CODING: Words stricken are deletions; words underlined are additions.





                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    

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11  Senator Diaz de la Portilla moved the following amendment:

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13         Senate Amendment (with title amendment) 

14         On page 9, between lines 13 and 14,

15

16  insert:

17         Section 6.  Paragraph (d) of subsection (5) of section

18  212.055, Florida Statutes, is amended, paragraph (e) is

19  redesignated as paragraph (f), and a new paragraph (e) is

20  added to said subsection, to read:

21         212.055  Discretionary sales surtaxes; legislative

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

23  legislative intent that any authorization for imposition of a

24  discretionary sales surtax shall be published in the Florida

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

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

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

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

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

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

31  be expended; and such other requirements as the Legislature

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1  may provide.  Taxable transactions and administrative

 2  procedures shall be as provided in s. 212.054.

 3         (5)  COUNTY PUBLIC HOSPITAL SURTAX.--Any county as

 4  defined in s. 125.011(1) may levy the surtax authorized in

 5  this subsection pursuant to an ordinance either approved by

 6  extraordinary vote of the county commission or conditioned to

 7  take effect only upon approval by a majority vote of the

 8  electors of the county voting in a referendum.  In a county as

 9  defined in s. 125.011(1), for the purposes of this subsection,

10  "county public general hospital" means a general hospital as

11  defined in s. 395.002 which is owned, operated, maintained, or

12  governed by the county or its agency, authority, or public

13  health trust.

14         (d)  Except as provided in subparagraphs 1. and 2., the

15  county must shall continue to contribute each year an amount

16  equal to at least 80 percent of that percentage of the total

17  county budget appropriated for the operation, administration,

18  and maintenance of the county public general hospital from the

19  county's general revenues in the fiscal year of the county

20  ending September 30, 1991:

21         1.  Twenty percent of such amount must be remitted to a

22  governing board, agency, or authority that is wholly

23  independent from the public health trust, agency, or authority

24  responsible for the county public general hospital, to be used

25  solely for the purpose of funding the plan for indigent health

26  care services provided for in paragraph (e);

27         2.  However, in the first year of the plan, a total of

28  $7 million shall be remitted to such governing board, agency,

29  or authority, to be used solely for the purpose of funding the

30  plan for indigent health care services provided for in

31  paragraph (e), and in the second year of the plan, a total of

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1  $10 million shall be so remitted and used.

 2         (e)  A governing board, agency, or authority shall be

 3  chartered by the county commission upon this act becoming law.

 4  The governing board, agency, or authority shall adopt and

 5  implement a health care plan for indigent health care

 6  services.  The governing board, agency, or authority shall

 7  consist of nine no more than seven and no fewer than five

 8  members appointed by the county commission.  The members of

 9  the governing board, agency, or authority shall be at least 18

10  years of age and residents of the county.  No member or

11  immediate family member of a member may be employed by or

12  affiliated with a health care provider or the public health

13  trust, agency, or authority responsible for the county public

14  general hospital. The Governor, the President of the Senate,

15  and the Speaker of the House of Representatives shall each

16  submit a list of six names to the county commission for

17  appointment to the governing board, agency, or authority. The

18  commission shall appoint, by a two-thirds majority vote, two

19  members from each list of names submitted. In addition, the

20  South Florida Hospital and Health Care Association, the

21  Miami-Dade County Public Health Trust, and the Miami-Dade

22  County Homeless Trust shall each submit a list of four names

23  for appointment. The commission shall appoint one member, by a

24  two-thirds majority vote, from each list of names submitted.

25  The following community organizations shall each appoint a

26  representative to a nominating committee:  the South Florida

27  Hospital and Healthcare Association, the Miami-Dade County

28  Public Health Trust, the Dade County Medical Association, the

29  Miami-Dade County Homeless Trust, and the Mayor of Miami-Dade

30  County.  This committee shall nominate between 10 and 14

31  county citizens for the governing board, agency, or authority.

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1  The slate shall be presented to the county commission and the

 2  county commission shall confirm the top five to seven

 3  nominees, depending on the size of the governing board. Until

 4  such time as the governing board, agency, or authority is

 5  created, the funds provided for in subparagraph (d)2. shall be

 6  placed in a restricted account set aside from other county

 7  funds and not disbursed by the county for any other purpose.

