HB 0297CS

CHAMBER ACTION



1The Committee on Health Care recommends the following:
2
3     Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to discretionary sales surtaxes; amending
7s. 212.055, F.S.; authorizing certain counties to levy by
8ordinance, subject to referendum approval, a surtax to
9fund trauma services provided by certain licensed trauma
10centers; requiring the ordinance to provide a plan for
11providing trauma services; providing for collection and
12distribution of surtax proceeds; providing duties of the
13clerk of the circuit court in maintaining a trust fund and
14investing and disbursing funds; requiring a biennial audit
15of the trust fund; providing for expiration and
16reenactment of the surtax; limiting the rate of the
17surtax; allowing small counties having a specified
18population to levy an indigent care surtax; providing
19procedures; providing uses of the surtax; providing a
20maximum tax rate; providing an effective date.
21
22Be It Enacted by the Legislature of the State of Florida:
23
24     Section 1.  Subsections (4) and (7) of section 212.055,
25Florida Statutes, are amended to read:
26     212.055  Discretionary sales surtaxes; legislative intent;
27authorization and use of proceeds.--It is the legislative intent
28that any authorization for imposition of a discretionary sales
29surtax shall be published in the Florida Statutes as a
30subsection of this section, irrespective of the duration of the
31levy. Each enactment shall specify the types of counties
32authorized to levy; the rate or rates which may be imposed; the
33maximum length of time the surtax may be imposed, if any; the
34procedure which must be followed to secure voter approval, if
35required; the purpose for which the proceeds may be expended;
36and such other requirements as the Legislature may provide.
37Taxable transactions and administrative procedures shall be as
38provided in s. 212.054.
39     (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--
40     (a)1.  The governing body in each county the government of
41which is not consolidated with that of one or more
42municipalities, which has a population of at least 800,000
43residents and is not authorized to levy a surtax under
44subsection (5), may levy, pursuant to an ordinance either
45approved by an extraordinary vote of the governing body or
46conditioned to take effect only upon approval by a majority vote
47of the electors of the county voting in a referendum, a
48discretionary sales surtax at a rate that may not exceed 0.5
49percent.
50     2.(b)  If the ordinance is conditioned on a referendum, a
51statement that includes a brief and general description of the
52purposes to be funded by the surtax and that conforms to the
53requirements of s. 101.161 shall be placed on the ballot by the
54governing body of the county. The following questions shall be
55placed on the ballot:
56
57
FOR THE....CENTS TAX
58
AGAINST THE....CENTS TAX
59
60     3.(c)  The ordinance adopted by the governing body
61providing for the imposition of the surtax shall set forth a
62plan for providing health care services to qualified residents,
63as defined in subparagraph 4 paragraph (d). Such plan and
64subsequent amendments to it shall fund a broad range of health
65care services for both indigent persons and the medically poor,
66including, but not limited to, primary care and preventive care
67as well as hospital care. The plan must also address the
68services to be provided by the Level I trauma center. It shall
69emphasize a continuity of care in the most cost-effective
70setting, taking into consideration both a high quality of care
71and geographic access. Where consistent with these objectives,
72it shall include, without limitation, services rendered by
73physicians, clinics, community hospitals, mental health centers,
74and alternative delivery sites, as well as at least one regional
75referral hospital where appropriate. It shall provide that
76agreements negotiated between the county and providers,
77including hospitals with a Level I trauma center, will include
78reimbursement methodologies that take into account the cost of
79services rendered to eligible patients, recognize hospitals that
80render a disproportionate share of indigent care, provide other
81incentives to promote the delivery of charity care, promote the
82advancement of technology in medical services, recognize the
83level of responsiveness to medical needs in trauma cases, and
84require cost containment including, but not limited to, case
85management. It must also provide that any hospitals that are
86owned and operated by government entities on May 21, 1991, must,
87as a condition of receiving funds under this subsection, afford
88public access equal to that provided under s. 286.011 as to
89meetings of the governing board, the subject of which is
90budgeting resources for the rendition of charity care as that
91term is defined in the Florida Hospital Uniform Reporting System
92(FHURS) manual referenced in s. 408.07. The plan shall also
93include innovative health care programs that provide cost-
94effective alternatives to traditional methods of service
95delivery and funding.
96     4.(d)  For the purpose of this paragraph subsection, the
97term "qualified resident" means residents of the authorizing
98county who are:
99     a.1.  Qualified as indigent persons as certified by the
100authorizing county;
101     b.2.  Certified by the authorizing county as meeting the
102definition of the medically poor, defined as persons having
103insufficient income, resources, and assets to provide the needed
104medical care without using resources required to meet basic
105needs for shelter, food, clothing, and personal expenses; or not
106being eligible for any other state or federal program, or having
107medical needs that are not covered by any such program; or
108having insufficient third-party insurance coverage. In all
109cases, the authorizing county is intended to serve as the payor
110of last resort; or
111     c.3.  Participating in innovative, cost-effective programs
112approved by the authorizing county.
