COD E R E D

Cost SharingPatients are required to make co-payments for inpatient facility and physician services,outpatient physician services and prescription drugs. The co-payments vary by incomecategory and there is an annual cap on co-payments of $120 per year for the lowest incomecategory (families below 37% of FPL).AdministrationDenver Health is governed by a nine-member board that is appointed by the mayor andis also city/county council approved. To help protect the board from political pressures,members can only be removed by a confirming vote of the council. A chief executive officer isappointed by the nine-member governing board. DH has the authority to issue debt.Hillsborough County HealthCare Plan xiii,xiv,xv,xviHillsborough County, FloridaStart Date: 1992Hillsborough County pursued legislation to create funding to purchase a managed careplan for the uninsured. The managed care plan offers four benefit packages to different types ofeligible individuals. Participating providers are reimbursed on a fee-for-service basis at apercentage of Medicare payments.In the late 1980s, volunteer professionals met to discuss the problems of the main publichospital, Tampa General, and the safety net in Hillsborough County. They concluded that ahealth advisory board should be created to give recommendations to the CountyCommissioners of Hillsborough County. Around the same time, a group of health care expertsenvisioned a managed care plan to deliver health care to the uninsured and indigent. The intentwas to save money by decreasing inappropriate emergency room care and increasing primaryand preventative health care services through the managed care model. An attempt was madeby the County Commissioners, the local medical society, the recently created health advisoryboard, and several business and community leaders to lobby the state legislature to allow theadoption of a sales tax for the purpose of financing the managed care plan. The new taxlegislation did not receive enough support and the proposal was rejected. In 1991, the Countyforces united again and the state approved legislation which permitted counties with apopulation of 800,000 or more to tax up to one half of one percent of its infrastructure sales taxtowards uninsured and indigent health care. 4 With the revenues from this tax the HillboroughCounty HealthCare Plan (HCHCP) was created.The HCHCP offers staff model managed care provider networks to uninsured andindigent residents with incomes up to 100% of the FPL. The plan divides the county into fourzones and contracts with one preferred provider network in each zone using a competitivebidding process. In 1999, the Board of County Commissioners gave permission to the HCHCPto negotiate with current providers rather than undergo a competitive bidding process. Four4 Section 212.055, Florida Statutes. From the state approval, the Hillsborough Board of County Commissionersenacted Ordinance 91-19, allowing a half-cent sales tax. The $26.8 million per year on property taxation mandatedby the State legislature would continue in addition to the new taxing scheme.D-9