HB 0129A 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 for construction of the act
7    in pari materia with laws enacted during the 2003 Regular
8    Session of the Legislature; providing an effective date.
9         
10          Be It Enacted by the Legislature of the State of Florida:
11         
12          Section 1. Subsection (7) of section 212.055, Florida
13    Statutes, is amended to read:
14          212.055 Discretionary sales surtaxes; legislative intent;
15    authorization and use of proceeds.--It is the legislative intent
16    that any authorization for imposition of a discretionary sales
17    surtax shall be published in the Florida Statutes as a
18    subsection of this section, irrespective of the duration of the
19    levy. Each enactment shall specify the types of counties
20    authorized to levy; the rate or rates which may be imposed; the
21    maximum length of time the surtax may be imposed, if any; the
22    procedure which must be followed to secure voter approval, if
23    required; the purpose for which the proceeds may be expended;
24    and such other requirements as the Legislature may provide.
25    Taxable transactions and administrative procedures shall be as
26    provided in s. 212.054.
27          (7) VOTER-APPROVED INDIGENT CARE SURTAX.--
28          (a)1.The governing body in each county that has a
29    population of less than 800,000 residents may levy an indigent
30    care surtax pursuant to an ordinance conditioned to take effect
31    only upon approval by a majority vote of the electors of the
32    county voting in a referendum. The surtax may be levied at a
33    rate not to exceed 0.5 percent, except that if a publicly
34    supported medical school is located in the county, the rate
35    shall not exceed 1 percent.
36          2. Notwithstanding subparagraph 1., the governing body of
37    any county that has a population of fewer than 30,000 residents
38    may levy an indigent care surtax pursuant to an ordinance
39    conditioned to take effect only upon approval by a majority vote
40    of the electors of the county voting in a referendum. The surtax
41    may be levied at a rate not to exceed 1 percent.
42          (b) A statement that includes a brief and general
43    description of the purposes to be funded by the surtax and that
44    conforms to the requirements of s. 101.161 shall be placed on
45    the ballot by the governing body of the county. The following
46    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    such county, provide that some or all of the surtax revenues and
88    any interest earned must be expended for the purpose of
89    servicing such bond indebtedness. Such county may also use the
90    services of the Division of Bond Finance of the State Board of
91    Administration pursuant to the State Bond Act to issue bonds
92    under this subparagraph. A jurisdiction may not issue bonds
93    under this subparagraph more frequently than once per year. Any
94    county that has a population of fewer than 30,000 residents at
95    the time any bonds authorized in this subparagraph are issued
96    retains the authority granted under this subparagraph throughout
97    the terms of such bonds, including the term of any refinancing
98    bonds, regardless of any subsequent increase in population which
99    would result in such county having 30,000 or more residents.
100          (d) For the purpose of this subsection, "qualified
101    residents" means residents of the authorizing county who are:
102          1. Qualified as indigent persons as certified by the
103    authorizing county;
104          2. Certified by the authorizing county as meeting the
105    definition of the medically poor, defined as persons having
106    insufficient income, resources, and assets to provide the needed
107    medical care without using resources required to meet basic
108    needs for shelter, food, clothing, and personal expenses; not
109    being eligible for any other state or federal program or having
110    medical needs that are not covered by any such program; or
111    having insufficient third-party insurance coverage. In all
112    cases, the authorizing county shall serve as the payor of last
113    resort; or
114          3. Participating in innovative, cost-effective programs
115    approved by the authorizing county.
116          (e) Moneys collected pursuant to this subsection remain
117    the property of the state and shall be distributed by the
118    Department of Revenue on a regular and periodic basis to the
119    clerk of the circuit court as ex officio custodian of the funds
120    of the authorizing county. The clerk of the circuit court shall:
121          1. Maintain the moneys in an indigent health care trust
122    fund.
123          2. Invest any funds held on deposit in the trust fund
124    pursuant to general law.
125          3. Disburse the funds, including any interest earned, to
126    any provider of health care services, as provided in paragraphs
127    (c) and (d), upon directive from the authorizing county.
128          4. Disburse the funds, including any interest earned, to
129    service any bond indebtedness authorized in this subsection upon
130    directive from the authorizing county, which directive may be
131    irrevocably given at the time the bond indebtedness is incurred.
132          (f) Notwithstanding any other provision of this section, a
133    county may not levy local option sales surtaxes authorized in
134    this subsection and subsections (2) and (3) in excess of a
135    combined rate of 1 percent or, if a publicly supported medical
136    school is located in the county or the county has a population
137    of fewer than 30,000 residents, in excess of a combined rate of
138    1.5 percent.
139          Section 2. If any law amended by this act was also amended
140    by a law enacted at the 2003 Regular Session of the Legislature,
141    such laws shall be construed as if they had been enacted at the
142    same session of the Legislature, and full effect shall be given
143    to each if possible.
144          Section 3. This act shall take effect upon becoming a law.