113     5.(e)  Moneys collected pursuant to this paragraph
114subsection remain the property of the state and shall be
115distributed by the Department of Revenue on a regular and
116periodic basis to the clerk of the circuit court as ex officio
117custodian of the funds of the authorizing county. The clerk of
118the circuit court shall:
119     a.1.  Maintain the moneys in an indigent health care trust
120fund;
121     b.2.  Invest any funds held on deposit in the trust fund
122pursuant to general law;
123     c.3.  Disburse the funds, including any interest earned, to
124any provider of health care services, as provided in
125subparagraphs 3. and 4. paragraphs (c) and (d), upon directive
126from the authorizing county. However, if a county has a
127population of at least 800,000 residents and has levied the
128surtax authorized in this paragraph subsection, notwithstanding
129any directive from the authorizing county, on October 1 of each
130calendar year, the clerk of the court shall issue a check in the
131amount of $6.5 million to a hospital in its jurisdiction that
132has a Level I trauma center or shall issue a check in the amount
133of $3.5 million to a hospital in its jurisdiction that has a
134Level I trauma center if that county enacts and implements a
135hospital lien law in accordance with chapter 98-499, Laws of
136Florida. The issuance of the checks on October 1 of each year is
137provided in recognition of the Level I trauma center status and
138shall be in addition to the base contract amount received during
139fiscal year 1999-2000 and any additional amount negotiated to
140the base contract. If the hospital receiving funds for its Level
141I trauma center status requests such funds to be used to
142generate federal matching funds under Medicaid, the clerk of the
143court shall instead issue a check to the Agency for Health Care
144Administration to accomplish that purpose to the extent that it
145is allowed through the General Appropriations Act; and
146     d.4.  Prepare on a biennial basis an audit of the trust
147fund specified in sub-subparagraph a. subparagraph 1. Commencing
148February 1, 2004, such audit shall be delivered to the governing
149body and to the chair of the legislative delegation of each
150authorizing county.
151     6.(f)  Notwithstanding any other provision of this section,
152a county shall not levy local option sales surtaxes authorized
153in this paragraph subsection and subsections (2) and (3) in
154excess of a combined rate of 1 percent.
155     (b)  Notwithstanding any other provision of this section,
156the governing body in each county the government of which is not
157consolidated with that of one or more municipalities, which has
158a population of less than 800,000 residents, may levy, by
159ordinance subject to approval by a majority of the electors of
160the county voting in a referendum, a discretionary sales surtax
161at a rate that may not exceed 0.25 percent for the sole purpose
162of funding trauma services provided by a trauma center licensed
163pursuant to chapter 395.
164     1.  A statement that includes a brief and general
165description of the purposes to be funded by the surtax and that
166conforms to the requirements of s. 101.161 shall be placed on
167the ballot by the governing body of the county. The following
168questions shall be placed on the ballot:
169
170____FOR the              -cents tax
171___ AGAINST the          -cents tax
172
173     2.  The ordinance adopted by the governing body of the
174county providing for the imposition of the surtax shall set
175forth a plan for providing trauma services to trauma victims
176presenting in the trauma service area in which such county is
177located.
178     3.  Moneys collected pursuant to this paragraph remain the
179property of the state and shall be distributed by the Department
180of Revenue on a regular and periodic basis to the clerk of the
181circuit court as ex officio custodian of the funds of the
182authorizing county. The clerk of the circuit court shall:
183     a.  Maintain the moneys in a trauma services trust fund.
184     b.  Invest any funds held on deposit in the trust fund
185pursuant to general law.
186     c.  Disburse the funds, including any interest earned on
187such funds, to the trauma center in its trauma service area, as
188provided in the plan set forth pursuant to subparagraph 2., upon
189directive from the authorizing county. If the trauma center
190receiving funds requests such funds to be used to generate
191federal matching funds under Medicaid, the custodian of the
192funds shall instead issue a check to the Agency for Health Care
193Administration to accomplish that purpose to the extent that the
194agency is allowed through the General Appropriations Act.
195     d.  Prepare on a biennial basis an audit of the trauma
196services trust fund specified in sub-subparagraph a., to be
197delivered to the authorizing county.
198     4.  A discretionary sales surtax imposed pursuant to this
199paragraph shall expire 4 years after the effective date of the
200surtax, unless reenacted by ordinance subject to approval by a
201majority of the electors of the county voting in a subsequent
202referendum.
203     5.  Notwithstanding any other provision of this section, a
204county shall not levy local option sales surtaxes authorized in
205this paragraph and subsections (2) and (3) in excess of a
206combined rate of 1 percent.
207     (7)  VOTER-APPROVED INDIGENT CARE SURTAX.--
208     (a)1.  The governing body in each county that has a
209population of less than 800,000 residents may levy an indigent
210care surtax pursuant to an ordinance conditioned to take effect
211only upon approval by a majority vote of the electors of the
212county voting in a referendum. The surtax may be levied at a
213rate not to exceed 0.5 percent, except that if a publicly
214supported medical school is located in the county, the rate
215shall not exceed 1 percent.
