Senate Bill 1394c2

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    Florida Senate - 2000                    CS for CS for SB 1394

    By the Committees on Fiscal Resource; Comprehensive Planning,
    Local and Military Affairs; and Senators Mitchell and Lee




    314-2219A-00

  1                      A bill to be entitled

  2         An act relating to discretionary sales

  3         surtaxes; amending s. 212.055, F.S.; expanding

  4         the authorized use of the indigent care surtax

  5         to include trauma centers; renaming the surtax;

  6         requiring the plan set out in the ordinance to

  7         include additional provisions concerning Level

  8         I trauma centers; providing requirements for

  9         annual disbursements to hospitals on October 1

10         to be in recognition of the Level I trauma

11         status and to be in addition to a base contract

12         amount plus any negotiated additions to

13         indigent care funding; authorizing funds

14         received to be used to generate federal

15         matching funds under certain conditions and

16         authorizing payment by the clerk of the courts;

17         authorizing certain counties to levy a

18         voter-approved indigent care surtax; providing

19         for the surtax to be conditioned upon approval

20         by a majority vote of the electors; limiting

21         the rate of the surtax; providing requirements

22         for the ordinance adopted by the governing body

23         of the county which imposes the surtax;

24         providing for proceeds of the surtax to be used

25         to provide health care services to qualified

26         residents; defining the term "qualified

27         resident"; providing for the administration of

28         proceeds collected pursuant to the surtax;

29         limiting the total amount of certain local

30         option sales surtaxes that may be imposed by a

31         county; authorizing certain school districts to

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1         levy additional discretionary millage;

  2         providing an effective date.

  3

  4  Be It Enacted by the Legislature of the State of Florida:

  5

  6         Section 1.  Subsection (4) of section 212.055, Florida

  7  Statutes, is amended, and subsection (7) is added to that

  8  section, to read:

  9         212.055  Discretionary sales surtaxes; legislative

10  intent; authorization and use of proceeds.--It is the

11  legislative intent that any authorization for imposition of a

12  discretionary sales surtax shall be published in the Florida

13  Statutes as a subsection of this section, irrespective of the

14  duration of the levy.  Each enactment shall specify the types

15  of counties authorized to levy; the rate or rates which may be

16  imposed; the maximum length of time the surtax may be imposed,

17  if any; the procedure which must be followed to secure voter

18  approval, if required; the purpose for which the proceeds may

19  be expended; and such other requirements as the Legislature

20  may provide.  Taxable transactions and administrative

21  procedures shall be as provided in s. 212.054.

22         (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--

23         (a)  The governing body in each county the government

24  of which is not consolidated with that of one or more

25  municipalities, which has a population of at least 800,000

26  residents and is not authorized to levy a surtax under

27  subsection (5) or subsection (6), may levy, pursuant to an

28  ordinance either approved by an extraordinary vote of the

29  governing body or conditioned to take effect only upon

30  approval by a majority vote of the electors of the county

31

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  voting in a referendum, a discretionary sales surtax at a rate

  2  that may not exceed 0.5 percent.

  3         (b)  If the ordinance is conditioned on a referendum, a

  4  statement that includes a brief and general description of the

  5  purposes to be funded by the surtax and that conforms to the

  6  requirements of s. 101.161 shall be placed on the ballot by

  7  the governing body of the county.  The following questions

  8  shall be placed on the ballot:

  9

10                     FOR THE. . . .CENTS TAX

11                   AGAINST THE. . . .CENTS TAX

12

13         (c)  The ordinance adopted by the governing body

14  providing for the imposition of the surtax shall set forth a

15  plan for providing health care services to qualified

16  residents, as defined in paragraph (d).  Such plan and

17  subsequent amendments to it shall fund a broad range of health

18  care services for both indigent persons and the medically

19  poor, including, but not limited to, primary care and

20  preventive care as well as hospital care. The plan must also

21  address the services to be provided by the Level I trauma

22  center. It shall emphasize a continuity of care in the most

23  cost-effective setting, taking into consideration both a high

24  quality of care and geographic access.  Where consistent with

25  these objectives, it shall include, without limitation,

26  services rendered by physicians, clinics, community hospitals,

27  mental health centers, and alternative delivery sites, as well

28  as at least one regional referral hospital where appropriate.

