Senate Bill sb0456

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    Florida Senate - 2004                                   SB 456

    By Senator Bennett





    21-624-04                                            See HB 43

  1                      A bill to be entitled

  2         An act relating to the school capital outlay

  3         surtax; amending s. 212.055, F.S.; authorizing

  4         counties to use a portion of surtax revenues

  5         for certain operational purposes under certain

  6         circumstances; providing requirements and

  7         limitations; providing for future repeal;

  8         providing an effective date.

  9  

10  Be It Enacted by the Legislature of the State of Florida:

11  

12         Section 1.  Section 212.055, Florida Statutes, as

13  amended by section 91 of chapter 2003-402, Laws of Florida, is

14  amended to read:

15         212.055  Discretionary sales surtaxes; legislative

16  intent; authorization and use of proceeds.--It is the

17  legislative intent that any authorization for imposition of a

18  discretionary sales surtax shall be published in the Florida

19  Statutes as a subsection of this section, irrespective of the

20  duration of the levy. Each enactment shall specify the types

21  of counties authorized to levy; the rate or rates which may be

22  imposed; the maximum length of time the surtax may be imposed,

23  if any; the procedure which must be followed to secure voter

24  approval, if required; the purpose for which the proceeds may

25  be expended; and such other requirements as the Legislature

26  may provide. Taxable transactions and administrative

27  procedures shall be as provided in s. 212.054.

28         (1)  CHARTER COUNTY TRANSIT SYSTEM SURTAX.--

29         (a)  Each charter county which adopted a charter prior

30  to January 1, 1984, and each county the government of which is

31  consolidated with that of one or more municipalities, may levy

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  a discretionary sales surtax, subject to approval by a

 2  majority vote of the electorate of the county or by a charter

 3  amendment approved by a majority vote of the electorate of the

 4  county.

 5         (b)  The rate shall be up to 1 percent.

 6         (c)  The proposal to adopt a discretionary sales surtax

 7  as provided in this subsection and to create a trust fund

 8  within the county accounts shall be placed on the ballot in

 9  accordance with law at a time to be set at the discretion of

10  the governing body.

11         (d)  Proceeds from the surtax shall be applied to as

12  many or as few of the uses enumerated below in whatever

13  combination the county commission deems appropriate:

14         1.  Deposited by the county in the trust fund and shall

15  be used for the purposes of development, construction,

16  equipment, maintenance, operation, supportive services,

17  including a countywide bus system, and related costs of a

18  fixed guideway rapid transit system;

19         2.  Remitted by the governing body of the county to an

20  expressway or transportation authority created by law to be

21  used, at the discretion of such authority, for the

22  development, construction, operation, or maintenance of roads

23  or bridges in the county, for the operation and maintenance of

24  a bus system, for the payment of principal and interest on

25  existing bonds issued for the construction of such roads or

26  bridges, and, upon approval by the county commission, such

27  proceeds may be pledged for bonds issued to refinance existing

28  bonds or new bonds issued for the construction of such roads

29  or bridges;

30         3.  For each county, as defined in s. 125.011(1), used

31  for the development, construction, operation, and maintenance

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  of roads and bridges in the county; for the expansion,

 2  operation, and maintenance of bus and fixed guideway systems;

 3  and for the payment of principal and interest on bonds issued

 4  for the construction of fixed guideway rapid transit systems,

 5  bus systems, roads, or bridges; and such proceeds may be

 6  pledged by the governing body of the county for bonds issued

 7  to refinance existing bonds or new bonds issued for the

 8  construction of such fixed guideway rapid transit systems, bus

 9  systems, roads, or bridges and no more than 25 percent used

10  for nontransit uses; and

11         4.  Used by the charter county for the planning,

12  development, construction, operation, and maintenance of roads

13  and bridges in the county; for the planning, development,

14  expansion, operation, and maintenance of bus and fixed

15  guideway systems; and for the payment of principal and

16  interest on bonds issued for the construction of fixed

17  guideway rapid transit systems, bus systems, roads, or

18  bridges; and such proceeds may be pledged by the governing

19  body of the county for bonds issued to refinance existing

20  bonds or new bonds issued for the construction of such fixed

21  guideway rapid transit systems, bus systems, roads, or

22  bridges. Pursuant to an interlocal agreement entered into

23  pursuant to chapter 163, the governing body of the charter

24  county may distribute proceeds from the tax to a municipality,

25  or an expressway or transportation authority created by law to

26  be expended for the purpose authorized by this paragraph.

