Senate Bill sb0634e2
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 A bill to be entitled
2 An act relating to the indigent care surtax;
3 amending s. 212.055, F.S.; authorizing certain
4 counties to levy by ordinance, subject to
5 referendum approval, a surtax to fund trauma
6 services provided by certain licensed trauma
7 centers; requiring the ordinance to provide a
8 plan for providing trauma services; providing
9 for collection and distribution of surtax
10 proceeds; providing duties of the clerk of the
11 circuit court, the clerk of the municipality,
12 or the treasurer of the special district in
13 maintaining a trust fund and investing and
14 disbursing funds; requiring a biennial audit of
15 the trust fund; providing for expiration and
16 reenactment of the surtax; limiting the rate of
17 the surtax; allowing small counties having a
18 specified population to levy an indigent care
19 surtax; providing procedures; providing uses of
20 the surtax; providing a maximum tax rate;
21 providing an effective date.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Subsections (4) and (7) of section 212.055,
26 Florida Statutes, are amended to read:
27 212.055 Discretionary sales surtaxes; legislative
28 intent; authorization and use of proceeds.--It is the
29 legislative intent that any authorization for imposition of a
30 discretionary sales surtax shall be published in the Florida
31 Statutes as a subsection of this section, irrespective of the
1
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 duration of the levy. Each enactment shall specify the types
2 of counties authorized to levy; the rate or rates which may be
3 imposed; the maximum length of time the surtax may be imposed,
4 if any; the procedure which must be followed to secure voter
5 approval, if required; the purpose for which the proceeds may
6 be expended; and such other requirements as the Legislature
7 may provide. Taxable transactions and administrative
8 procedures shall be as provided in s. 212.054.
9 (4) INDIGENT CARE AND TRAUMA CENTER SURTAX.--
10 (a)1. The governing body in each county the government
11 of which is not consolidated with that of one or more
12 municipalities, which has a population of at least 800,000
13 residents and is not authorized to levy a surtax under
14 subsection (5), may levy, pursuant to an ordinance either
15 approved by an extraordinary vote of the governing body or
16 conditioned to take effect only upon approval by a majority
17 vote of the electors of the county voting in a referendum, a
18 discretionary sales surtax at a rate that may not exceed 0.5
19 percent.
20 2.(b) If the ordinance is conditioned on a referendum,
21 a statement that includes a brief and general description of
22 the purposes to be funded by the surtax and that conforms to
23 the requirements of s. 101.161 shall be placed on the ballot
24 by the governing body of the county. The following questions
25 shall be placed on the ballot:
26
27 FOR THE. . . .CENTS TAX
28 AGAINST THE. . . .CENTS TAX
29
30 3.(c) The ordinance adopted by the governing body
31 providing for the imposition of the surtax shall set forth a
2
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 plan for providing health care services to qualified
2 residents, as defined in subparagraph 4 paragraph (d). Such
3 plan and subsequent amendments to it shall fund a broad range
4 of health care services for both indigent persons and the
5 medically poor, including, but not limited to, primary care
6 and preventive care as well as hospital care. The plan must
7 also address the services to be provided by the Level I trauma
8 center. It shall emphasize a continuity of care in the most
9 cost-effective setting, taking into consideration both a high
10 quality of care and geographic access. Where consistent with
11 these objectives, it shall include, without limitation,
12 services rendered by physicians, clinics, community hospitals,
13 mental health centers, and alternative delivery sites, as well
14 as at least one regional referral hospital where appropriate.
15 It shall provide that agreements negotiated between the county
16 and providers, including hospitals with a Level I trauma
17 center, will include reimbursement methodologies that take
18 into account the cost of services rendered to eligible
19 patients, recognize hospitals that render a disproportionate
20 share of indigent care, provide other incentives to promote
21 the delivery of charity care, promote the advancement of
22 technology in medical services, recognize the level of
23 responsiveness to medical needs in trauma cases, and require
24 cost containment including, but not limited to, case
25 management. It must also provide that any hospitals that are
26 owned and operated by government entities on May 21, 1991,
27 must, as a condition of receiving funds under this subsection,
28 afford public access equal to that provided under s. 286.011
29 as to meetings of the governing board, the subject of which is
30 budgeting resources for the rendition of charity care as that
31 term is defined in the Florida Hospital Uniform Reporting
3
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 System (FHURS) manual referenced in s. 408.07. The plan shall
2 also include innovative health care programs that provide
3 cost-effective alternatives to traditional methods of service
4 delivery and funding.
5 4.(d) For the purpose of this paragraph subsection,
6 the term "qualified resident" means residents of the
7 authorizing county who are:
8 a.1. Qualified as indigent persons as certified by the
9 authorizing county;
10 b.2. Certified by the authorizing county as meeting
11 the definition of the medically poor, defined as persons
12 having insufficient income, resources, and assets to provide
13 the needed medical care without using resources required to
14 meet basic needs for shelter, food, clothing, and personal
15 expenses; or not being eligible for any other state or federal
16 program, or having medical needs that are not covered by any
17 such program; or having insufficient third-party insurance
18 coverage. In all cases, the authorizing county is intended to
19 serve as the payor of last resort; or
20 c.3. Participating in innovative, cost-effective
21 programs approved by the authorizing county.