29  It shall provide that agreements negotiated between the county

30  and providers, including hospitals with a Level I trauma

31  center, will include reimbursement methodologies that take

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  into account the cost of services rendered to eligible

  2  patients, recognize hospitals that render a disproportionate

  3  share of indigent care, provide other incentives to promote

  4  the delivery of charity care, promote the advancement of

  5  technology in medical services, recognize the level of

  6  responsiveness to medical needs in trauma cases, and require

  7  cost containment including, but not limited to, case

  8  management. It must also provide that any hospitals that are

  9  owned and operated by government entities on May 21, 1991,

10  must, as a condition of receiving funds under this subsection,

11  afford public access equal to that provided under s. 286.011

12  as to meetings of the governing board, the subject of which is

13  budgeting resources for the rendition of charity care as that

14  term is defined in the Florida Hospital Uniform Reporting

15  System (FHURS) manual referenced in s. 408.07.  The plan shall

16  also include innovative health care programs that provide

17  cost-effective alternatives to traditional methods of service

18  delivery and funding.

19         (d)  For the purpose of this subsection, the term

20  "qualified resident" means residents of the authorizing county

21  who are:

22         1.  Qualified as indigent persons as certified by the

23  authorizing county;

24         2.  Certified by the authorizing county as meeting the

25  definition of the medically poor, defined as persons having

26  insufficient income, resources, and assets to provide the

27  needed medical care without using resources required to meet

28  basic needs for shelter, food, clothing, and personal

29  expenses; or not being eligible for any other state or federal

30  program, or having medical needs that are not covered by any

31  such program; or having insufficient third-party insurance

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  coverage.  In all cases, the authorizing county is intended to

  2  serve as the payor of last resort; or

  3         3.  Participating in innovative, cost-effective

  4  programs approved by the authorizing county.

  5         (e)  Moneys collected pursuant to this subsection

  6  remain the property of the state and shall be distributed by

  7  the Department of Revenue on a regular and periodic basis to

  8  the clerk of the circuit court as ex officio custodian of the

  9  funds of the authorizing county. The clerk of the circuit

10  court shall:

11         1.  Maintain the moneys in an indigent health care

12  trust fund;

13         2.  Invest any funds held on deposit in the trust fund

14  pursuant to general law; and

15         3.  Disburse the funds, including any interest earned,

16  to any provider of health care services, as provided in

17  paragraphs (c) and (d), upon directive from the authorizing

18  county. However, if a county has a population of at least

19  800,000 residents and has levied the surtax authorized in this

20  subsection, notwithstanding any directive from the authorizing

21  county, on October 1 of each calendar year, the clerk of the

22  court shall issue a check in the amount of $6.5 million to a

23  hospital in its jurisdiction that has a Level I trauma center

24  or shall issue a check in the amount of $3.5 million to a

25  hospital in its jurisdiction that has a Level I trauma center

26  if that county enacts and implements a hospital lien law in

27  accordance with chapter 98-499, Laws of Florida. The issuance

28  of the checks on October 1 of each year is provided in

29  recognition of the Level I trauma center status and shall be

30  in addition to the base contract amount received during fiscal

31  year 1999-2000 and any additional amount negotiated to the

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  base contract. If the hospital receiving funds for its Level I

  2  trauma center status requests such funds to be used to

  3  generate federal matching funds under Medicaid, the clerk of

  4  the court shall instead issue a check to the Agency for Health

  5  Care Administration to accomplish that purpose to the extent

  6  that it is allowed through the General Appropriations Act.

  7         (f)  Notwithstanding any other provision of this

  8  section, a county shall not levy local option sales surtaxes

  9  authorized in this subsection and subsections (2) and (3) in

10  excess of a combined rate of 1 percent.

11         (g)  This subsection expires October 1, 2005.

12         (7)  VOTER-APPROVED INDIGENT CARE SURTAX.--

13         (a)  The governing body in each county that has a

14  population of less than 800,000 residents may levy an indigent

15  care surtax pursuant to an ordinance conditioned to take

16  effect only upon approval by a majority vote of the electors

17  of the county voting in a referendum. The surtax may be levied

18  at a rate not to exceed 0.5 percent.