216     2.  Notwithstanding subparagraph 1., the governing body of
217any county that has a population of fewer than 50,000 residents
218may levy an indigent care surtax pursuant to an ordinance
219conditioned to take effect only upon approval by a majority vote
220of the electors of the county voting in a referendum. The surtax
221may be levied at a rate not to exceed 1 percent.
222     (b)  A statement that includes a brief and general
223description of the purposes to be funded by the surtax and that
224conforms to the requirements of s. 101.161 shall be placed on
225the ballot by the governing body of the county. The following
226questions shall be placed on the ballot:
227
228
FOR THE. . . .CENTS TAX
229
AGAINST THE. . . .CENTS TAX
230
231     (c)1.  The ordinance adopted by the governing body
232providing for the imposition of the surtax must set forth a plan
233for providing health care services to qualified residents, as
234defined in paragraph (d). The plan and subsequent amendments to
235it shall fund a broad range of health care services for indigent
236persons and the medically poor, including, but not limited to,
237primary care and preventive care, as well as hospital care. It
238shall emphasize a continuity of care in the most cost-effective
239setting, taking into consideration a high quality of care and
240geographic access. Where consistent with these objectives, it
241shall include, without limitation, services rendered by
242physicians, clinics, community hospitals, mental health centers,
243and alternative delivery sites, as well as at least one regional
244referral hospital where appropriate. It shall provide that
245agreements negotiated between the county and providers shall
246include reimbursement methodologies that take into account the
247cost of services rendered to eligible patients, recognize
248hospitals that render a disproportionate share of indigent care,
249provide other incentives to promote the delivery of charity
250care, and require cost containment, including, but not limited
251to, case management. The plan must also include innovative
252health care programs that provide cost-effective alternatives to
253traditional methods of service delivery and funding.
254     2.  In addition to the uses specified or services required
255to be provided under this subsection, the ordinance adopted by a
256county that has a population of fewer than 50,000 residents may
257pledge surtax proceeds to service new or existing bond
258indebtedness incurred to finance, plan, construct, or
259reconstruct a public or not-for-profit hospital in such county
260and any land acquisition, land improvement, design, or
261engineering costs related to such hospital, if the governing
262body of the county determines that a public or not-for-profit
263hospital existing at the time of issuance of the bonds
264authorized under this subparagraph would, more likely than not,
265otherwise cease to operate. The plan required under this
266paragraph may, by an extraordinary vote of the governing body of
267such county, provide that some or all of the surtax revenues and
268any interest earned must be expended for the purpose of
269servicing such bond indebtedness. Such county may also use the
270services of the Division of Bond Finance of the State Board of
271Administration pursuant to the State Bond Act to issue bonds
272under this subparagraph. A jurisdiction may not issue bonds
273under this subparagraph more frequently than once per year. Any
274county that has a population of fewer than 50,000 residents at
275the time any bonds authorized in this subparagraph are issued
276retains the authority granted under this subparagraph throughout
277the terms of such bonds, including the term of any refinancing
278bonds, regardless of any subsequent increase in population which
279would result in such county having 50,000 or more residents.
280     (d)  For the purpose of this subsection, "qualified
281residents" means residents of the authorizing county who are:
282     1.  Qualified as indigent persons as certified by the
283authorizing county;
284     2.  Certified by the authorizing county as meeting the
285definition of the medically poor, defined as persons having
286insufficient income, resources, and assets to provide the needed
287medical care without using resources required to meet basic
288needs for shelter, food, clothing, and personal expenses; not
289being eligible for any other state or federal program or having
290medical needs that are not covered by any such program; or
291having insufficient third-party insurance coverage. In all
292cases, the authorizing county shall serve as the payor of last
293resort; or
294     3.  Participating in innovative, cost-effective programs
295approved by the authorizing county.
296     (e)  Moneys collected pursuant to this subsection remain
297the property of the state and shall be distributed by the
298Department of Revenue on a regular and periodic basis to the
299clerk of the circuit court as ex officio custodian of the funds
300of the authorizing county. The clerk of the circuit court shall:
301     1.  Maintain the moneys in an indigent health care trust
302fund.
303     2.  Invest any funds held on deposit in the trust fund
304pursuant to general law.
305     3.  Disburse the funds, including any interest earned, to
306any provider of health care services, as provided in paragraphs
307(c) and (d), upon directive from the authorizing county.
308     4.  Disburse the funds, including any interest earned, to
309service any bond indebtedness authorized in this subsection upon
310directive from the authorizing county, which directive may be
311irrevocably given at the time the bond indebtedness is incurred.
312     (f)  Notwithstanding any other provision of this section, a
313county may not levy local option sales surtaxes authorized in
314this subsection and subsections (2) and (3) in excess of a
315combined rate of 1 percent or, if a publicly supported medical
316school is located in the county or the county has a population
317of fewer than 50,000 residents, in excess of a combined rate of
3181.5 percent.
319     Section 2.  This act shall take effect upon becoming a law.


CODING: Words stricken are deletions; words underlined are additions.