HB 321

1
A bill to be entitled
2An act relating to discretionary sales surtaxes; amending
3s. 212.055, F.S.; providing a maximum rate per county for
4the total of specified discretionary sales surtaxes;
5renaming the Charter County Transit System Surtax as the
6Charter County Transportation System Surtax; expanding the
7eligibility to levy the transportation system surtax to
8all charter counties; revising authorized use of the
9transportation system surtax; providing an effective date.
10
11Be It Enacted by the Legislature of the State of Florida:
12
13     Section 1.  Section 212.055, Florida Statutes, is amended
14to read:
15     212.055  Discretionary sales surtaxes; legislative intent;
16authorization and use of proceeds.--It is the legislative intent
17that any authorization for imposition of a discretionary sales
18surtax shall be published in the Florida Statutes as a
19subsection of this section, irrespective of the duration of the
20levy. Each enactment shall specify the types of counties
21authorized to levy; the rate or rates which may be imposed; the
22maximum length of time the surtax may be imposed, if any; the
23procedure which must be followed to secure voter approval, if
24required; the purpose for which the proceeds may be expended;
25and such other requirements as the Legislature may provide. The
26maximum rate for any county for the total of all discretionary
27sales surtaxes imposed by this section shall be 1.5 percent.
28Taxable transactions and administrative procedures shall be as
29provided in s. 212.054.
30     (1)  CHARTER COUNTY TRANSPORTATION TRANSIT SYSTEM SURTAX.--
31     (a)  Each charter county that has which adopted a charter
32prior to January 1, 1984, and each county the government of
33which is consolidated with that of one or more municipalities,
34may levy a discretionary sales surtax, subject to approval by a
35majority vote of the electorate of the county or by a charter
36amendment approved by a majority vote of the electorate of the
37county.
38     (b)  The rate shall be up to 1 percent.
39     (c)  The proposal to adopt a discretionary sales surtax as
40provided in this subsection and to create a trust fund within
41the county accounts shall be placed on the ballot in accordance
42with law at a time to be set at the discretion of the governing
43body.
44     (d)  Proceeds from the surtax shall be applied to as many
45or as few of the uses enumerated below in whatever combination
46the county commission deems appropriate:
47     1.  Deposited by the county in the trust fund and shall be
48used for the purposes of development, construction, equipment,
49maintenance, operation, supportive services, including a
50countywide bus system, and related costs of a fixed guideway
51rapid transit system.;
52     2.  Remitted by the governing body of the county to an
53expressway, transit, or transportation authority created by law
54to be used, at the discretion of such authority, for the
55development, construction, operation, or maintenance of roads or
56bridges in the county;, for the operation and maintenance of a
57bus system, for the payment of principal and interest on
58existing bonds issued for the construction of such roads or
59bridges, and, upon approval by the county commission, such
60proceeds may be pledged for bonds issued to refinance existing
61bonds or new bonds issued for the construction of such roads or
62bridges; for the planning, development, expansion, operation,
63and maintenance of bus systems and fixed guideway transit
64systems, including light rail, commuter rail, and fixed guideway
65rapid transit systems; and for the payment of principal and
66interest on bonds issued for the construction of such bus
67systems and fixed guideway transit systems, including light
68rail, commuter rail, and fixed guideway rapid transit systems.
69     3.  Used by the charter county for the development,
70construction, operation, and maintenance of roads and bridges in
71the county; for the expansion, operation, and maintenance of bus
72and fixed guideway systems; and for the payment of principal and
73interest on bonds issued for the construction of fixed guideway
74rapid transit systems, bus systems, roads, or bridges; and such
75proceeds may be pledged by the governing body of the county for
76bonds issued to refinance existing bonds or new bonds issued for
77the construction of such fixed guideway rapid transit systems,
78bus systems, roads, or bridges and no more than 25 percent used
79for nontransit uses.; and
80     4.  Used by the charter county for the planning,
81development, construction, operation, and maintenance of roads
82and bridges in the county; for the planning, development,
83expansion, operation, and maintenance of bus and fixed guideway
84systems; and for the payment of principal and interest on bonds
85issued for the construction of fixed guideway rapid transit
86systems, bus systems, roads, or bridges; and such proceeds may
87be pledged by the governing body of the county for bonds issued
88to refinance existing bonds or new bonds issued for the
89construction of such fixed guideway rapid transit systems, bus
90systems, roads, or bridges. Pursuant to an interlocal agreement
91entered into pursuant to chapter 163, the governing body of the
92charter county may distribute proceeds from the tax to a
93municipality, or an expressway or transportation authority
94created by law to be expended for the purpose authorized by this
95paragraph.