 8         1.  The plan shall divide the county into a minimum of

 9  four and maximum of six service areas, with at least two no

10  more than one participant hospitals hospital per service area.

11  The county public general hospital shall be designated as the

12  provider for one of the service areas.  Services shall be

13  provided through participants' primary acute care facilities.

14         2.  The plan and subsequent amendments to it shall fund

15  a defined range of health care services for both indigent

16  persons and the medically poor, including primary care,

17  preventive care, hospital emergency room care, and hospital

18  care necessary to stabilize the patient. For the purposes of

19  this section, "stabilization" means stabilization as defined

20  in s. 397.311(30). Where consistent with these objectives, the

21  plan may include services rendered by physicians, clinics,

22  community hospitals, and alternative delivery sites, as well

23  as at least two regional referral hospitals per service area.

24  The plan shall provide that agreements negotiated between the

25  governing board, agency, or authority and providers shall

26  recognize hospitals that render a disproportionate share of

27  indigent care, provide other incentives to promote the

28  delivery of charity care to draw down federal funds where

29  appropriate, and require cost containment, including, but not

30  limited to, case management. From the funds specified in

31  subparagraphs (d)1. and 2. for indigent health care services,

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1  service providers shall receive reimbursement at a Medicaid

 2  rate to be determined by the governing board, agency, or

 3  authority created pursuant to this paragraph for the initial

 4  emergency room visit, and a per-member per-month fee or

 5  capitation for those members enrolled in their service area,

 6  as compensation for the services rendered following the

 7  initial emergency visit. Except for provisions of emergency

 8  services, upon determination of eligibility, enrollment shall

 9  be deemed to have occurred at the time services were rendered.

10  The provisions for specific reimbursement of emergency

11  services shall be repealed on July 1, 2001, unless otherwise

12  reenacted by the Legislature. The capitation amount or rate

13  shall be determined prior to program implementation by an

14  independent actuarial consultant. In no event shall such

15  reimbursement rates exceed the Medicaid rate. The plan must

16  also provide that any hospitals owned and operated by

17  government entities on or after the effective date of this act

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

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

20  as to any meeting of the governing board, agency, or authority

21  the subject of which is budgeting resources for the retention

22  of charity care, as that term is defined in the rules of the

23  Agency for Health Care Administration. The plan shall also

24  include innovative health care programs that provide

25  cost-effective alternatives to traditional methods of service

26  and delivery funding.

27         3.  The plan's benefits shall be made available to all

28  county residents currently eligible to receive health care

29  services as indigents or medically poor as defined in

30  paragraph (4)(d).

31         4.  Eligible residents who participate in the health

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1  care plan shall receive coverage for a period of 12 months or

 2  the period extending from the time of enrollment to the end of

 3  the current fiscal year, per enrollment period, whichever is

 4  less.

 5         5.  At the end of each fiscal year, the governing

 6  board, agency, or authority shall prepare an audit that

 7  reviews the budget of the plan, delivery of services, and

 8  quality of services, and makes recommendations to increase the

 9  plan's efficiency.  The audit shall take into account

10  participant hospital satisfaction with the plan and assess the

11  amount of poststabilization patient transfers requested, and

12  accepted or denied, by the county public general hospital.

13         Section 7.  The amendments to section 212.055(5),

14  Florida Statutes, made by this act shall be reviewed by the

15  Legislature prior to October 1, 2004, and shall be repealed on

16  that date unless otherwise reenacted by the Legislature.

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18  (Redesignate subsequent sections.)

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21  ================ T I T L E   A M E N D M E N T ===============

22  And the title is amended as follows:

23         On page 1, line 21, after the second semicolon,

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25  insert:

26         amending s. 212.055, F.S.; revising provisions

27         that require the counties authorized to levy

28         the surtax to annually appropriate a specified

29         minimum amount for operation, administration,

30         and maintenance of the county public general

31         hospital; providing procedure for disbursement

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                                                  SENATE AMENDMENT

    Bill No. HB 509, 1st Eng.

    Amendment No.    





 1         of funds; requiring a governing board, agency,

 2         or authority in such counties to adopt and

 3         implement a health care plan for indigent

 4         health care services; providing for appointment

 5         of members of such entity; specifying

 6         provisions of the plan; providing for annual

 7         audit; providing for compensation to service

 8         providers; providing for future review and

 9         repeal;

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