to DHA regarding what WC recording equipment would be sufficient to replace a court reporter in time for inclusion in the 2019-21 agency request.
DHS—Care and Treatment Services: Under DHS, JFC also unanimously approved a motion to add physicians assistants to one of Walker’s provisions regarding health care professionals. Walker had proposed to eliminate an existing prohibition on state employees who are certain health care professionals from holding a full-time position with one state agency and another position with another state agency or authority. The exemption would allow the state mental health institutes to retain University of Wisconsin Hospital and Clinics employees on a limited-term employment basis for services provided at the state mental health institutes. The committee kept Walker’s provision in place and agreed to add physicians assistants to the proposed exemption.
Reps. Mark Born (R-Beaver Dam) and Katrina Shankland (D-Stevens Point) also proposed a motion, which passed 13-3, that changes requirements relating to plans for supervised release of sexually violent persons (SVPs) and the representation of SVPs by the state Public Defender. The motion provides that under these new requirements, the county where the individual will be released must prepare a report developed by a temporary committee on appropriate residential options to submit to DHS. When preparing the report, the county must consult with a local law enforcement agency having jurisdiction over the residential options. Law enforcement could submit a written report that provides information relating to the residential option, and if the report is submitted by law enforcement, the county department must include it in the agency’s report that they submit to DHS.
In the May 18 executive session, JFC rejected many of Walker’s proposals including the tuition freeze for Wisconsin technical colleges, the elimination of the Labor and Industry Review Commission (LIRC) and modified his plan for the Volkswagen settlement funds. Additionally, the committee voted on many other proposals under the Wisconsin Technical College System, the Historical Society and shared revenue and tax relief.
LIRC: The budget proposed by the governor repealed the Labor and Industry Review Commission (LIRC). LIRC is composed of three gubernatorial appointed commissioners and their staff. They resolve appeals of disputed unemployment insurance, worker’s compensation, and equal rights decisions. The governor proposed to eliminate LIRC and transfer the responsibility for administrative review of administrative decisions to the Department of Hearing and Appeals administrator for worker’s compensation decisions and to Department of Workforce Development administrators for unemployment insurance decisions and equal rights decisions.
JFC disagreed with the governor and voted to maintain LIRC. They did agree to eliminate some vacant positions and requested the Chief Justice of the Supreme Court to survey decisions of LIRC, citing the statutes LIRC interpreted and whether LIRC’s decisions proceeded on to Circuit Court. JFC asked that the Chief Justice submit a report of the survey’s findings to the governor and JFC by July of 2018.
Shared revenue and tax relief—direct aid payment: As part of its 2016 emissions violation settlement agreement with the U.S. Environmental Protection Agency (EPA) and the California Air Resources Board (CARB), Volkswagen Group of America (VWGoA) has committed to fund an environmental mitigation trust. Funds are allocated proportionally to each state, with Wisconsin receiving $63.5 million. Governor Walker’s budget appropriated $42 million of funds, allocating $16 million for the replacement of the state fleet and $26 million for Milwaukee County for replacing County vehicles. JFC modified the governor’s plan and reduced the portion for state fleet replacement to $10 million and eliminated the funding to Milwaukee County. Instead, JFC provided $32 million to create a competitive statewide capital assistance program for transit systems for replacing transit vehicles under the terms of the Volkswagen settlement.
This week’s JFC sessions began in the afternoon on Tuesday, May 23. The committee approved Walker’s proposals to consolidate human resources functions under DOA and to expand requirements for parents under the Wisconsin Works welfare program, among other proposals. The committee debated how the state should help Wisconsinites with student loans, rejecting a motion from Democrats that would have helped people refinance loans. The committee was also scheduled to vote on the University of Wisconsin System budget, but, because GOP lawmakers were still not in consensus about Walker’s proposed five percent tuition cut, JFC postponed voting until Thursday.
JFC began May 25 with a session on the University of Wisconsin System budget that had been postponed Tuesday. After almost three hours of debate, the committee passed an omnibus motion, 12-4. Then, JFC postponed votes on the Building Commission and Building Program, and instead started the official scheduled May 25 session by taking up the Department of Health Services budget – including Medicaid. The session ran into early Thursday evening, but JFC eventually passed an omnibus motion on DHS, along party lines. Highlights are below:
UW System: After delaying the Tuesday vote on the UW-System, JFC Republicans offered an omnibus motion on Thursday that rejected Gov. Walker’s proposed 5 percent tuition cut. The motion nixed the tuition cut, but instead kept in place a tuition freeze for the next biennium. The omnibus motion approved Walker’s proposal for performance-based funding for UW campuses, but gave UW regents the authority to measure performance under four broad goals established by the legislature. Also included in the omnibus motion is $1.5 million for a new Tommy G. Thompson Center on Public Leadership at UW-Madison. The net change to Gov. Walker’s would be a $6.8 million reduction in GPR. The motion passed 12-4, along party lines.
