Milwaukee County mental health functions, programs, and services, creation of the Milwaukee County Mental Health Board, and making an appropriation. (FE)

overseeing the provision of mental health programs and services in Milwaukee County; making the final determination on mental health policy in Milwaukee County; replacing the Milwaukee County board of supervisors (county board) in all mental health functions typically performed by a county board; and attempting to achieve costs savings in the provision of mental health programs and services in Milwaukee County. The MCMHB must facilitate delivery of mental health services in an efficient and effective manner by committing to community-based, person-centered, 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 experiencing mental illness from the corrections system when appropriate; and maximizing use of mobile crisis units and crisis intervention training. Under the bill, any contract related to mental health with a value of at least $100,000, to which Milwaukee County is a party, may take effect only if the MCMHB does not vote to reject the contract within 14 days after the contract is signed or countersigned by the county executive.

Under the bill, the MCMHB must allocate moneys for mental health functions, programs, and services in Milwaukee County within a total budget amount which is incorporated into the Milwaukee County budget by the county board. The bill sets the total budget amount for each fiscal year to be the sum of a base budget amount equal to $177,425,000 and any amount of unexpended moneys held by the Milwaukee County treasurer in a mental health reserve fund mandated by the bill, subject to the following adjustments:

1) The bill requires the Milwaukee County treasurer to hold in a mental health reserve fund any moneys that were appropriated, but not expended, in a fiscal year for mental health functions, programs, and services in Milwaukee County, and specifies that moneys in the reserve fund may be expended only for such functions, programs, and services. If in the fiscal year previous to the fiscal year for which the budget is being determined, the county treasurer is holding any such unexpended moneys in the mental health reserve fund, the base budget amount for the fiscal year for which the budget is being determined is decreased by the amount of those unexpended moneys.

2) If there are no moneys in the mental health reserve fund, the MCMHB requests a mental health budget increase from the Milwaukee County executive, and the Milwaukee County executive approves the mental health budget increase, the base budget amount, together with any increase under item 3), below, is increased to reflect the percentage change in a certain consumer price index during the calendar year preceding the fiscal year for which the budget is being determined or, if that percentage change is positive and if there is a smaller positive percentage change in the property tax levy between the two calendar years preceding the fiscal year for which the budget is being determined, to reflect that smaller positive percentage change.

3) If the MCMHB is transferred jurisdiction of a function, service, or program, under a procedure specified in the bill, that it did not have jurisdiction over initially, the base budget amount is increased by the amount expended by Milwaukee County on that function, service, or program in the fiscal year before the fiscal year in which the function, program, or service is transferred. The increase applies for every fiscal year for which the MCMHB has jurisdiction over the function, service, or program.

Under the bill, the Milwaukee County board may not provide funding and the Milwaukee County executive may not approve funding, in any fiscal year, for mental health functions, services, and programs that is less than or more than the total budget amount calculated for that fiscal year, as described above.

The bill removes the jurisdiction over any mental health policy, functions, programs, or services, from the Milwaukee County board. The bill prohibits the Milwaukee County board from creating new mental health functions, programs, or services that are under its jurisdiction. Disputes between the Milwaukee County board and the MCMHB over whether a function, program, or service is a mental health function, program, or service are resolved by the secretary of DHS.

Under the bill, the Milwaukee County executive must nominate an individual to be the administrator of any division of the county department of human services that administers behavioral health for Milwaukee County. The administrator may be hired only upon approval of the MCMHB. The Milwaukee County executive determines the salary and benefits and job duties of this administrator, but the county executive may not assign the administrator any duties that are not related to mental health functions, programs, and services in Milwaukee County. The administrator may be removed by the MCMHB on its own by a vote of 8 of the members or, if the Milwaukee County executive has recommended removal, by a vote of 6 members of the MCMHB. The bill prohibits the Milwaukee County board from hiring, removing, or disciplining, setting the salary or benefits of, or assigning or removing job duties of this administrator.

Under current law, a county board has the primary responsibility for the well-being, treatment, and care of the mentally ill, developmentally disabled, alcoholic, and other drug dependent citizens residing within its county and for ensuring that those individuals in need of such emergency services found within its county receive immediate emergency services. The primary responsibility is limited, under current law, to the programs, services, and resources that the county board is reasonably able to provide within the limits of available state and federal funds and of county funds required to be appropriated to match state funds. Under the bill, in Milwaukee County, the MCMHB has primary responsibility for the well-being, treatment, and care of the mentally ill, alcoholic, and other drug dependent citizens residing within Milwaukee County and for ensuring that those individuals in need of such emergency services found within Milwaukee County receive emergency services. Under the bill, the Milwaukee County board retains the primary responsibility for the well-being, treatment, and care of developmentally disabled citizens residing in Milwaukee County, except where the responsibility is delegated explicitly to the MCMHB.

Under current mental health-related statutes, the county board has certain powers and duties. The bill makes changes to some powers and duties of the county board including the following:

1. Under current law, county departments of community programs among others, submit budget for services first to DHS. DHS submits a model of the contract containing the allocation of funds to the county board, which must approve the contract. Currently, the county board may appropriate moneys not used to match state funds. The bill requires the department to submit contracts related to mental health in Milwaukee County to the MCMHB.

2. Current law allows DHS to withhold a portion of the appropriation allocated to certain county departments, including the county department of community programs, for certain reasons, including duplicative services, inconsistency with federal statutes or regulations, and inconsistency with the contract with the county department. Under current law the county department affected by the withholding of the appropriation, may submit to the county board a plan to rectify the deficiency that prompted the withholding. The county board may approve or amend the plan and submit the plan to DHS. Under the bill, if the withholding is related to mental health in Milwaukee County, the county department submits the report to the MCMHB and the MCMHB approves or amends the plan for submittal to DHS.

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.