96     (2)  LOCAL GOVERNMENT INFRASTRUCTURE SURTAX.--
97     (a)1.  The governing authority in each county may levy a
98discretionary sales surtax of 0.5 percent or 1 percent. The levy
99of the surtax shall be pursuant to ordinance enacted by a
100majority of the members of the county governing authority and
101approved by a majority of the electors of the county voting in a
102referendum on the surtax. If the governing bodies of the
103municipalities representing a majority of the county's
104population adopt uniform resolutions establishing the rate of
105the surtax and calling for a referendum on the surtax, the levy
106of the surtax shall be placed on the ballot and shall take
107effect if approved by a majority of the electors of the county
108voting in the referendum on the surtax.
109     2.  If the surtax was levied pursuant to a referendum held
110before July 1, 1993, the surtax may not be levied beyond the
111time established in the ordinance, or, if the ordinance did not
112limit the period of the levy, the surtax may not be levied for
113more than 15 years. The levy of such surtax may be extended only
114by approval of a majority of the electors of the county voting
115in a referendum on the surtax.
116     (b)  A statement which includes a brief general description
117of the projects to be funded by the surtax and which conforms to
118the requirements of s. 101.161 shall be placed on the ballot by
119the governing authority of any county which enacts an ordinance
120calling for a referendum on the levy of the surtax or in which
121the governing bodies of the municipalities representing a
122majority of the county's population adopt uniform resolutions
123calling for a referendum on the surtax. The following question
124shall be placed on the ballot:
125
126_____FOR the_____-cent sales tax
127_____AGAINST the_____-cent sales tax
128     (c)  Pursuant to s. 212.054(4), the proceeds of the surtax
129levied under this subsection shall be distributed to the county
130and the municipalities within such county in which the surtax
131was collected, according to:
132     1.  An interlocal agreement between the county governing
133authority and the governing bodies of the municipalities
134representing a majority of the county's municipal population,
135which agreement may include a school district with the consent
136of the county governing authority and the governing bodies of
137the municipalities representing a majority of the county's
138municipal population; or
139     2.  If there is no interlocal agreement, according to the
140formula provided in s. 218.62.
141
142Any change in the distribution formula must take effect on the
143first day of any month that begins at least 60 days after
144written notification of that change has been made to the
145department.
146     (d)1.  The proceeds of the surtax authorized by this
147subsection and any interest accrued thereto shall be expended by
148the school district or within the county and municipalities
149within the county, or, in the case of a negotiated joint county
150agreement, within another county, to finance, plan, and
151construct infrastructure and to acquire land for public
152recreation or conservation or protection of natural resources
153and to finance the closure of county-owned or municipally owned
154solid waste landfills that are already closed or are required to
155close by order of the Department of Environmental Protection.
156Any use of such proceeds or interest for purposes of landfill
157closure prior to July 1, 1993, is ratified. Neither the proceeds
158nor any interest accrued thereto shall be used for operational
159expenses of any infrastructure, except that any county with a
160population of less than 75,000 that is required to close a
161landfill by order of the Department of Environmental Protection
162may use the proceeds or any interest accrued thereto for long-
163term maintenance costs associated with landfill closure.
164Counties, as defined in s. 125.011(1), and charter counties may,
165in addition, use the proceeds and any interest accrued thereto
166to retire or service indebtedness incurred for bonds issued
167prior to July 1, 1987, for infrastructure purposes, and for
168bonds subsequently issued to refund such bonds. Any use of such
169proceeds or interest for purposes of retiring or servicing
170indebtedness incurred for such refunding bonds prior to July 1,
1711999, is ratified.
172     2.  For the purposes of this paragraph, the term
173"infrastructure" means:
174     a.  Any fixed capital expenditure or fixed capital outlay
175associated with the construction, reconstruction, or improvement
176of public facilities that have a life expectancy of 5 or more
177years and any land acquisition, land improvement, design, and
178engineering costs related thereto.
179     b.  A fire department vehicle, an emergency medical service
180vehicle, a sheriff's office vehicle, a police department
181vehicle, or any other vehicle, and such equipment necessary to
182outfit the vehicle for its official use or equipment that has a
183life expectancy of at least 5 years.
184     c.  Any expenditure for the construction, lease, or
185maintenance of, or provision of utilities or security for,
186facilities as defined in s. 29.008.
187     d.  Any fixed capital expenditure or fixed capital outlay
188associated with the improvement of private facilities that have
189a life expectancy of 5 or more years and that the owner agrees
190to make available for use on a temporary basis as needed by a
191local government as a public emergency shelter or a staging area
192for emergency response equipment during an emergency officially
193declared by the state or by the local government under s.
194252.38. Such improvements under this sub-subparagraph are
195limited to those necessary to comply with current standards for
196public emergency evacuation shelters. The owner shall enter into
197a written contract with the local government providing the
198improvement funding to make such private facility available to
199the public for purposes of emergency shelter at no cost to the
200local government for a minimum period of 10 years after
201completion of the improvement, with the provision that such
202obligation will transfer to any subsequent owner until the end
203of the minimum period.