22 5.(e) Moneys collected pursuant to this paragraph
23 subsection remain the property of the state and shall be
24 distributed by the Department of Revenue on a regular and
25 periodic basis to the clerk of the circuit court as ex officio
26 custodian of the funds of the authorizing county. The clerk of
27 the circuit court shall:
28 a.1. Maintain the moneys in an indigent health care
29 trust fund;
30 b.2. Invest any funds held on deposit in the trust
31 fund pursuant to general law;
4
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 c.3. Disburse the funds, including any interest
2 earned, to any provider of health care services, as provided
3 in subparagraphs 3. and 4. paragraphs (c) and (d), upon
4 directive from the authorizing county. However, if a county
5 has a population of at least 800,000 residents and has levied
6 the surtax authorized in this paragraph subsection,
7 notwithstanding any directive from the authorizing county, on
8 October 1 of each calendar year, the clerk of the court shall
9 issue a check in the amount of $6.5 million to a hospital in
10 its jurisdiction that has a Level I trauma center or shall
11 issue a check in the amount of $3.5 million to a hospital in
12 its jurisdiction that has a Level I trauma center if that
13 county enacts and implements a hospital lien law in accordance
14 with chapter 98-499, Laws of Florida. The issuance of the
15 checks on October 1 of each year is provided in recognition of
16 the Level I trauma center status and shall be in addition to
17 the base contract amount received during fiscal year 1999-2000
18 and any additional amount negotiated to the base contract. If
19 the hospital receiving funds for its Level I trauma center
20 status requests such funds to be used to generate federal
21 matching funds under Medicaid, the clerk of the court shall
22 instead issue a check to the Agency for Health Care
23 Administration to accomplish that purpose to the extent that
24 it is allowed through the General Appropriations Act; and
25 d.4. Prepare on a biennial basis an audit of the trust
26 fund specified in sub-subparagraph a. subparagraph 1.
27 Commencing February 1, 2004, such audit shall be delivered to
28 the governing body and to the chair of the legislative
29 delegation of each authorizing county.
30 6.(f) Notwithstanding any other provision of this
31 section, a county shall not levy local option sales surtaxes
5
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 authorized in this paragraph subsection and subsections (2)
2 and (3) in excess of a combined rate of 1 percent.
3 (b) Notwithstanding any other provision of this
4 section, the governing body in each county the government of
5 which is not consolidated with that of one or more
6 municipalities and which has a population of less than 800,000
7 residents, may levy, by ordinance subject to approval by a
8 majority of the electors of the county voting in a referendum,
9 a discretionary sales surtax at a rate that may not exceed
10 0.25 percent for the sole purpose of funding trauma services
11 provided by a trauma center licensed under chapter 395.
12 1. A statement that includes a brief and general
13 description of the purposes to be funded by the surtax and
14 that conforms to the requirements of s. 101.161 shall be
15 placed on the ballot by the governing body of the county. The
16 following questions shall be placed on the ballot:
17
18 FOR THE. . . .CENTS TAX
19 AGAINST THE. . . .CENTS TAX
20
21 2. The ordinance adopted by the governing body of the
22 county providing for the imposition of the surtax shall set
23 forth a plan for providing trauma services to trauma victims
24 presenting in the trauma service area in which such county is
25 located.
26 3. Moneys collected under this paragraph remain the
27 property of the state and shall be distributed by the
28 Department of Revenue on a regular and periodic basis to the
29 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:
6
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 a. Maintain the moneys in a trauma services trust
2 fund.
3 b. Invest any funds held on deposit in the trust fund
4 under general law.
5 c. Disburse the funds, including any interest earned
6 on such funds, to the trauma center in its trauma service area
7 as provided in the plan set forth pursuant to subparagraph 2.
8 upon directive from the authorizing county. If the trauma
9 center receiving funds requests that such funds be used to
10 generate federal matching funds under Medicaid, the custodian
11 of the funds shall instead issue a check to the Agency for
12 Health Care Administration to accomplish that purpose to the
13 extent that the agency is authorized in the General
14 Appropriations Act.
15 d. Prepare on a biennial basis an audit of the trauma
16 services trust fund specified in sub-subparagraph a., to be
17 delivered to the authorizing county.
18 4. A discretionary sales surtax imposed under this
19 paragraph shall expire 4 years after the effective date of the
20 surtax unless reenacted by ordinance subject to approval by a
21 majority of the electors of the county voting in a subsequent
22 referendum.
23 5. Notwithstanding any other provision of this
24 section, a county may not levy local option sales surtaxes
25 authorized in this paragraph and subsections (2) and (3) in
26 excess of a combined rate of 1 percent.
27 (7) VOTER-APPROVED INDIGENT CARE SURTAX.--
28 (a)1. The governing body in each county that has a
29 population of fewer less than 800,000 residents may levy an
30 indigent care surtax pursuant to an ordinance conditioned to
31 take effect only upon approval by a majority vote of the
7
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 electors of the county voting in a referendum. The surtax may
2 be levied at a rate not to exceed 0.5 percent, except that if
3 a publicly supported medical school is located in the county,
4 the rate shall not exceed 1 percent.
