Senate Bill sb0634e1

    SB 634                                   First Engrossed (ntc)



  1                      A bill to be entitled

  2         An act relating to the indigent care surtax;

  3         amending s. 212.055, F.S.; allowing small

  4         counties having a specified population to levy

  5         an indigent care surtax; providing procedures;

  6         providing uses of the surtax; providing a

  7         maximum tax rate; providing an effective date.

  8  

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

10  

11         Section 1.  Subsection (7) of section 212.055, Florida

12  Statutes, is amended to read:

13         212.055  Discretionary sales surtaxes; legislative

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

15  legislative intent that any authorization for imposition of a

16  discretionary sales surtax shall be published in the Florida

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

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

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

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

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

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

23  be expended; and such other requirements as the Legislature

24  may provide.  Taxable transactions and administrative

25  procedures shall be as provided in s. 212.054.

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

27         (a)1.  The governing body in each county that has a

28  population of fewer less than 800,000 residents may levy an

29  indigent care surtax pursuant to an ordinance conditioned to

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

31  electors of the county voting in a referendum. The surtax may


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    SB 634                                   First Engrossed (ntc)



 1  be levied at a rate not to exceed 0.5 percent, except that if

 2  a publicly supported medical school is located in the county,

 3  the rate shall not exceed 1 percent.

 4         2.  Notwithstanding subparagraph 1., the governing body

 5  of any county that has a population of fewer than 50,000

 6  residents may levy an indigent care surtax pursuant to an

 7  ordinance conditioned to take effect only upon approval by a

 8  majority vote of the electors of the county voting in a

 9  referendum. The surtax may be levied at a rate not to exceed 1

10  percent.

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

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

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

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

15  following questions shall be placed on the ballot:

16  

17                     FOR THE. . . .CENTS TAX

18                   AGAINST THE. . . .CENTS TAX

19  

20         (c)1.  The ordinance adopted by the governing body

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

22  plan for providing health care services to qualified

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

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

25  care services for indigent persons and the medically poor,

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

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

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

29  into consideration a high quality of care and geographic

30  access. Where consistent with these objectives, it shall

31  include, without limitation, services rendered by physicians,


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    SB 634                                   First Engrossed (ntc)



 1  clinics, community hospitals, mental health centers, and

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

 3  referral hospital where appropriate. It shall provide that

 4  agreements negotiated between the county and providers shall

 5  include reimbursement methodologies that take into account the

 6  cost of services rendered to eligible patients, recognize

 7  hospitals that render a disproportionate share of indigent

 8  care, provide other incentives to promote the delivery of

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

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

11  innovative health care programs that provide cost-effective

12  alternatives to traditional methods of service delivery and

13  funding.

14         2.  In addition to the uses specified or services

15  required to be provided under this subsection, the ordinance

16  adopted by a county that has a population of fewer than 50,000

17  residents may pledge surtax proceeds to service new or

18  existing bond indebtedness incurred to finance, plan,

19  construct, or reconstruct a public or not-for-profit hospital

20  in such county and any land acquisition, land improvement,

21  design, or engineering costs related to such hospital, if the

22  governing body of the county determines that a public or

23  not-for-profit hospital existing at the time of issuance of

24  the bonds authorized under this subparagraph would, more

25  likely than not, otherwise cease to operate. The plan required

26  under this paragraph may, by an extraordinary vote of the

27  governing body of such county, provide that some or all of the

28  surtax revenues and any interest earned must be expended for

29  the purpose of servicing such bond indebtedness. Such county

30  may also use the services of the Division of Bond Finance of

31  the State Board of Administration pursuant to the State Bond


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    SB 634                                   First Engrossed (ntc)



 1  Act to issue bonds under this subparagraph. A jurisdiction may

 2  not issue bonds under this subparagraph more frequently than

 3  once per year. Any county that has a population of fewer than

 4  50,000 residents at the time any bonds authorized in this

 5  subparagraph are issued retains the authority granted under

 6  this subparagraph throughout the terms of such bonds,

 7  including the term of any refinancing bonds, regardless of any

 8  subsequent increase in population which would result in such

 9  county having 50,000 or more residents.

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

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

12         1.  Qualified as indigent persons as certified by the

13  authorizing county;

14         2.  Certified by the authorizing county as meeting the

15  definition of the medically poor, defined as persons having

16  insufficient income, resources, and assets to provide the

17  needed medical care without using resources required to meet

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

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

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

21  such program; or having insufficient third-party insurance

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

23  the payor of last resort; or

24         3.  Participating in innovative, cost-effective

25  programs approved by the authorizing county.

26         (e)  Moneys collected pursuant to this subsection

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

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

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

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

31  court shall:


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    SB 634                                   First Engrossed (ntc)



 1         1.  Maintain the moneys in an indigent health care

 2  trust fund.

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

 4  pursuant to general law.

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

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

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

 8  county.

 9         4.  Disburse the funds, including any interest earned,

10  to service any bond indebtedness authorized in this subsection

11  upon directive from the authorizing county, which directive

12  may be irrevocably given at the time the bond indebtedness is

13  incurred.

14         (f)  Notwithstanding any other provision of this

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

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

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

18  supported medical school is located in the county or the

19  county has a population of fewer than 50,000 residents, in

20  excess of a combined rate of 1.5 percent.

21         Section 2.  This act shall take effect upon becoming a

22  law.

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