27         (2)  LOCAL GOVERNMENT INFRASTRUCTURE SURTAX.--

28         (a)1.  The governing authority in each county may levy

29  a discretionary sales surtax of 0.5 percent or 1 percent.  The

30  levy of the surtax shall be pursuant to ordinance enacted by a

31  majority of the members of the county governing authority and

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  approved by a majority of the electors of the county voting in

 2  a referendum on the surtax.  If the governing bodies of the

 3  municipalities representing a majority of the county's

 4  population adopt uniform resolutions establishing the rate of

 5  the surtax and calling for a referendum on the surtax, the

 6  levy of the surtax shall be placed on the ballot and shall

 7  take effect if approved by a majority of the electors of the

 8  county voting in the referendum on the surtax.

 9         2.  If the surtax was levied pursuant to a referendum

10  held before July 1, 1993, the surtax may not be levied beyond

11  the time established in the ordinance, or, if the ordinance

12  did not limit the period of the levy, the surtax may not be

13  levied for more than 15 years. The levy of such surtax may be

14  extended only by approval of a majority of the electors of the

15  county voting in a referendum on the surtax.

16         (b)  A statement which includes a brief general

17  description of the projects to be funded by the surtax and

18  which conforms to the requirements of s. 101.161 shall be

19  placed on the ballot by the governing authority of any county

20  which enacts an ordinance calling for a referendum on the levy

21  of the surtax or in which the governing bodies of the

22  municipalities representing a majority of the county's

23  population adopt uniform resolutions calling for a referendum

24  on the surtax.  The following question shall be placed on the

25  ballot:

26  

27        ....FOR the               ....-cent sales tax

28        ....AGAINST the           ....-cent sales tax

29  

30         (c)  Pursuant to s. 212.054(4), the proceeds of the

31  surtax levied under this subsection shall be distributed to

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  the county and the municipalities within such county in which

 2  the surtax was collected, according to:

 3         1.  An interlocal agreement between the county

 4  governing authority and the governing bodies of the

 5  municipalities representing a majority of the county's

 6  municipal population, which agreement may include a school

 7  district with the consent of the county governing authority

 8  and the governing bodies of the municipalities representing a

 9  majority of the county's municipal population; or

10         2.  If there is no interlocal agreement, according to

11  the formula provided in s. 218.62.

12  

13  Any change in the distribution formula must take effect on the

14  first day of any month that begins at least 60 days after

15  written notification of that change has been made to the

16  department.

17         (d)1.  The proceeds of the surtax authorized by this

18  subsection and any interest accrued thereto shall be expended

19  by the school district or within the county and municipalities

20  within the county, or, in the case of a negotiated joint

21  county agreement, within another county, to finance, plan, and

22  construct infrastructure and to acquire land for public

23  recreation or conservation or protection of natural resources

24  and to finance the closure of county-owned or municipally

25  owned solid waste landfills that are already closed or are

26  required to close by order of the Department of Environmental

27  Protection. Any use of such proceeds or interest for purposes

28  of landfill closure prior to July 1, 1993, is ratified.

29  Neither the proceeds nor any interest accrued thereto shall be

30  used for operational expenses of any infrastructure, except

31  that any county with a population of less than 75,000 that is

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  required to close a landfill by order of the Department of

 2  Environmental Protection may use the proceeds or any interest

 3  accrued thereto for long-term maintenance costs associated

 4  with landfill closure. Counties, as defined in s. 125.011(1),

 5  and charter counties may, in addition, use the proceeds and

 6  any interest accrued thereto to retire or service indebtedness

 7  incurred for bonds issued prior to July 1, 1987, for

 8  infrastructure purposes, and for bonds subsequently issued to

 9  refund such bonds. Any use of such proceeds or interest for

10  purposes of retiring or servicing indebtedness incurred for

11  such refunding bonds prior to July 1, 1999, is ratified.

12         2.  For the purposes of this paragraph,

13  "infrastructure" means:

14         a.  Any fixed capital expenditure or fixed capital

15  outlay associated with the construction, reconstruction, or

16  improvement of public facilities which have a life expectancy

17  of 5 or more years and any land acquisition, land improvement,

18  design, and engineering costs related thereto.

19         b.  A fire department vehicle, an emergency medical

20  service vehicle, a sheriff's office vehicle, a police

21  department vehicle, or any other vehicle, and such equipment

22  necessary to outfit the vehicle for its official use or

23  equipment that has a life expectancy of at least 5 years.

24         c.  Any expenditure for the construction, lease, or

25  maintenance of, or provision of utilities or security for,

26  facilities as defined in s. 29.008.