Throughout the debate on the UW-System, Democrats continued to push for more funding and for free tuition at two-year schools, a proposal they advocated for but was rejected under Tuesday’s technical college system budget. Their omnibus proposal was rejected 3-12.
DHS—Medicaid Services: Wrapping up a long day, the JFC debate on the DHS budget ended up only lasting until 7:45 p.m. on Thursday. Democrats offered several failed motions throughout the DHS budget debate, including a motion from Erpenbach and Taylor that would increase Medicaid cost to continue and funding for provider reimbursements, as well as require DHS to accept full Medicaid expansion under the Affordable Care Act. These Democratic motions failed, and eventually JFC approved 12-4 an omnibus motion from committee Republicans.
Medicaid cost to continue
Gov. Walker’s DHS budget had proposed a $280 million increase in the state’s Medicaid program, or “cost-to-continue.” The omnibus motion reduced this number by $95 million GPR to reflect a re-estimate of the benefits costs under cost to continue, consistent with Legislative Fiscal Bureau revisions. The motion does not transfer additional dollars from the general fund to the Medicaid trust fund to provide reserves, which was an alternative considered in the budget paper. However, the motion provided $50 million GPR to increase the committee’s program supplements appropriation, meaning that additional dollars would be available for Medicaid, but the funds would not be strictly tied to Medicaid.
Childless adults waiver
The omnibus motion also approved Walker’s recommendation that DHS submit a waiver to the federal government that would establish a work requirement for childless adults in BadgerCare Plus. The waiver would limit childless adults to 48 months of Medicaid eligibility unless they are working or participating in a job training program. The waiver also includes substance abuse and drug testing, monthly premiums ranging from $1 to $10 and healthy behavior incentives for childless adults in BadgerCare Plus.
Ambulatory surgical center assessment
In his budget, the governor’s proposed elimination of the Ambulatory Surgical Center (ASC) assessment. Under the ASC assessment, the state collects $16.7 million tax on state based ASC’s gross patient revenue. The state then draws down federal matching funds and pays out $20.1 million in access payments to ASCs that service Medicaid patients. Due to changes with federal rules and limitations, the assessment in the current fiscal year was greatly reduced to a tax of $5 million and access payments of $6 million. JFC’s omnibus motion deleted Walker’s proposal and instead maintained current law to continue the assessment, collecting $5 million annually and distributing $6 million in access payments.
Advanced practice clinician grants
The omnibus motion also added a provision that incorporates Assembly Bill 227 on advanced practice clinician training grants into the budget. The motion provides $500,000 GPR annually, beginning in 2018-2019 to establish a grant program for training advanced practice physicians, particularly in rural areas. The motion defines “advanced practice clinician” as a physician assistant or advanced practice nurse. A hospital or clinic may receive up to $50,000 per year under this program. Recipients will be required to match the grant dollar-for-dollar.
The motion provided an increase to the disproportionate share hospitals (DSH) under Medicaid and created a new supplemental payment for hospitals that do not qualify for DSH payments because they do not provide obstetric services. The DSH payments were increased by $30.8 million in 2017-18 ($12.5 million GPR and $18.1 million FED) and $31 million in 2018-19 ($12.5 million GPR and $18.3 million FED). The new supplemental payment program is funded at $250,000 GPR annually, drawing in $355K in FED in 2017-18 and $359K in FED in 2018-19.
Family Care Partnership Expansion
Also, included in the motion was a directive from JFC to DHS to expand the Family Care Partnership program statewide by the end of calendar year 2017. DHS will need to submit a waiver from the federal Centers for Medicare and Medicaid Services.
Intensive Care Coordination Pilot Program
The motion also included an item to create a pilot program for “intensive care coordination” funded for $2.25 million over the biennium. The pilot program would reimburse hospitals and health care systems for intensive care coordination services for Medical Assistance recipients.
Enhanced MA Reimbursement Rates for Dental Services Provided by Certain Facilities that Serve Individuals with Disabilities
Another provision included in the omnibus motion provided enhanced Medicaid reimbursement payment rates for dental services at facilities where at least 90 percent of the services are to individuals with cognitive and physical disabilities. Increased rates will be equal to 200 percent of MA reimbursement rates that would otherwise be paid for dental services.