5 2. Notwithstanding subparagraph 1., the governing body
6 of any county that has a population of fewer than 50,000
7 residents may levy an indigent care surtax pursuant to an
8 ordinance conditioned to take effect only upon approval by a
9 majority vote of the electors of the county voting in a
10 referendum. The surtax may be levied at a rate not to exceed 1
11 percent.
12 (b) A statement that includes a brief and general
13 description of the purposes to be funded by the surtax and
14 that conforms to the requirements of s. 101.161 shall be
15 placed on the ballot by the governing body of the county. The
16 following questions shall be placed on the ballot:
17
18 FOR THE. . . .CENTS TAX
19 AGAINST THE. . . .CENTS TAX
20
21 (c)1. The ordinance adopted by the governing body
22 providing for the imposition of the surtax must set forth a
23 plan for providing health care services to qualified
24 residents, as defined in paragraph (d). The plan and
25 subsequent amendments to it shall fund a broad range of health
26 care services for indigent persons and the medically poor,
27 including, but not limited to, primary care and preventive
28 care, as well as hospital care. It shall emphasize a
29 continuity of care in the most cost-effective setting, taking
30 into consideration a high quality of care and geographic
31 access. Where consistent with these objectives, it shall
8
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 include, without limitation, services rendered by physicians,
2 clinics, community hospitals, mental health centers, and
3 alternative delivery sites, as well as at least one regional
4 referral hospital where appropriate. It shall provide that
5 agreements negotiated between the county and providers shall
6 include reimbursement methodologies that take into account the
7 cost of services rendered to eligible patients, recognize
8 hospitals that render a disproportionate share of indigent
9 care, provide other incentives to promote the delivery of
10 charity care, and require cost containment, including, but not
11 limited to, case management. The plan must also include
12 innovative health care programs that provide cost-effective
13 alternatives to traditional methods of service delivery and
14 funding.
15 2. In addition to the uses specified or services
16 required to be provided under this subsection, the ordinance
17 adopted by a county that has a population of fewer than 50,000
18 residents may pledge surtax proceeds to service new or
19 existing bond indebtedness incurred to finance, plan,
20 construct, or reconstruct a public or not-for-profit hospital
21 in such county and any land acquisition, land improvement,
22 design, or engineering costs related to such hospital, if the
23 governing body of the county determines that a public or
24 not-for-profit hospital existing at the time of issuance of
25 the bonds authorized under this subparagraph would, more
26 likely than not, otherwise cease to operate. The plan required
27 under this paragraph may, by an extraordinary vote of the
28 governing body of such county, provide that some or all of the
29 surtax revenues and any interest earned must be expended for
30 the purpose of servicing such bond indebtedness. Such county
31 may also use the services of the Division of Bond Finance of
9
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
1 the State Board of Administration pursuant to the State Bond
2 Act to issue bonds under this subparagraph. A jurisdiction may
3 not issue bonds under this subparagraph more frequently than
4 once per year. Any county that has a population of fewer than
5 50,000 residents at the time any bonds authorized in this
6 subparagraph are issued retains the authority granted under
7 this subparagraph throughout the terms of such bonds,
8 including the term of any refinancing bonds, regardless of any
9 subsequent increase in population which would result in such
10 county having 50,000 or more residents.
11 (d) For the purpose of this subsection, "qualified
12 residents" means residents of the authorizing county who are:
13 1. Qualified as indigent persons as certified by the
14 authorizing county;
15 2. Certified by the authorizing county as meeting the
16 definition of the medically poor, defined as persons having
17 insufficient income, resources, and assets to provide the
18 needed medical care without using resources required to meet
19 basic needs for shelter, food, clothing, and personal
20 expenses; not being eligible for any other state or federal
21 program or having medical needs that are not covered by any
22 such program; or having insufficient third-party insurance
23 coverage. In all cases, the authorizing county shall serve as
24 the payor of last resort; or
25 3. Participating in innovative, cost-effective
26 programs approved by the authorizing county.
27 (e) Moneys collected pursuant to this subsection
28 remain the property of the state and shall be distributed by
29 the Department of Revenue on a regular and periodic basis to
30 the clerk of the circuit court as ex officio custodian of the
31
10
CODING: Words stricken are deletions; words underlined are additions.
SB 634 Second Engrossed
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.
11 4. Disburse the funds, including any interest earned,
12 to service any bond indebtedness authorized in this subsection
13 upon directive from the authorizing county, which directive
14 may be irrevocably given at the time the bond indebtedness is
15 incurred.
16 (f) Notwithstanding any other provision of this
17 section, a county may not levy local option sales surtaxes
18 authorized in this subsection and subsections (2) and (3) in
19 excess of a combined rate of 1 percent or, if a publicly
20 supported medical school is located in the county or the
21 county has a population of fewer than 50,000 residents, in
22 excess of a combined rate of 1.5 percent.
23 Section 2. This act shall take effect upon becoming a
24 law.
25
26
27
28
29
30
31
11
CODING: Words stricken are deletions; words underlined are additions.