27         3.  Notwithstanding any other provision of this

28  subsection, a discretionary sales surtax imposed or extended

29  after the effective date of this act may provide for an amount

30  not to exceed 15 percent of the local option sales surtax

31  proceeds to be allocated for deposit to a trust fund within

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  the county's accounts created for the purpose of funding

 2  economic development projects of a general public purpose

 3  targeted to improve local economies, including the funding of

 4  operational costs and incentives related to such economic

 5  development. The ballot statement must indicate the intention

 6  to make an allocation under the authority of this

 7  subparagraph.

 8         (e)  School districts, counties, and municipalities

 9  receiving proceeds under the provisions of this subsection may

10  pledge such proceeds for the purpose of servicing new bond

11  indebtedness incurred pursuant to law. Local governments may

12  use the services of the Division of Bond Finance of the State

13  Board of Administration pursuant to the State Bond Act to

14  issue any bonds through the provisions of this subsection.  In

15  no case may a jurisdiction issue bonds pursuant to this

16  subsection more frequently than once per year. Counties and

17  municipalities may join together for the issuance of bonds

18  authorized by this subsection.

19         (f)1.  Notwithstanding paragraph (d), a county that has

20  a population of 50,000 or less on April 1, 1992, or any county

21  designated as an area of critical state concern on the

22  effective date of this act, and that imposed the surtax before

23  July 1, 1992, may use the proceeds and interest of the surtax

24  for any public purpose if:

25         a.  The debt service obligations for any year are met;

26         b.  The county's comprehensive plan has been determined

27  to be in compliance with part II of chapter 163; and

28         c.  The county has adopted an amendment to the surtax

29  ordinance pursuant to the procedure provided in s. 125.66

30  authorizing additional uses of the surtax proceeds and

31  interest.

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1         2.  A municipality located within a county that has a

 2  population of 50,000 or less on April 1, 1992, or within a

 3  county designated as an area of critical state concern on the

 4  effective date of this act, and that imposed the surtax before

 5  July 1, 1992, may not use the proceeds and interest of the

 6  surtax for any purpose other than an infrastructure purpose

 7  authorized in paragraph (d) unless the municipality's

 8  comprehensive plan has been determined to be in compliance

 9  with part II of chapter 163 and the municipality has adopted

10  an amendment to its surtax ordinance or resolution pursuant to

11  the procedure provided in s. 166.041 authorizing additional

12  uses of the surtax proceeds and interest.  Such municipality

13  may expend the surtax proceeds and interest for any public

14  purpose authorized in the amendment.

15         3.  Those counties designated as an area of critical

16  state concern which qualify to use the surtax for any public

17  purpose may use only up to 10 percent of the surtax proceeds

18  for any public purpose other than for infrastructure purposes

19  authorized by this section.

20         (g)  Notwithstanding paragraph (d), a county in which

21  40 percent or more of the just value of real property is

22  exempt or immune from ad valorem taxation, and the

23  municipalities within such a county, may use the proceeds and

24  interest of the surtax for operation and maintenance of parks

25  and recreation programs and facilities established with the

26  proceeds of the surtax.

27         (h)  Notwithstanding any other provision of this

28  section, a county shall not levy local option sales surtaxes

29  authorized in this subsection and subsections (3), (4), and

30  (5) in excess of a combined rate of 1 percent.

31         (3)  SMALL COUNTY SURTAX.--

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1         (a)  The governing authority in each county that has a

 2  population of 50,000 or less on April 1, 1992, may levy a

 3  discretionary sales surtax of 0.5 percent or 1 percent.  The

 4  levy of the surtax shall be pursuant to ordinance enacted by

 5  an extraordinary vote of the members of the county governing

 6  authority if the surtax revenues are expended for operating

 7  purposes.  If the surtax revenues are expended for the purpose

 8  of servicing bond indebtedness, the surtax shall be approved

 9  by a majority of the electors of the county voting in a

10  referendum on the surtax.

11         (b)  A statement that includes a brief general

12  description of the projects to be funded by the surtax and

13  conforms to the requirements of s. 101.161 shall be placed on

14  the ballot by the governing authority of any county that

15  enacts an ordinance calling for a referendum on the levy of

16  the surtax for the purpose of servicing bond indebtedness.

17  The following question shall be placed on the ballot:

18  

19        ....FOR the               ....-cent sales tax

20        ....AGAINST the           ....-cent sales tax

21  

22         (c)  Pursuant to s. 212.054(4), the proceeds of the

23  surtax levied under this subsection shall be distributed to

24  the county and the municipalities within the county in which

25  the surtax was collected, according to:

26         1.  An interlocal agreement between the county

27  governing authority and the governing bodies of the

28  municipalities representing a majority of the county's

29  municipal population, which agreement may include a school

30  district with the consent of the county governing authority

31  

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  and the governing bodies of the municipalities representing a

 2  majority of the county's municipal population; or

 3         2.  If there is no interlocal agreement, according to

 4  the formula provided in s. 218.62.

