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