HB 0583 2003
1	A bill to be entitled
2	An act relating to the indigent care surtax; amending s.
3	212.055, F.S.; allowing small counties having a specified
4	population to levy an indigent care surtax; providing
5	procedures; providing uses of the surtax; providing a
6	maximum tax rate; providing an effective date.
7
8	Be It Enacted by the Legislature of the State of Florida:
9
10	Section 1. Subsection (7) of section 212.055, Florida
11	Statutes, is amended to read:
12	212.055 Discretionary sales surtaxes; legislative intent;
13	authorization and use of proceeds.--It is the legislative intent
14	that any authorization for imposition of a discretionary sales
15	surtax shall be published in the Florida Statutes as a
16	subsection of this section, irrespective of the duration of the
17	levy. Each enactment shall specify the types of counties
18	authorized to levy; the rate or rates which may be imposed; the
19	maximum length of time the surtax may be imposed, if any; the
20	procedure which must be followed to secure voter approval, if
21	required; the purpose for which the proceeds may be expended;
22	and such other requirements as the Legislature may provide.
23	Taxable transactions and administrative procedures shall be as
24	provided in s. 212.054.
25	(7) VOTER-APPROVED INDIGENT CARE SURTAX.--
26	(a)1.The governing body in each county that has a
27	population of less than 800,000 residents may levy an indigent
28	care surtax pursuant to an ordinance conditioned to take effect
29	only upon approval by a majority vote of the electors of the
30	county voting in a referendum. The surtax may be levied at a
31	rate not to exceed 0.5 percent, except that if a publicly
32	supported medical school is located in the county, the rate
33	shall not exceed 1 percent.
34	2. Notwithstanding subparagraph 1., the governing body of
35	any county that has a population of fewer than 30,000 residents
36	may levy an indigent care surtax pursuant to an ordinance
37	approved by a unanimous vote of the governing body or
38	conditioned to take effect only upon approval by a majority vote
39	of the electors of the county voting in a referendum. The surtax
40	may be levied at a rate not to exceed 1 percent.
41	(b) If the surtax is conditioned to take effect upon
42	approval in a referendum,a statement that includes a brief and
43	general description of the purposes to be funded by the surtax
44	and that conforms to the requirements of s. 101.161 shall be
45	placed on the ballot by the governing body of the county. The
46	following questions shall be placed on the ballot:
47
48	FOR THE. . . .CENTS TAX
49	AGAINST THE. . . .CENTS TAX
50
51	(c)1.The ordinance adopted by the governing body
52	providing for the imposition of the surtax must set forth a plan
53	for providing health care services to qualified residents, as
54	defined in paragraph (d). The plan and subsequent amendments to
55	it shall fund a broad range of health care services for indigent
56	persons and the medically poor, including, but not limited to,
57	primary care and preventive care, as well as hospital care. It
58	shall emphasize a continuity of care in the most cost-effective
59	setting, taking into consideration a high quality of care and
60	geographic access. Where consistent with these objectives, it
61	shall include, without limitation, services rendered by
62	physicians, clinics, community hospitals, mental health centers,
63	and alternative delivery sites, as well as at least one regional
64	referral hospital where appropriate. It shall provide that
65	agreements negotiated between the county and providers shall
66	include reimbursement methodologies that take into account the
67	cost of services rendered to eligible patients, recognize
68	hospitals that render a disproportionate share of indigent care,
69	provide other incentives to promote the delivery of charity
70	care, and require cost containment, including, but not limited
71	to, case management. The plan must also include innovative
72	health care programs that provide cost-effective alternatives to
73	traditional methods of service delivery and funding.
74	2. In addition to the uses specified or services required
75	to be provided under this subsection, the ordinance adopted by a
76	county that has a population of fewer than 30,000 residents may
77	pledge surtax proceeds to service new or existing bond
78	indebtedness incurred to finance, plan, construct, or
79	reconstruct a public or not-for-profit hospital in such county
80	and any land acquisition, land improvement, design, or
81	engineering costs related to such hospital, if the governing
82	body of the county determines that a public or not-for-profit
83	hospital existing at the time of issuance of the bonds
84	authorized under this subparagraph would, more likely than not,
85	otherwise cease to operate. The plan required under this
86	paragraph may, by an extraordinary vote of the governing body of
87	the county of such county, provide that some or all of the
88	surtax revenues and any interest earned must be expended for the
89	purpose of servicing such bond indebtedness. Such county may
90	also use the services of the Division of Bond Finance of the
91	State Board of Administration pursuant to the State Bond Act to
92	issue bonds under this subparagraph. A jurisdiction may not
93	issue bonds under this subparagraph more frequently than once
94	per year. Any county that has a population of fewer than 30,000
95	residents at the time the bonds authorized in this subparagraph
96	are issued retains the authority granted under this subparagraph
97	throughout the term of the bonds, including the term of any
98	refinancing bonds, regardless of any subsequent increase in
99	population which would result in the county having 30,000 or
100	more residents and regardless of amendments to or repeal of this
101	subparagraph.
102	(d) For the purpose of this subsection, "qualified
103	residents" means residents of the authorizing county who are:
104	1. Qualified as indigent persons as certified by the
105	authorizing county;
106	2. Certified by the authorizing county as meeting the
107	definition of the medically poor, defined as persons having
108	insufficient income, resources, and assets to provide the needed
109	medical care without using resources required to meet basic
110	needs for shelter, food, clothing, and personal expenses; not
111	being eligible for any other state or federal program or having
112	medical needs that are not covered by any such program; or
113	having insufficient third-party insurance coverage. In all
114	cases, the authorizing county shall serve as the payor of last
115	resort; or
116	3. Participating in innovative, cost-effective programs
117	approved by the authorizing county.
118	(e) Moneys collected pursuant to this subsection remain
119	the property of the state and shall be distributed by the
120	Department of Revenue on a regular and periodic basis to the
121	clerk of the circuit court as ex officio custodian of the funds
122	of the authorizing county. The clerk of the circuit court shall:
123	1. Maintain the moneys in an indigent health care trust
124	fund.
125	2. Invest any funds held on deposit in the trust fund
126	pursuant to general law.
127	3. Disburse the funds, including any interest earned, to
128	any provider of health care services, as provided in paragraphs
129	(c) and (d), upon directive from the authorizing county.
130	4. Disburse the funds, including any interest earned, to
131	service any bond indebtedness authorized in this subsection upon
132	directive from the authorizing county, which directive may be
133	irrevocably given at the time the bond indebtedness is incurred.
134	(f) Notwithstanding any other provision of this section, a
135	county may not levy local option sales surtaxes authorized in
136	this subsection and subsections (2) and (3) in excess of a
137	combined rate of 1 percent or, if a publicly supported medical
138	school is located in the county or the county has a population
139	of fewer than 30,000 residents, in excess of a combined rate of
140	1.5 percent.
141	Section 2. This act shall take effect upon becoming a law.