204     3.  Notwithstanding any other provision of this subsection,
205a discretionary sales surtax imposed or extended after the
206effective date of this act may provide for an amount not to
207exceed 15 percent of the local option sales surtax proceeds to
208be allocated for deposit to a trust fund within the county's
209accounts created for the purpose of funding economic development
210projects of a general public purpose targeted to improve local
211economies, including the funding of operational costs and
212incentives related to such economic development. The ballot
213statement must indicate the intention to make an allocation
214under the authority of this subparagraph.
215     (e)  School districts, counties, and municipalities
216receiving proceeds under the provisions of this subsection may
217pledge such proceeds for the purpose of servicing new bond
218indebtedness incurred pursuant to law. Local governments may use
219the services of the Division of Bond Finance of the State Board
220of Administration pursuant to the State Bond Act to issue any
221bonds through the provisions of this subsection. Counties and
222municipalities may join together for the issuance of bonds
223authorized by this subsection.
224     (f)1.  Notwithstanding paragraph (d), a county that has a
225population of 50,000 or less on April 1, 1992, or any county
226designated as an area of critical state concern on the effective
227date of this act, and that imposed the surtax before July 1,
2281992, may use the proceeds and interest of the surtax for any
229public purpose if:
230     a.  The debt service obligations for any year are met;
231     b.  The county's comprehensive plan has been determined to
232be in compliance with part II of chapter 163; and
233     c.  The county has adopted an amendment to the surtax
234ordinance pursuant to the procedure provided in s. 125.66
235authorizing additional uses of the surtax proceeds and interest.
236     2.  A municipality located within a county that has a
237population of 50,000 or less on April 1, 1992, or within a
238county designated as an area of critical state concern on the
239effective date of this act, and that imposed the surtax before
240July 1, 1992, may not use the proceeds and interest of the
241surtax for any purpose other than an infrastructure purpose
242authorized in paragraph (d) unless the municipality's
243comprehensive plan has been determined to be in compliance with
244part II of chapter 163 and the municipality has adopted an
245amendment to its surtax ordinance or resolution pursuant to the
246procedure provided in s. 166.041 authorizing additional uses of
247the surtax proceeds and interest. Such municipality may expend
248the surtax proceeds and interest for any public purpose
249authorized in the amendment.
250     3.  Those counties designated as an area of critical state
251concern which qualify to use the surtax for any public purpose
252may use only up to 10 percent of the surtax proceeds for any
253public purpose other than for infrastructure purposes authorized
254by this section. A county that was designated as an area of
255critical state concern for at least 20 consecutive years prior
256to removal of the designation, and that qualified to use the
257surtax for any public purpose at the time of the removal of the
258designation, may continue to use up to 10 percent of the surtax
259proceeds for any public purpose other than for infrastructure
260purposes for 20 years following removal of the designation,
261notwithstanding subparagraph (a)2. After expiration of the 20-
262year period, a county may continue to use up to 10 percent of
263the surtax proceeds for any public purpose other than for
264infrastructure if the county adopts an ordinance providing for
265such continued use of the surtax proceeds.
266     (g)  Notwithstanding paragraph (d), a county having a
267population greater than 75,000 in which the taxable value of
268real property is less than 60 percent of the just value of real
269property for ad valorem tax purposes for the tax year in which
270an infrastructure surtax referendum is placed before the voters,
271and the municipalities within such a county, may use the
272proceeds and interest of the surtax for operation and
273maintenance of parks and recreation programs and facilities
274established with the proceeds of the surtax throughout the
275duration of the surtax levy or while interest earnings accruing
276from the proceeds of the surtax are available for such use,
277whichever period is longer.
278     (h)  Notwithstanding any other provision of this section, a
279county shall not levy local option sales surtaxes authorized in
280this subsection and subsections (3), (4), and (5) in excess of a
281combined rate of 1 percent.
282     (3)  SMALL COUNTY SURTAX.--
283     (a)  The governing authority in each county that has a
284population of 50,000 or less on April 1, 1992, may levy a
285discretionary sales surtax of 0.5 percent or 1 percent. The levy
286of the surtax shall be pursuant to ordinance enacted by an
287extraordinary vote of the members of the county governing
288authority if the surtax revenues are expended for operating
289purposes. If the surtax revenues are expended for the purpose of
290servicing bond indebtedness, the surtax shall be approved by a
291majority of the electors of the county voting in a referendum on
292the surtax.
