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.