 5  

 6  Any change in the distribution formula shall take effect on

 7  the first day of any month that begins at least 60 days after

 8  written notification of that change has been made to the

 9  department.

10         (d)1.  If the surtax is levied pursuant to a

11  referendum, the proceeds of the surtax and any interest

12  accrued thereto may be expended by the school district or

13  within the county and municipalities within the county, or, in

14  the case of a negotiated joint county agreement, within

15  another county, for the purpose of servicing bond indebtedness

16  to finance, plan, and construct infrastructure and to acquire

17  land for public recreation or conservation or protection of

18  natural resources.  However, if the surtax is levied pursuant

19  to an ordinance approved by an extraordinary vote of the

20  members of the county governing authority, the proceeds and

21  any interest accrued thereto may be used for operational

22  expenses of any infrastructure or for any public purpose

23  authorized in the ordinance under which the surtax is levied.

24         2.  For the purposes of this paragraph,

25  "infrastructure" means any fixed capital expenditure or fixed

26  capital costs associated with the construction,

27  reconstruction, or improvement of public facilities that have

28  a life expectancy of 5 or more years and any land acquisition,

29  land improvement, design, and engineering costs related

30  thereto.

31  

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1         (e)  A school district, county, or municipality that

 2  receives proceeds under this subsection following a referendum

 3  may pledge the proceeds for the purpose of servicing new bond

 4  indebtedness incurred pursuant to law. Local governments may

 5  use the services of the Division of Bond Finance pursuant to

 6  the State Bond Act to issue any bonds through the provisions

 7  of this subsection.  A jurisdiction may not issue bonds

 8  pursuant to this subsection more frequently than once per

 9  year.  A county and municipality may join together to issue

10  bonds authorized by this subsection.

11         (f)  Notwithstanding any other provision of this

12  section, a county shall not levy local option sales surtaxes

13  authorized in this subsection and subsections (2), (4), and

14  (5) in excess of a combined rate of 1 percent.

15         (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--

16         (a)  The governing body in each county the government

17  of which is not consolidated with that of one or more

18  municipalities, which has a population of at least 800,000

19  residents and is not authorized to levy a surtax under

20  subsection (5), may levy, pursuant to an ordinance either

21  approved by an extraordinary vote of the governing body or

22  conditioned to take effect only upon approval by a majority

23  vote of the electors of the county voting in a referendum, a

24  discretionary sales surtax at a rate that may not exceed 0.5

25  percent.

26         (b)  If the ordinance is conditioned on a referendum, a

27  statement that includes a brief and general description of the

28  purposes to be funded by the surtax and that conforms to the

29  requirements of s. 101.161 shall be placed on the ballot by

30  the governing body of the county.  The following questions

31  shall be placed on the ballot:

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  

 2                     FOR THE. . . .CENTS TAX

 3                   AGAINST THE. . . .CENTS TAX

 4  

 5         (c)  The ordinance adopted by the governing body

 6  providing for the imposition of the surtax shall set forth a

 7  plan for providing health care services to qualified

 8  residents, as defined in paragraph (d).  Such plan and

 9  subsequent amendments to it shall fund a broad range of health

10  care services for both indigent persons and the medically

11  poor, including, but not limited to, primary care and

12  preventive care as well as hospital care. The plan must also

13  address the services to be provided by the Level I trauma

14  center. It shall emphasize a continuity of care in the most

15  cost-effective setting, taking into consideration both a high

16  quality of care and geographic access. Where consistent with

17  these objectives, it shall include, without limitation,

18  services rendered by physicians, clinics, community hospitals,

19  mental health centers, and alternative delivery sites, as well

20  as at least one regional referral hospital where appropriate.

21  It shall provide that agreements negotiated between the county

22  and providers, including hospitals with a Level I trauma

23  center, will include reimbursement methodologies that take

24  into account the cost of services rendered to eligible

25  patients, recognize hospitals that render a disproportionate

26  share of indigent care, provide other incentives to promote

27  the delivery of charity care, promote the advancement of

28  technology in medical services, recognize the level of

29  responsiveness to medical needs in trauma cases, and require

30  cost containment including, but not limited to, case

31  management. It must also provide that any hospitals that are

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  owned and operated by government entities on May 21, 1991,

 2  must, as a condition of receiving funds under this subsection,

 3  afford public access equal to that provided under s. 286.011

 4  as to meetings of the governing board, the subject of which is

 5  budgeting resources for the rendition of charity care as that

 6  term is defined in the Florida Hospital Uniform Reporting

 7  System (FHURS) manual referenced in s. 408.07.  The plan shall

 8  also include innovative health care programs that provide

 9  cost-effective alternatives to traditional methods of service

10  delivery and funding.