293     (b)  A statement that includes a brief general description
294of the projects to be funded by the surtax and conforms to the
295requirements of s. 101.161 shall be placed on the ballot by the
296governing authority of any county that enacts an ordinance
297calling for a referendum on the levy of the surtax for the
298purpose of servicing bond indebtedness. The following question
299shall be placed on the ballot:
300
301_____FOR the_____-cent sales tax
302_____AGAINST the_____-cent sales tax
303     (c)  Pursuant to s. 212.054(4), the proceeds of the surtax
304levied under this subsection shall be distributed to the county
305and the municipalities within the county in which the surtax was
306collected, according to:
307     1.  An interlocal agreement between the county governing
308authority and the governing bodies of the municipalities
309representing a majority of the county's municipal population,
310which agreement may include a school district with the consent
311of the county governing authority and the governing bodies of
312the municipalities representing a majority of the county's
313municipal population; or
314     2.  If there is no interlocal agreement, according to the
315formula provided in s. 218.62.
316
317Any change in the distribution formula shall take effect on the
318first day of any month that begins at least 60 days after
319written notification of that change has been made to the
320department.
321     (d)1.  If the surtax is levied pursuant to a referendum,
322the proceeds of the surtax and any interest accrued thereto may
323be expended by the school district or within the county and
324municipalities within the county, or, in the case of a
325negotiated joint county agreement, within another county, for
326the purpose of servicing bond indebtedness to finance, plan, and
327construct infrastructure and to acquire land for public
328recreation or conservation or protection of natural resources.
329However, if the surtax is levied pursuant to an ordinance
330approved by an extraordinary vote of the members of the county
331governing authority, the proceeds and any interest accrued
332thereto may be used for operational expenses of any
333infrastructure or for any public purpose authorized in the
334ordinance under which the surtax is levied.
335     2.  For the purposes of this paragraph, "infrastructure"
336means any fixed capital expenditure or fixed capital costs
337associated with the construction, reconstruction, or improvement
338of public facilities that have a life expectancy of 5 or more
339years and any land acquisition, land improvement, design, and
340engineering costs related thereto.
341     (e)  A school district, county, or municipality that
342receives proceeds under this subsection following a referendum
343may pledge the proceeds for the purpose of servicing new bond
344indebtedness incurred pursuant to law. Local governments may use
345the services of the Division of Bond Finance pursuant to the
346State Bond Act to issue any bonds through the provisions of this
347subsection. A jurisdiction may not issue bonds pursuant to this
348subsection more frequently than once per year. A county and
349municipality may join together to issue bonds authorized by this
350subsection.
351     (f)  Notwithstanding any other provision of this section, a
352county shall not levy local option sales surtaxes authorized in
353this subsection and subsections (2), (4), and (5) in excess of a
354combined rate of 1 percent.
355     (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--
356     (a)1.  The governing body in each county the government of
357which is not consolidated with that of one or more
358municipalities, which has a population of at least 800,000
359residents and is not authorized to levy a surtax under
360subsection (5), may levy, pursuant to an ordinance either
361approved by an extraordinary vote of the governing body or
362conditioned to take effect only upon approval by a majority vote
363of the electors of the county voting in a referendum, a
364discretionary sales surtax at a rate that may not exceed 0.5
365percent.
366     2.  If the ordinance is conditioned on a referendum, a
367statement that includes a brief and general description of the
368purposes to be funded by the surtax and that conforms to the
369requirements of s. 101.161 shall be placed on the ballot by the
370governing body of the county. The following questions shall be
371placed on the ballot:
372
373_____FOR THE_____CENTS TAX
374_____AGAINST THE_____CENTS TAX
375     3.  The ordinance adopted by the governing body providing
376for the imposition of the surtax shall set forth a plan for
377providing health care services to qualified residents, as
378defined in subparagraph 4. Such plan and subsequent amendments
379to it shall fund a broad range of health care services for both
380indigent persons and the medically poor, including, but not
381limited to, primary care and preventive care as well as hospital
382care. The plan must also address the services to be provided by
383the Level I trauma center. It shall emphasize a continuity of
384care in the most cost-effective setting, taking into
385consideration both a high quality of care and geographic access.
386Where consistent with these objectives, it shall include,
387without limitation, services rendered by physicians, clinics,
388community hospitals, mental health centers, and alternative
389delivery sites, as well as at least one regional referral
390hospital where appropriate. It shall provide that agreements
391negotiated between the county and providers, including hospitals
392with a Level I trauma center, will include reimbursement
393methodologies that take into account the cost of services
394rendered to eligible patients, recognize hospitals that render a
395disproportionate share of indigent care, provide other
396incentives to promote the delivery of charity care, promote the
397advancement of technology in medical services, recognize the
398level of responsiveness to medical needs in trauma cases, and
399require cost containment including, but not limited to, case
400management. It must also provide that any hospitals that are
401owned and operated by government entities on May 21, 1991, must,
402as a condition of receiving funds under this subsection, afford
403public access equal to that provided under s. 286.011 as to
404meetings of the governing board, the subject of which is
405budgeting resources for the rendition of charity care as that
406term is defined in the Florida Hospital Uniform Reporting System
407(FHURS) manual referenced in s. 408.07. The plan shall also
408include innovative health care programs that provide cost-
409effective alternatives to traditional methods of service
410delivery and funding.
