HB 0583 2003
1	CHAMBER ACTION
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6	The Committee on Local Government & Veterans' Affairs recommends
7	the following:
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9	Committee Substitute
10	Remove the entire bill and insert:
11	A bill to be entitled
12	An act relating to the indigent care surtax; amending s.
13	212.055, F.S.; allowing small counties having a specified
14	population to levy an indigent care surtax; providing
15	procedures; providing uses of the surtax; providing a
16	maximum tax rate; providing an effective date.
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18	Be It Enacted by the Legislature of the State of Florida:
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20	Section 1. Subsection (7) of section 212.055, Florida
21	Statutes, is amended to read:
22	212.055 Discretionary sales surtaxes; legislative intent;
23	authorization and use of proceeds.--It is the legislative intent
24	that any authorization for imposition of a discretionary sales
25	surtax shall be published in the Florida Statutes as a
26	subsection of this section, irrespective of the duration of the
27	levy. Each enactment shall specify the types of counties
28	authorized to levy; the rate or rates which may be imposed; the
29	maximum length of time the surtax may be imposed, if any; the
30	procedure which must be followed to secure voter approval, if
31	required; the purpose for which the proceeds may be expended;
32	and such other requirements as the Legislature may provide.
33	Taxable transactions and administrative procedures shall be as
34	provided in s. 212.054.
35	(7) VOTER-APPROVED INDIGENT CARE SURTAX.--
36	(a)1.The governing body in each county that has a
37	population of less than 800,000 residents may levy an indigent
38	care surtax pursuant to an ordinance conditioned to take effect
39	only upon approval by a majority vote of the electors of the
40	county voting in a referendum. The surtax may be levied at a
41	rate not to exceed 0.5 percent, except that if a publicly
42	supported medical school is located in the county, the rate
43	shall not exceed 1 percent.
44	2. Notwithstanding subparagraph 1., the governing body of
45	any county that has a population of fewer than 30,000 residents
46	may levy an indigent care surtax pursuant to an ordinance
47	conditioned to take effect only upon approval by a majority vote
48	of the electors of the county voting in a referendum. The surtax
49	may be levied at a rate not to exceed 1 percent.
50	(b) If the surtax is conditioned to take effect upon
51	approval in a referendum,a statement that includes a brief and
52	general description of the purposes to be funded by the surtax
53	and that conforms to the requirements of s. 101.161 shall be
54	placed on the ballot by the governing body of the county. The
55	following questions shall be placed on the ballot:
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57	FOR THE. . . .CENTS TAX
58	AGAINST THE. . . .CENTS TAX
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60	(c)1.The ordinance adopted by the governing body
61	providing for the imposition of the surtax must set forth a plan
62	for providing health care services to qualified residents, as
63	defined in paragraph (d). The plan and subsequent amendments to
64	it shall fund a broad range of health care services for indigent
65	persons and the medically poor, including, but not limited to,
66	primary care and preventive care, as well as hospital care. It
67	shall emphasize a continuity of care in the most cost-effective
68	setting, taking into consideration a high quality of care and
69	geographic access. Where consistent with these objectives, it
70	shall include, without limitation, services rendered by
71	physicians, clinics, community hospitals, mental health centers,
72	and alternative delivery sites, as well as at least one regional
73	referral hospital where appropriate. It shall provide that
74	agreements negotiated between the county and providers shall
75	include reimbursement methodologies that take into account the
76	cost of services rendered to eligible patients, recognize
77	hospitals that render a disproportionate share of indigent care,
78	provide other incentives to promote the delivery of charity
79	care, and require cost containment, including, but not limited
80	to, case management. The plan must also include innovative
81	health care programs that provide cost-effective alternatives to
82	traditional methods of service delivery and funding.
83	2. In addition to the uses specified or services required
84	to be provided under this subsection, the ordinance adopted by a
85	county that has a population of fewer than 30,000 residents may
86	pledge surtax proceeds to service new or existing bond
87	indebtedness incurred to finance, plan, construct, or
88	reconstruct a public or not-for-profit hospital in such county
89	and any land acquisition, land improvement, design, or
90	engineering costs related to such hospital, if the governing
91	body of the county determines that a public or not-for-profit
92	hospital existing at the time of issuance of the bonds
93	authorized under this subparagraph would, more likely than not,
94	otherwise cease to operate. The plan required under this
95	paragraph may, by an extraordinary vote of the governing body of
96	such county, provide that some or all of the surtax revenues and
97	any interest earned must be expended for the purpose of
98	servicing such bond indebtedness. Such county may also use the
99	services of the Division of Bond Finance of the State Board of
100	Administration pursuant to the State Bond Act to issue bonds
101	under this subparagraph. A jurisdiction may not issue bonds
102	under this subparagraph more frequently than once per year. Any
103	county that has a population of fewer than 30,000 residents at
104	the time any bonds authorized in this subparagraph are issued
105	retains the authority granted under this subparagraph throughout
106	the terms of such bonds, including the term of any refinancing
107	bonds, regardless of any subsequent increase in population which
108	would result in such county having 30,000 or more residents.
109	(d) For the purpose of this subsection, "qualified
110	residents" means residents of the authorizing county who are:
111	1. Qualified as indigent persons as certified by the
112	authorizing county;
113	2. Certified by the authorizing county as meeting the
114	definition of the medically poor, defined as persons having
115	insufficient income, resources, and assets to provide the needed
116	medical care without using resources required to meet basic
117	needs for shelter, food, clothing, and personal expenses; not
118	being eligible for any other state or federal program or having
119	medical needs that are not covered by any such program; or
120	having insufficient third-party insurance coverage. In all
121	cases, the authorizing county shall serve as the payor of last
122	resort; or
123	3. Participating in innovative, cost-effective programs
124	approved by the authorizing county.
125	(e) Moneys collected pursuant to this subsection remain
126	the property of the state and shall be distributed by the
127	Department of Revenue on a regular and periodic basis to the
128	clerk of the circuit court as ex officio custodian of the funds
129	of the authorizing county. The clerk of the circuit court shall:
130	1. Maintain the moneys in an indigent health care trust
131	fund.
132	2. Invest any funds held on deposit in the trust fund
133	pursuant to general law.
134	3. Disburse the funds, including any interest earned, to
135	any provider of health care services, as provided in paragraphs
136	(c) and (d), upon directive from the authorizing county.
137	4. Disburse the funds, including any interest earned, to
138	service any bond indebtedness authorized in this subsection upon
139	directive from the authorizing county, which directive may be
140	irrevocably given at the time the bond indebtedness is incurred.
141	(f) Notwithstanding any other provision of this section, a
142	county may not levy local option sales surtaxes authorized in
143	this subsection and subsections (2) and(3) in excess of a
144	combined rate of 1 percent or, if a publicly supported medical
145	school is located in the county or the county has a population
146	of fewer than 30,000 residents, in excess of a combined rate of
147	1.5 percent.
148	Section 2. This act shall take effect upon becoming a law.