11         (d)  For the purpose of this subsection, the term

12  "qualified resident" means residents of the authorizing county

13  who are:

14         1.  Qualified as indigent persons as certified by the

15  authorizing county;

16         2.  Certified by the authorizing county as meeting the

17  definition of the medically poor, defined as persons having

18  insufficient income, resources, and assets to provide the

19  needed medical care without using resources required to meet

20  basic needs for shelter, food, clothing, and personal

21  expenses; or not being eligible for any other state or federal

22  program, or having medical needs that are not covered by any

23  such program; or having insufficient third-party insurance

24  coverage.  In all cases, the authorizing county is intended to

25  serve as the payor of last resort; or

26         3.  Participating in innovative, cost-effective

27  programs approved by the authorizing county.

28         (e)  Moneys collected pursuant to this subsection

29  remain the property of the state and shall be distributed by

30  the Department of Revenue on a regular and periodic basis to

31  the clerk of the circuit court as ex officio custodian of the

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  funds of the authorizing county. The clerk of the circuit

 2  court shall:

 3         1.  Maintain the moneys in an indigent health care

 4  trust fund;

 5         2.  Invest any funds held on deposit in the trust fund

 6  pursuant to general law;

 7         3.  Disburse the funds, including any interest earned,

 8  to any provider of health care services, as provided in

 9  paragraphs (c) and (d), upon directive from the authorizing

10  county. However, if a county has a population of at least

11  800,000 residents and has levied the surtax authorized in this

12  subsection, notwithstanding any directive from the authorizing

13  county, on October 1 of each calendar year, the clerk of the

14  court shall issue a check in the amount of $6.5 million to a

15  hospital in its jurisdiction that has a Level I trauma center

16  or shall issue a check in the amount of $3.5 million to a

17  hospital in its jurisdiction that has a Level I trauma center

18  if that county enacts and implements a hospital lien law in

19  accordance with chapter 98-499, Laws of Florida. The issuance

20  of the checks on October 1 of each year is provided in

21  recognition of the Level I trauma center status and shall be

22  in addition to the base contract amount received during fiscal

23  year 1999-2000 and any additional amount negotiated to the

24  base contract. If the hospital receiving funds for its Level I

25  trauma center status requests such funds to be used to

26  generate federal matching funds under Medicaid, the clerk of

27  the court shall instead issue a check to the Agency for Health

28  Care Administration to accomplish that purpose to the extent

29  that it is allowed through the General Appropriations Act; and

30         4.  Prepare on a biennial basis an audit of the trust

31  fund specified in subparagraph 1. Commencing February 1, 2004,

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  such audit shall be delivered to the governing body and to the

 2  chair of the legislative delegation of each authorizing

 3  county.

 4         (f)  Notwithstanding any other provision of this

 5  section, a county shall not levy local option sales surtaxes

 6  authorized in this subsection and subsections (2) and (3) in

 7  excess of a combined rate of 1 percent.

 8         (5)  COUNTY PUBLIC HOSPITAL SURTAX.--Any county as

 9  defined in s. 125.011(1) may levy the surtax authorized in

10  this subsection pursuant to an ordinance either approved by

11  extraordinary vote of the county commission or conditioned to

12  take effect only upon approval by a majority vote of the

13  electors of the county voting in a referendum.  In a county as

14  defined in s. 125.011(1), for the purposes of this subsection,

15  "county public general hospital" means a general hospital as

16  defined in s. 395.002 which is owned, operated, maintained, or

17  governed by the county or its agency, authority, or public

18  health trust.

19         (a)  The rate shall be 0.5 percent.

20         (b)  If the ordinance is conditioned on a referendum,

21  the proposal to adopt the county public hospital surtax shall

22  be placed on the ballot in accordance with law at a time to be

23  set at the discretion of the governing body.  The referendum

24  question on the ballot shall include a brief general

25  description of the health care services to be funded by the

26  surtax.

27         (c)  Proceeds from the surtax shall be:

28         1.  Deposited by the county in a special fund, set

29  aside from other county funds, to be used only for the

30  operation, maintenance, and administration of the county

31  public general hospital; and

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1         2.  Remitted promptly by the county to the agency,

 2  authority, or public health trust created by law which

 3  administers or operates the county public general hospital.