411     4.  For the purpose of this paragraph, the term "qualified
412resident" means residents of the authorizing county who are:
413     a.  Qualified as indigent persons as certified by the
414authorizing county;
415     b.  Certified by the authorizing county as meeting the
416definition of the medically poor, defined as persons having
417insufficient income, resources, and assets to provide the needed
418medical care without using resources required to meet basic
419needs for shelter, food, clothing, and personal expenses; or not
420being eligible for any other state or federal program, or having
421medical needs that are not covered by any such program; or
422having insufficient third-party insurance coverage. In all
423cases, the authorizing county is intended to serve as the payor
424of last resort; or
425     c.  Participating in innovative, cost-effective programs
426approved by the authorizing county.
427     5.  Moneys collected pursuant to this paragraph remain the
428property of the state and shall be distributed by the Department
429of Revenue on a regular and periodic basis to the clerk of the
430circuit court as ex officio custodian of the funds of the
431authorizing county. The clerk of the circuit court shall:
432     a.  Maintain the moneys in an indigent health care trust
433fund;
434     b.  Invest any funds held on deposit in the trust fund
435pursuant to general law;
436     c.  Disburse the funds, including any interest earned, to
437any provider of health care services, as provided in
438subparagraphs 3. and 4., upon directive from the authorizing
439county. However, if a county has a population of at least
440800,000 residents and has levied the surtax authorized in this
441paragraph, notwithstanding any directive from the authorizing
442county, on October 1 of each calendar year, the clerk of the
443court shall issue a check in the amount of $6.5 million to a
444hospital in its jurisdiction that has a Level I trauma center or
445shall issue a check in the amount of $3.5 million to a hospital
446in its jurisdiction that has a Level I trauma center if that
447county enacts and implements a hospital lien law in accordance
448with chapter 98-499, Laws of Florida. The issuance of the checks
449on October 1 of each year is provided in recognition of the
450Level I trauma center status and shall be in addition to the
451base contract amount received during fiscal year 1999-2000 and
452any additional amount negotiated to the base contract. If the
453hospital receiving funds for its Level I trauma center status
454requests such funds to be used to generate federal matching
455funds under Medicaid, the clerk of the court shall instead issue
456a check to the Agency for Health Care Administration to
457accomplish that purpose to the extent that it is allowed through
458the General Appropriations Act; and
459     d.  Prepare on a biennial basis an audit of the trust fund
460specified in sub-subparagraph a. Commencing February 1, 2004,
461such audit shall be delivered to the governing body and to the
462chair of the legislative delegation of each authorizing county.
463     6.  Notwithstanding any other provision of this section, a
464county shall not levy local option sales surtaxes authorized in
465this paragraph and subsections (2) and (3) in excess of a
466combined rate of 1 percent.
467     (b)  Notwithstanding any other provision of this section,
468the governing body in each county the government of which is not
469consolidated with that of one or more municipalities and which
470has a population of less than 800,000 residents, may levy, by
471ordinance subject to approval by a majority of the electors of
472the county voting in a referendum, a discretionary sales surtax
473at a rate that may not exceed 0.25 percent for the sole purpose
474of funding trauma services provided by a trauma center licensed
475pursuant to chapter 395.
476     1.  A statement that includes a brief and general
477description of the purposes to be funded by the surtax and that
478conforms to the requirements of s. 101.161 shall be placed on
479the ballot by the governing body of the county. The following
480shall be placed on the ballot:
481
482_____FOR THE_____CENTS TAX
483_____AGAINST THE_____CENTS TAX
484     2.  The ordinance adopted by the governing body of the
485county providing for the imposition of the surtax shall set
486forth a plan for providing trauma services to trauma victims
487presenting in the trauma service area in which such county is
488located.
489     3.  Moneys collected pursuant to this paragraph remain the
490property of the state and shall be distributed by the Department
491of Revenue on a regular and periodic basis to the clerk of the
492circuit court as ex officio custodian of the funds of the
493authorizing county. The clerk of the circuit court shall:
494     a.  Maintain the moneys in a trauma services trust fund.
495     b.  Invest any funds held on deposit in the trust fund
496pursuant to general law.
497     c.  Disburse the funds, including any interest earned on
498such funds, to the trauma center in its trauma service area, as
499provided in the plan set forth pursuant to subparagraph 2., upon
500directive from the authorizing county. If the trauma center
501receiving funds requests such funds be used to generate federal
502matching funds under Medicaid, the custodian of the funds shall
503instead issue a check to the Agency for Health Care
504Administration to accomplish that purpose to the extent that the
505agency is allowed through the General Appropriations Act.
506     d.  Prepare on a biennial basis an audit of the trauma
507services trust fund specified in sub-subparagraph a., to be
508delivered to the authorizing county.
