HB 0297 2004
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	conditioned to take effect only upon approval by a majority vote
38	of the electors of the county voting in a referendum. The surtax
39	may be levied at a rate not to exceed 1 percent.
40	(b) A statement that includes a brief and general
41	description of the purposes to be funded by the surtax and that
42	conforms to the requirements of s. 101.161 shall be placed on
43	the ballot by the governing body of the county. The following
44	questions shall be placed on the ballot:
45
46	FOR THE. . . .CENTS TAX
47	AGAINST THE. . . .CENTS TAX
48
49	(c)1.The ordinance adopted by the governing body
50	providing for the imposition of the surtax must set forth a plan
51	for providing health care services to qualified residents, as
52	defined in paragraph (d). The plan and subsequent amendments to
53	it shall fund a broad range of health care services for indigent
54	persons and the medically poor, including, but not limited to,
55	primary care and preventive care, as well as hospital care. It
56	shall emphasize a continuity of care in the most cost-effective
57	setting, taking into consideration a high quality of care and
58	geographic access. Where consistent with these objectives, it
59	shall include, without limitation, services rendered by
60	physicians, clinics, community hospitals, mental health centers,
61	and alternative delivery sites, as well as at least one regional
62	referral hospital where appropriate. It shall provide that
63	agreements negotiated between the county and providers shall
64	include reimbursement methodologies that take into account the
65	cost of services rendered to eligible patients, recognize
66	hospitals that render a disproportionate share of indigent care,
67	provide other incentives to promote the delivery of charity
68	care, and require cost containment, including, but not limited
69	to, case management. The plan must also include innovative
70	health care programs that provide cost-effective alternatives to
71	traditional methods of service delivery and funding.
72	2. In addition to the uses specified or services required
73	to be provided under this subsection, the ordinance adopted by a
74	county that has a population of fewer than 30,000 residents may
75	pledge surtax proceeds to service new or existing bond
76	indebtedness incurred to finance, plan, construct, or
77	reconstruct a public or not-for-profit hospital in such county
78	and any land acquisition, land improvement, design, or
79	engineering costs related to such hospital, if the governing
80	body of the county determines that a public or not-for-profit
81	hospital existing at the time of issuance of the bonds
82	authorized under this subparagraph would, more likely than not,
83	otherwise cease to operate. The plan required under this
84	paragraph may, by an extraordinary vote of the governing body of
85	such county, provide that some or all of the surtax revenues and
86	any interest earned must be expended for the purpose of
87	servicing such bond indebtedness. Such county may also use the
88	services of the Division of Bond Finance of the State Board of
89	Administration pursuant to the State Bond Act to issue bonds
90	under this subparagraph. A jurisdiction may not issue bonds
91	under this subparagraph more frequently than once per year. Any
92	county that has a population of fewer than 30,000 residents at
93	the time any bonds authorized in this subparagraph are issued
94	retains the authority granted under this subparagraph throughout
95	the terms of such bonds, including the term of any refinancing
96	bonds, regardless of any subsequent increase in population which
97	would result in such county having 30,000 or more residents.
98	(d) For the purpose of this subsection, "qualified
99	residents" means residents of the authorizing county who are:
100	1. Qualified as indigent persons as certified by the
101	authorizing county;
102	2. Certified by the authorizing county as meeting the
103	definition of the medically poor, defined as persons having
104	insufficient income, resources, and assets to provide the needed
105	medical care without using resources required to meet basic
106	needs for shelter, food, clothing, and personal expenses; not
107	being eligible for any other state or federal program or having
108	medical needs that are not covered by any such program; or
109	having insufficient third-party insurance coverage. In all
110	cases, the authorizing county shall serve as the payor of last
111	resort; or
112	3. Participating in innovative, cost-effective programs
113	approved by the authorizing county.
114	(e) Moneys collected pursuant to this subsection remain
115	the property of the state and shall be distributed by the
116	Department of Revenue on a regular and periodic basis to the
117	clerk of the circuit court as ex officio custodian of the funds
118	of the authorizing county. The clerk of the circuit court shall:
119	1. Maintain the moneys in an indigent health care trust
120	fund.
121	2. Invest any funds held on deposit in the trust fund
122	pursuant to general law.
123	3. Disburse the funds, including any interest earned, to
124	any provider of health care services, as provided in paragraphs
125	(c) and (d), upon directive from the authorizing county.
126	4. Disburse the funds, including any interest earned, to
127	service any bond indebtedness authorized in this subsection upon
128	directive from the authorizing county, which directive may be
129	irrevocably given at the time the bond indebtedness is incurred.
130	(f) Notwithstanding any other provision of this section, a
131	county may not levy local option sales surtaxes authorized in
132	this subsection and subsections (2) and (3) in excess of a
133	combined rate of 1 percent or, if a publicly supported medical
134	school is located in the county or the county has a population
135	of fewer than 30,000 residents, in excess of a combined rate of
136	1.5 percent.
137	Section 2. This act shall take effect upon becoming a law.
138