 4         (d)  Except as provided in subparagraphs 1. and 2., the

 5  county must continue to contribute each year an amount equal

 6  to at least 80 percent of that percentage of the total county

 7  budget appropriated for the operation, administration, and

 8  maintenance of the county public general hospital from the

 9  county's general revenues in the fiscal year of the county

10  ending September 30, 1991:

11         1.  Twenty-five percent of such amount must be remitted

12  to a governing board, agency, or authority that is wholly

13  independent from the public health trust, agency, or authority

14  responsible for the county public general hospital, to be used

15  solely for the purpose of funding the plan for indigent health

16  care services provided for in paragraph (e);

17         2.  However, in the first year of the plan, a total of

18  $10 million shall be remitted to such governing board, agency,

19  or authority, to be used solely for the purpose of funding the

20  plan for indigent health care services provided for in

21  paragraph (e), and in the second year of the plan, a total of

22  $15 million shall be so remitted and used.

23         (e)  A governing board, agency, or authority shall be

24  chartered by the county commission upon this act becoming law.

25  The governing board, agency, or authority shall adopt and

26  implement a health care plan for indigent health care

27  services.  The governing board, agency, or authority shall

28  consist of no more than seven and no fewer than five members

29  appointed by the county commission.  The members of the

30  governing board, agency, or authority shall be at least 18

31  years of age and residents of the county.  No member may be

                                  16

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  employed by or affiliated with a health care provider or the

 2  public health trust, agency, or authority responsible for the

 3  county public general hospital. The following community

 4  organizations shall each appoint a representative to a

 5  nominating committee:  the South Florida Hospital and

 6  Healthcare Association, the Miami-Dade County Public Health

 7  Trust, the Dade County Medical Association, the Miami-Dade

 8  County Homeless Trust, and the Mayor of Miami-Dade County.

 9  This committee shall nominate between 10 and 14 county

10  citizens for the governing board, agency, or authority.  The

11  slate shall be presented to the county commission and the

12  county commission shall confirm the top five to seven

13  nominees, depending on the size of the governing board.  Until

14  such time as the governing board, agency, or authority is

15  created, the funds provided for in subparagraph (d)2. shall be

16  placed in a restricted account set aside from other county

17  funds and not disbursed by the county for any other purpose.

18         1.  The plan shall divide the county into a minimum of

19  four and maximum of six service areas, with no more than one

20  participant hospital per service area. The county public

21  general hospital shall be designated as the provider for one

22  of the service areas.  Services shall be provided through

23  participants' primary acute care facilities.

24         2.  The plan and subsequent amendments to it shall fund

25  a defined range of health care services for both indigent

26  persons and the medically poor, including primary care,

27  preventive care, hospital emergency room care, and hospital

28  care necessary to stabilize the patient. For the purposes of

29  this section, "stabilization" means stabilization as defined

30  in s. 397.311(29). Where consistent with these objectives, the

31  plan may include services rendered by physicians, clinics,

                                  17

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  community hospitals, and alternative delivery sites, as well

 2  as at least one regional referral hospital per service area.

 3  The plan shall provide that agreements negotiated between the

 4  governing board, agency, or authority and providers shall

 5  recognize hospitals that render a disproportionate share of

 6  indigent care, provide other incentives to promote the

 7  delivery of charity care to draw down federal funds where

 8  appropriate, and require cost containment, including, but not

 9  limited to, case management. From the funds specified in

10  subparagraphs (d)1. and 2. for indigent health care services,

11  service providers shall receive reimbursement at a Medicaid

12  rate to be determined by the governing board, agency, or

13  authority created pursuant to this paragraph for the initial

14  emergency room visit, and a per-member per-month fee or

15  capitation for those members enrolled in their service area,

16  as compensation for the services rendered following the

17  initial emergency visit. Except for provisions of emergency

18  services, upon determination of eligibility, enrollment shall

19  be deemed to have occurred at the time services were rendered.

20  The provisions for specific reimbursement of emergency

21  services shall be repealed on July 1, 2001, unless otherwise

22  reenacted by the Legislature. The capitation amount or rate

23  shall be determined prior to program implementation by an

24  independent actuarial consultant. In no event shall such

25  reimbursement rates exceed the Medicaid rate. The plan must

26  also provide that any hospitals owned and operated by

27  government entities on or after the effective date of this act

28  must, as a condition of receiving funds under this subsection,

29  afford public access equal to that provided under s. 286.011

30  as to any meeting of the governing board, agency, or authority

31  the subject of which is budgeting resources for the retention

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  of charity care, as that term is defined in the rules of the

 2  Agency for Health Care Administration. The plan shall also

 3  include innovative health care programs that provide

 4  cost-effective alternatives to traditional methods of service

 5  and delivery funding.