509     4.  A discretionary sales surtax imposed pursuant to this
510paragraph shall expire 4 years after the effective date of the
511surtax, unless reenacted by ordinance subject to approval by a
512majority of the electors of the county voting in a subsequent
513referendum.
514     5.  Notwithstanding any other provision of this section, a
515county shall not levy local option sales surtaxes authorized in
516this paragraph and subsections (2) and (3) in excess of a
517combined rate of 1 percent.
518     (5)  COUNTY PUBLIC HOSPITAL SURTAX.--Any county as defined
519in s. 125.011(1) may levy the surtax authorized in this
520subsection pursuant to an ordinance either approved by
521extraordinary vote of the county commission or conditioned to
522take effect only upon approval by a majority vote of the
523electors of the county voting in a referendum. In a county as
524defined in s. 125.011(1), for the purposes of this subsection,
525"county public general hospital" means a general hospital as
526defined in s. 395.002 which is owned, operated, maintained, or
527governed by the county or its agency, authority, or public
528health trust.
529     (a)  The rate shall be 0.5 percent.
530     (b)  If the ordinance is conditioned on a referendum, the
531proposal to adopt the county public hospital surtax shall be
532placed on the ballot in accordance with law at a time to be set
533at the discretion of the governing body. The referendum question
534on the ballot shall include a brief general description of the
535health care services to be funded by the surtax.
536     (c)  Proceeds from the surtax shall be:
537     1.  Deposited by the county in a special fund, set aside
538from other county funds, to be used only for the operation,
539maintenance, and administration of the county public general
540hospital; and
541     2.  Remitted promptly by the county to the agency,
542authority, or public health trust created by law which
543administers or operates the county public general hospital.
544     (d)  Except as provided in subparagraphs 1. and 2., the
545county must continue to contribute each year an amount equal to
546at least 80 percent of that percentage of the total county
547budget appropriated for the operation, administration, and
548maintenance of the county public general hospital from the
549county's general revenues in the fiscal year of the county
550ending September 30, 1991:
551     1.  Twenty-five percent of such amount must be remitted to
552a governing board, agency, or authority that is wholly
553independent from the public health trust, agency, or authority
554responsible for the county public general hospital, to be used
555solely for the purpose of funding the plan for indigent health
556care services provided for in paragraph (e);
557     2.  However, in the first year of the plan, a total of $10
558million shall be remitted to such governing board, agency, or
559authority, to be used solely for the purpose of funding the plan
560for indigent health care services provided for in paragraph (e),
561and in the second year of the plan, a total of $15 million shall
562be so remitted and used.
563     (e)  A governing board, agency, or authority shall be
564chartered by the county commission upon this act becoming law.
565The governing board, agency, or authority shall adopt and
566implement a health care plan for indigent health care services.
567The governing board, agency, or authority shall consist of no
568more than seven and no fewer than five members appointed by the
569county commission. The members of the governing board, agency,
570or authority shall be at least 18 years of age and residents of
571the county. No member may be employed by or affiliated with a
572health care provider or the public health trust, agency, or
573authority responsible for the county public general hospital.
574The following community organizations shall each appoint a
575representative to a nominating committee: the South Florida
576Hospital and Healthcare Association, the Miami-Dade County
577Public Health Trust, the Dade County Medical Association, the
578Miami-Dade County Homeless Trust, and the Mayor of Miami-Dade
579County. This committee shall nominate between 10 and 14 county
580citizens for the governing board, agency, or authority. The
581slate shall be presented to the county commission and the county
582commission shall confirm the top five to seven nominees,
583depending on the size of the governing board. Until such time as
584the governing board, agency, or authority is created, the funds
585provided for in subparagraph (d)2. shall be placed in a
586restricted account set aside from other county funds and not
587disbursed by the county for any other purpose.
588     1.  The plan shall divide the county into a minimum of four
589and maximum of six service areas, with no more than one
590participant hospital per service area. The county public general
591hospital shall be designated as the provider for one of the
592service areas. Services shall be provided through participants'
593primary acute care facilities.
594     2.  The plan and subsequent amendments to it shall fund a
595defined range of health care services for both indigent persons
596and the medically poor, including primary care, preventive care,
597hospital emergency room care, and hospital care necessary to
598stabilize the patient. For the purposes of this section,
599"stabilization" means stabilization as defined in s.
600397.311(30). Where consistent with these objectives, the plan
601may include services rendered by physicians, clinics, community
602hospitals, and alternative delivery sites, as well as at least
603one regional referral hospital per service area. The plan shall
604provide that agreements negotiated between the governing board,
605agency, or authority and providers shall recognize hospitals
606that render a disproportionate share of indigent care, provide
607other incentives to promote the delivery of charity care to draw
608down federal funds where appropriate, and require cost
609containment, including, but not limited to, case management.
