CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. HB 509, 1st Eng.
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 9, between lines 13 and 14,
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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-five percent of such amount must be remitted
22 to a 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 $10 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 $15 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 no more than seven and no fewer than five members
8 appointed by the county commission. The members of the
9 governing board, agency, or authority shall be at least 18
10 years of age and residents of the county. No member may be
11 employed by or affiliated with a health care provider or the
12 public health trust, agency, or authority responsible for the
13 county public general hospital. The following community
14 organizations shall each appoint a representative to a
15 nominating committee: the South Florida Hospital and
16 Healthcare Association, the Miami-Dade County Public Health
17 Trust, the Dade County Medical Association, the Miami-Dade
18 County Homeless Trust, and the Mayor of Miami-Dade County.
19 This committee shall nominate between 10 and 14 county
20 citizens for the governing board, agency, or authority. The
21 slate shall be presented to the county commission and the
22 county commission shall confirm the top five to seven
23 nominees, depending on the size of the governing board. Until
24 such time as the governing board, agency, or authority is
25 created, the funds provided for in subparagraph (d)2. shall be
26 placed in a restricted account set aside from other county
27 funds and not disbursed by the county for any other purpose.
28 1. The plan shall divide the county into a minimum of
29 four and maximum of six service areas, with no more than one
30 participant hospital per service area. The county public
31 general hospital shall be designated as the provider for one
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SENATE AMENDMENT
Bill No. HB 509, 1st Eng.
Amendment No.
1 of the service areas. Services shall be provided through
2 participants' primary acute care facilities.
3 2. The plan and subsequent amendments to it shall fund
4 a defined range of health care services for both indigent
5 persons and the medically poor, including primary care,
6 preventive care, hospital emergency room care, and hospital
7 care necessary to stabilize the patient. For the purposes of
8 this section, "stabilization" means stabilization as defined
9 in s. 397.311(30). Where consistent with these objectives, the
10 plan may include services rendered by physicians, clinics,
11 community hospitals, and alternative delivery sites, as well
12 as at least one regional referral hospital per service area.
13 The plan shall provide that agreements negotiated between the
14 governing board, agency, or authority and providers shall
15 recognize hospitals that render a disproportionate share of
16 indigent care, provide other incentives to promote the
17 delivery of charity care to draw down federal funds where
18 appropriate, and require cost containment, including, but not
19 limited to, case management. From the funds specified in
20 subparagraphs (d)1. and 2. for indigent health care services,
21 service providers shall receive reimbursement at a Medicaid
22 rate to be determined by the governing board, agency, or
23 authority created pursuant to this paragraph for the initial
24 emergency room visit, and a per-member per-month fee or
25 capitation for those members enrolled in their service area,
26 as compensation for the services rendered following the
27 initial emergency visit. Except for provisions of emergency
28 services, upon determination of eligibility, enrollment shall
29 be deemed to have occurred at the time services were rendered.
30 The provisions for specific reimbursement of emergency
31 services shall be repealed on July 1, 2001, unless otherwise
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SENATE AMENDMENT
Bill No. HB 509, 1st Eng.
Amendment No.
1 reenacted by the Legislature. The capitation amount or rate
2 shall be determined prior to program implementation by an
3 independent actuarial consultant. In no event shall such
4 reimbursement rates exceed the Medicaid rate. The plan must
5 also provide that any hospitals owned and operated by
6 government entities on or after the effective date of this act
7 must, as a condition of receiving funds under this subsection,
8 afford public access equal to that provided under s. 286.011
9 as to any meeting of the governing board, agency, or authority
10 the subject of which is budgeting resources for the retention
11 of charity care, as that term is defined in the rules of the
12 Agency for Health Care Administration. The plan shall also
13 include innovative health care programs that provide
14 cost-effective alternatives to traditional methods of service
15 and delivery funding.
16 3. The plan's benefits shall be made available to all
17 county residents currently eligible to receive health care
18 services as indigents or medically poor as defined in
19 paragraph (4)(d).
20 4. Eligible residents who participate in the health
21 care plan shall receive coverage for a period of 12 months or
22 the period extending from the time of enrollment to the end of
23 the current fiscal year, per enrollment period, whichever is
24 less.
25 5. At the end of each fiscal year, the governing
26 board, agency, or authority shall prepare an audit that
27 reviews the budget of the plan, delivery of services, and
28 quality of services, and makes recommendations to increase the
29 plan's efficiency. The audit shall take into account
30 participant hospital satisfaction with the plan and assess the
31 amount of poststabilization patient transfers requested, and
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SENATE AMENDMENT
Bill No. HB 509, 1st Eng.
Amendment No.
1 accepted or denied, by the county public general hospital.
2 Section 7. The provisions of this act shall be
3 reviewed by the Legislature prior to October 1, 2005, and
4 shall be repealed on that date unless otherwise reenacted by
5 the Legislature.
6 Section 8. This act shall take effect October 1, 2000.
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8 (Redesignate subsequent sections.)
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12 And the title is amended as follows:
13 On page 1, line 21, after the second semicolon,
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15 insert:
16 amending s. 212.055, F.S.; revising provisions
17 that require the counties authorized to levy
18 the surtax to annually appropriate a specified
19 minimum amount for operation, administration,
20 and maintenance of the county public general
21 hospital; providing procedure for disbursement
22 of funds; requiring a governing board, agency,
23 or authority in such counties to adopt and
24 implement a health care plan for indigent
25 health care services; providing for appointment
26 of members of such entity; specifying
27 provisions of the plan; providing for annual
28 audit; providing for compensation to service
29 providers; providing for future review and
30 repeal;
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