 6         3.  The plan's benefits shall be made available to all

 7  county residents currently eligible to receive health care

 8  services as indigents or medically poor as defined in

 9  paragraph (4)(d).

10         4.  Eligible residents who participate in the health

11  care plan shall receive coverage for a period of 12 months or

12  the period extending from the time of enrollment to the end of

13  the current fiscal year, per enrollment period, whichever is

14  less.

15         5.  At the end of each fiscal year, the governing

16  board, agency, or authority shall prepare an audit that

17  reviews the budget of the plan, delivery of services, and

18  quality of services, and makes recommendations to increase the

19  plan's efficiency.  The audit shall take into account

20  participant hospital satisfaction with the plan and assess the

21  amount of poststabilization patient transfers requested, and

22  accepted or denied, by the county public general hospital.

23         (f)  Notwithstanding any other provision of this

24  section, a county may not levy local option sales surtaxes

25  authorized in this subsection and subsections (2) and (3) in

26  excess of a combined rate of 1 percent.

27         (6)  SCHOOL CAPITAL OUTLAY SURTAX.--

28         (a)1.  The school board in each county may levy,

29  pursuant to resolution conditioned to take effect only upon

30  approval by a majority vote of the electors of the county

31  

                                  19

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  voting in a referendum, a discretionary sales surtax at a rate

 2  that may not exceed 0.5 percent.

 3         2.(b)  The resolution shall include a statement that

 4  provides a brief and general description of the school capital

 5  outlay projects to be funded by the surtax. If applicable, the

 6  resolution must state that the district school board has been

 7  recognized by the State Board of Education as having a Florida

 8  Frugal Schools Program. The statement shall conform to the

 9  requirements of s. 101.161 and shall be placed on the ballot

10  by the governing body of the county. The following question

11  shall be placed on the ballot:

12  

13        ....FOR THE               ....CENTS TAX

14        ....AGAINST THE           ....CENTS TAX

15  

16         3.(c)  The resolution providing for the imposition of

17  the surtax shall set forth a plan for use of the surtax

18  proceeds for fixed capital expenditures or fixed capital costs

19  associated with the construction, reconstruction, or

20  improvement of school facilities and campuses which have a

21  useful life expectancy of 5 or more years, and any land

22  acquisition, land improvement, design, and engineering costs

23  related thereto. Additionally, the plan shall include the

24  costs of retrofitting and providing for technology

25  implementation, including hardware and software, for the

26  various sites within the school district. Surtax revenues may

27  be used for the purpose of servicing bond indebtedness to

28  finance projects authorized by this subsection, and any

29  interest accrued thereto may be held in trust to finance such

30  projects. Neither the proceeds of the surtax nor any interest

31  accrued thereto shall be used for operational expenses. If the

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  district school board has been recognized by the State Board

 2  of Education as having a Florida Frugal Schools Program, the

 3  district's plan for use of the surtax proceeds must be

 4  consistent with this subsection and with uses assured under

 5  the Florida Frugal Schools Program.

 6         4.(d)  Any school board imposing the surtax shall

 7  implement a freeze on noncapital local school property taxes,

 8  at the millage rate imposed in the year prior to the

 9  implementation of the surtax, for a period of at least 3 years

10  from the date of imposition of the surtax. This provision

11  shall not apply to existing debt service or required state

12  taxes.

13         5.(e)  Surtax revenues collected by the Department of

14  Revenue pursuant to this subsection shall be distributed to

15  the school board imposing the surtax in accordance with law.

16         (b)1.  Notwithstanding the provisions of paragraph (a),

17  the school board in any county may use up to 50 percent of the

18  revenues generated by the surtax for operational purposes

19  solely for salaries and benefits for teachers. However, in

20  addition to the requirements of paragraph (a), the resolution

21  providing for the imposition of the surtax shall specify the

22  percentage of surtax revenues to be used solely for salaries

23  and benefits for teachers as authorized by this paragraph. The

24  plan setting forth the use of surtax proceeds shall include

25  uses solely for salaries and benefits for teachers. The plan

26  shall provide criteria to account for use of proceeds solely

27  for salaries and benefits for teachers and shall provide for

28  an annual report by the school board documenting such use.