610From the funds specified in subparagraphs (d)1. and 2. for
611indigent health care services, service providers shall receive
612reimbursement at a Medicaid rate to be determined by the
613governing board, agency, or authority created pursuant to this
614paragraph for the initial emergency room visit, and a per-member
615per-month fee or capitation for those members enrolled in their
616service area, as compensation for the services rendered
617following the initial emergency visit. Except for provisions of
618emergency services, upon determination of eligibility,
619enrollment shall be deemed to have occurred at the time services
620were rendered. The provisions for specific reimbursement of
621emergency services shall be repealed on July 1, 2001, unless
622otherwise reenacted by the Legislature. The capitation amount or
623rate shall be determined prior to program implementation by an
624independent actuarial consultant. In no event shall such
625reimbursement rates exceed the Medicaid rate. The plan must also
626provide that any hospitals owned and operated by government
627entities on or after the effective date of this act must, as a
628condition of receiving funds under this subsection, afford
629public access equal to that provided under s. 286.011 as to any
630meeting of the governing board, agency, or authority the subject
631of which is budgeting resources for the retention of charity
632care, as that term is defined in the rules of the Agency for
633Health Care Administration. The plan shall also include
634innovative health care programs that provide cost-effective
635alternatives to traditional methods of service and delivery
636funding.
637     3.  The plan's benefits shall be made available to all
638county residents currently eligible to receive health care
639services as indigents or medically poor as defined in paragraph
640(4)(d).
641     4.  Eligible residents who participate in the health care
642plan shall receive coverage for a period of 12 months or the
643period extending from the time of enrollment to the end of the
644current fiscal year, per enrollment period, whichever is less.
645     5.  At the end of each fiscal year, the governing board,
646agency, or authority shall prepare an audit that reviews the
647budget of the plan, delivery of services, and quality of
648services, and makes recommendations to increase the plan's
649efficiency. The audit shall take into account participant
650hospital satisfaction with the plan and assess the amount of
651poststabilization patient transfers requested, and accepted or
652denied, by the county public general hospital.
653     (f)  Notwithstanding any other provision of this section, a
654county may not levy local option sales surtaxes authorized in
655this subsection and subsections (2) and (3) in excess of a
656combined rate of 1 percent.
657     (6)  SCHOOL CAPITAL OUTLAY SURTAX.--
658     (a)  The school board in each county may levy, pursuant to
659resolution conditioned to take effect only upon approval by a
660majority vote of the electors of the county voting in a
661referendum, a discretionary sales surtax at a rate that may not
662exceed 0.5 percent.
663     (b)  The resolution shall include a statement that provides
664a brief and general description of the school capital outlay
665projects to be funded by the surtax. The statement shall conform
666to the requirements of s. 101.161 and shall be placed on the
667ballot by the governing body of the county. The following
668question shall be placed on the ballot:
669
670_____FOR THE_____CENTS TAX
671_____AGAINST THE_____CENTS TAX
672     (c)  The resolution providing for the imposition of the
673surtax shall set forth a plan for use of the surtax proceeds for
674fixed capital expenditures or fixed capital costs associated
675with the construction, reconstruction, or improvement of school
676facilities and campuses which have a useful life expectancy of 5
677or more years, and any land acquisition, land improvement,
678design, and engineering costs related thereto. Additionally, the
679plan shall include the costs of retrofitting and providing for
680technology implementation, including hardware and software, for
681the various sites within the school district. Surtax revenues
682may be used for the purpose of servicing bond indebtedness to
683finance projects authorized by this subsection, and any interest
684accrued thereto may be held in trust to finance such projects.
685Neither the proceeds of the surtax nor any interest accrued
686thereto shall be used for operational expenses.
687     (d)  Any school board imposing the surtax shall implement a
688freeze on noncapital local school property taxes, at the millage
689rate imposed in the year prior to the implementation of the
690surtax, for a period of at least 3 years from the date of
691imposition of the surtax. This provision shall not apply to
692existing debt service or taxes authorized in the General
693Appropriations Act.
694     (e)  Surtax revenues collected by the Department of Revenue
695pursuant to this subsection shall be distributed to the school
696board imposing the surtax in accordance with law.
697     (7)  VOTER-APPROVED INDIGENT CARE SURTAX.--
698     (a)1.  The governing body in each county that has a
699population of fewer than 800,000 residents may levy an indigent
700care surtax pursuant to an ordinance conditioned to take effect
701only upon approval by a majority vote of the electors of the
702county voting in a referendum. The surtax may be levied at a
703rate not to exceed 0.5 percent, except that if a publicly
704supported medical school is located in the county, the rate
705shall not exceed 1 percent.