19         (b)  A statement that includes a brief and general

20  description of the purposes to be funded by the surtax and

21  that conforms to the requirements of s. 101.161 shall be

22  placed on the ballot by the governing body of the county. The

23  following questions shall be placed on the ballot:

24

25                     FOR THE. . . .CENTS TAX

26                   AGAINST THE. . . .CENTS TAX

27

28         (c)  The ordinance adopted by the governing body

29  providing for the imposition of the surtax must set forth a

30  plan for providing health care services to qualified

31  residents, as defined in paragraph (d). The plan and

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  subsequent amendments to it shall fund a broad range of health

  2  care services for indigent persons and the medically poor,

  3  including, but not limited to, primary care and preventive

  4  care, as well as hospital care. It shall emphasize a

  5  continuity of care in the most cost-effective setting, taking

  6  into consideration a high quality of care and geographic

  7  access. Where consistent with these objectives, it shall

  8  include, without limitation, services rendered by physicians,

  9  clinics, community hospitals, mental health centers, and

10  alternative delivery sites, as well as at least one regional

11  referral hospital where appropriate. It shall provide that

12  agreements negotiated between the county and providers will

13  include reimbursement methodologies that take into account the

14  cost of services rendered to eligible patients, recognize

15  hospitals that render a disproportionate share of indigent

16  care, provide other incentives to promote the delivery of

17  charity care, and require cost containment including, but not

18  limited to, case management. The plan must also include

19  innovative health care programs that provide cost-effective

20  alternatives to traditional methods of service delivery and

21  funding.

22         (d)  For the purpose of this subsection, the term

23  "qualified resident" means residents of the authorizing county

24  who are:

25         1.  Qualified as indigent persons as certified by the

26  authorizing county;

27         2.  Certified by the authorizing county as meeting the

28  definition of the medically poor, defined as persons having

29  insufficient income, resources, and assets to provide the

30  needed medical care without using resources required to meet

31  basic needs for shelter, food, clothing, and personal

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  expenses; not being eligible for any other state or federal

  2  program or having medical needs that are not covered by any

  3  such program; or having insufficient third-party insurance

  4  coverage. In all cases, the authorizing county shall serve as

  5  the payor of last resort; or

  6         3.  Participating in innovative, cost-effective

  7  programs approved by the authorizing county.

  8         (e)  Moneys collected pursuant to this subsection

  9  remain the property of the state and shall be distributed by

10  the Department of Revenue on a regular and periodic basis to

11  the clerk of the circuit court as ex officio custodian of the

12  funds of the authorizing county. The clerk of the circuit

13  court shall:

14         1.  Maintain the moneys in an indigent health care

15  trust fund;

16         2.  Invest any funds held on deposit in the trust fund

17  pursuant to general law; and

18         3.  Disburse the funds, including any interest earned,

19  to any provider of health care services, as provided in

20  paragraphs (c) and (d), upon directive from the authorizing

21  county.

22         (f)  Notwithstanding any other provision of this

23  section, a county may not levy local option sales surtaxes

24  authorized in this subsection and subsections (2) and (3) in

25  excess of a combined rate of 1 percent.

26         Section 2.  Notwithstanding the General Appropriations

27  Act for 2000-2001, those school districts that have submitted

28  proposals to be a charter school district under section

29  228.058, Florida Statutes, prior to March 1, 2000, may levy up

30  to 1.0 additional discretionary school millage, for 1 year

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    Florida Senate - 2000                    CS for CS for SB 1394
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  1  only, to provide funds necessary to implement the transition

  2  to charter district status.

  3         Section 3.  This act shall take effect upon becoming a

  4  law.

  5

  6          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
  7                            CS/SB 1394

  8

  9  1)    Increases the amount of money the clerk of the court
          must issue a county that has levied the indigent health
10        and trauma center surtax to a help fund its Level I
          trauma center from $6.0 million to $6.5 million and the
11        alternative amount from $3.0 million to $3.5 million.

12  2)    Provides that if the hospital receiving funds for its
          Level I trauma center status requests such funds to be
13        used to generate federal matching funds under Medicaid,
          the clerk of the court shall instead issue a check to
14        the AHCA to accomplish that purpose.

15  3)    Authorizes those school districts that have submitted
          proposals to be a charter school district under s.
16        228.058, F.S., prior to March 1, 2000, to levy up to 1.0
          additional discretionary school millage, for one year
17        only, to provide funds necessary to implement the
          transition to charter district status.
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