29         2.  The school board of any county which has levied the

30  surtax authorized in this subsection before July 1, 2004, and

31  wishes to use a percentage of surtax revenues solely for

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  salaries and benefits for teachers as provided in this

 2  paragraph may do so only pursuant to a new resolution

 3  conditioned to take effect only upon approval by a majority

 4  vote of the electors of the county voting in a referendum as

 5  provided in subparagraph (a)2. However, the amount of surtax

 6  revenues authorized for use solely for salaries and benefits

 7  for teachers under this subparagraph shall be available only

 8  to the extent such revenues are not otherwise dedicated to

 9  service bond indebtedness in such counties as provided in

10  paragraph (a), if applicable.

11         3.  This paragraph is repealed July 1, 2008.

12         (7)  VOTER-APPROVED INDIGENT CARE SURTAX.--

13         (a)  The governing body in each county that has a

14  population of less than 800,000 residents may levy an indigent

15  care surtax pursuant to an ordinance conditioned to take

16  effect only upon approval by a majority vote of the electors

17  of the county voting in a referendum. The surtax may be levied

18  at a rate not to exceed 0.5 percent, except that if a publicly

19  supported medical school is located in the county, the rate

20  shall not exceed 1 percent.

21         (b)  A statement that includes a brief and general

22  description of the purposes to be funded by the surtax and

23  that conforms to the requirements of s. 101.161 shall be

24  placed on the ballot by the governing body of the county. The

25  following questions shall be placed on the ballot:

26  

27                     FOR THE. . . .CENTS TAX

28                   AGAINST THE. . . .CENTS TAX

29  

30         (c)  The ordinance adopted by the governing body

31  providing for the imposition of the surtax must set forth a

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  plan for providing health care services to qualified

 2  residents, as defined in paragraph (d). The plan and

 3  subsequent amendments to it shall fund a broad range of health

 4  care services for indigent persons and the medically poor,

 5  including, but not limited to, primary care and preventive

 6  care, as well as hospital care. It shall emphasize a

 7  continuity of care in the most cost-effective setting, taking

 8  into consideration a high quality of care and geographic

 9  access. Where consistent with these objectives, it shall

10  include, without limitation, services rendered by physicians,

11  clinics, community hospitals, mental health centers, and

12  alternative delivery sites, as well as at least one regional

13  referral hospital where appropriate. It shall provide that

14  agreements negotiated between the county and providers shall

15  include reimbursement methodologies that take into account the

16  cost of services rendered to eligible patients, recognize

17  hospitals that render a disproportionate share of indigent

18  care, provide other incentives to promote the delivery of

19  charity care, and require cost containment, including, but not

20  limited to, case management. The plan must also include

21  innovative health care programs that provide cost-effective

22  alternatives to traditional methods of service delivery and

23  funding.

24         (d)  For the purpose of this subsection, "qualified

25  residents" means residents of the authorizing county who are:

26         1.  Qualified as indigent persons as certified by the

27  authorizing county;

28         2.  Certified by the authorizing county as meeting the

29  definition of the medically poor, defined as persons having

30  insufficient income, resources, and assets to provide the

31  needed medical care without using resources required to meet

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    Florida Senate - 2004                                   SB 456
    21-624-04                                            See HB 43




 1  basic needs for shelter, food, clothing, and personal

 2  expenses; not being eligible for any other state or federal

 3  program or having medical needs that are not covered by any

 4  such program; or having insufficient third-party insurance

 5  coverage. In all cases, the authorizing county shall serve as

 6  the payor of last resort; or

 7         3.  Participating in innovative, cost-effective

 8  programs approved by the authorizing county.

 9         (e)  Moneys collected pursuant to this subsection

10  remain the property of the state and shall be distributed by

11  the Department of Revenue on a regular and periodic basis to

12  the clerk of the circuit court as ex officio custodian of the

13  funds of the authorizing county. The clerk of the circuit

14  court shall:

15         1.  Maintain the moneys in an indigent health care

16  trust fund.

17         2.  Invest any funds held on deposit in the trust fund

18  pursuant to general law.

19         3.  Disburse the funds, including any interest earned,

20  to any provider of health care services, as provided in

21  paragraphs (c) and (d), upon directive from the authorizing

22  county.

23         (f)  Notwithstanding any other provision of this

24  section, a county may not levy local option sales surtaxes

25  authorized in this subsection and subsections (2) and (3) in

26  excess of a combined rate of 1 percent or, if a publicly

27  supported medical school is located in the county, in excess

28  of a combined rate of 1.5 percent.

29         Section 2.  This act shall take effect July 1, 2004.

30  

31  

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