706     2.  Notwithstanding subparagraph 1., the governing body of
707any county that has a population of fewer than 50,000 residents
708may levy an indigent care surtax pursuant to an ordinance
709conditioned to take effect only upon approval by a majority vote
710of the electors of the county voting in a referendum. The surtax
711may be levied at a rate not to exceed 1 percent.
712     (b)  A statement that includes a brief and general
713description of the purposes to be funded by the surtax and that
714conforms to the requirements of s. 101.161 shall be placed on
715the ballot by the governing body of the county. The following
716questions shall be placed on the ballot:
717
718_____FOR THE_____CENTS TAX
719_____AGAINST THE_____CENTS TAX
720     (c)1.  The ordinance adopted by the governing body
721providing for the imposition of the surtax must set forth a plan
722for providing health care services to qualified residents, as
723defined in paragraph (d). The plan and subsequent amendments to
724it shall fund a broad range of health care services for indigent
725persons and the medically poor, including, but not limited to,
726primary care and preventive care, as well as hospital care. It
727shall emphasize a continuity of care in the most cost-effective
728setting, taking into consideration a high quality of care and
729geographic access. Where consistent with these objectives, it
730shall include, without limitation, services rendered by
731physicians, clinics, community hospitals, mental health centers,
732and alternative delivery sites, as well as at least one regional
733referral hospital where appropriate. It shall provide that
734agreements negotiated between the county and providers shall
735include reimbursement methodologies that take into account the
736cost of services rendered to eligible patients, recognize
737hospitals that render a disproportionate share of indigent care,
738provide other incentives to promote the delivery of charity
739care, and require cost containment, including, but not limited
740to, case management. The plan must also include innovative
741health care programs that provide cost-effective alternatives to
742traditional methods of service delivery and funding.
743     2.  In addition to the uses specified or services required
744to be provided under this subsection, the ordinance adopted by a
745county that has a population of fewer than 50,000 residents may
746pledge surtax proceeds to service new or existing bond
747indebtedness incurred to finance, plan, construct, or
748reconstruct a public or not-for-profit hospital in such county
749and any land acquisition, land improvement, design, or
750engineering costs related to such hospital, if the governing
751body of the county determines that a public or not-for-profit
752hospital existing at the time of issuance of the bonds
753authorized under this subparagraph would, more likely than not,
754otherwise cease to operate. The plan required under this
755paragraph may, by an extraordinary vote of the governing body of
756such county, provide that some or all of the surtax revenues and
757any interest earned must be expended for the purpose of
758servicing such bond indebtedness. Such county may also use the
759services of the Division of Bond Finance of the State Board of
760Administration pursuant to the State Bond Act to issue bonds
761under this subparagraph. A jurisdiction may not issue bonds
762under this subparagraph more frequently than once per year. Any
763county that has a population of fewer than 50,000 residents at
764the time any bonds authorized in this subparagraph are issued
765retains the authority granted under this subparagraph throughout
766the terms of such bonds, including the term of any refinancing
767bonds, regardless of any subsequent increase in population which
768would result in such county having 50,000 or more residents.
769     (d)  For the purpose of this subsection, the term
770"qualified residents" means residents of the authorizing county
771who are:
772     1.  Qualified as indigent persons as certified by the
773authorizing county;
774     2.  Certified by the authorizing county as meeting the
775definition of the medically poor, defined as persons having
776insufficient income, resources, and assets to provide the needed
777medical care without using resources required to meet basic
778needs for shelter, food, clothing, and personal expenses; not
779being eligible for any other state or federal program or having
780medical needs that are not covered by any such program; or
781having insufficient third-party insurance coverage. In all
782cases, the authorizing county shall serve as the payor of last
783resort; or
784     3.  Participating in innovative, cost-effective programs
785approved by the authorizing county.
786     (e)  Moneys collected pursuant to this subsection remain
787the property of the state and shall be distributed by the
788Department of Revenue on a regular and periodic basis to the
789clerk of the circuit court as ex officio custodian of the funds
790of the authorizing county. The clerk of the circuit court shall:
791     1.  Maintain the moneys in an indigent health care trust
792fund.
793     2.  Invest any funds held on deposit in the trust fund
794pursuant to general law.
795     3.  Disburse the funds, including any interest earned, to
796any provider of health care services, as provided in paragraphs
797(c) and (d), upon directive from the authorizing county.
798     4.  Disburse the funds, including any interest earned, to
799service any bond indebtedness authorized in this subsection upon
800directive from the authorizing county, which directive may be
801irrevocably given at the time the bond indebtedness is incurred.
802     (f)  Notwithstanding any other provision of this section, a
803county may not levy local option sales surtaxes authorized in
804this subsection and subsections (2) and (3) in excess of a
805combined rate of 1 percent or, if a publicly supported medical
806school is located in the county or the county has a population
807of fewer than 50,000 residents, in excess of a combined rate of
8081.5 percent.
809     Section 2.  This act shall take effect July 1, 2009.


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