By Berlanga H.B. No. 1338
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to temporary reciprocal licenses for certain physicians,
1-3 the relationship between hospitals and other health care providers
1-4 in rural areas, establishing a program to assist certain nonprofit
1-5 organizations in recruiting and retaining health professionals to
1-6 practice in medically underserved areas, the distribution of
1-7 certain fees collected and tuition charged at medical schools.
1-8 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-9 SECTION 1. This Act may be cited as the Omnibus Health
1-10 Professional Shortage Act.
1-11 SECTION 2. Section 3.031, Medical Practice Act (Article
1-12 4495b, Texas Revised Civil Statutes) is amended to read as follow:
1-13 Sec. 3.031. (a) The board shall issue a temporary
1-14 reciprocal license to a physician who:
1-15 (1) meets the requirements of Section 3.03(a)(1) of
1-16 this Act;
1-17 (2) has accepted employment with a rural hospital, <of
1-18 the Texas Department of Mental Health and Mental Retardation;> is
1-19 employed by or contracts with a federally qualified health center,
1-20 contracts with an entity located in a medically underserved area or
1-21 locates in a medically underserved area;
1-22 (3) has not been subjected to disciplinary action by a
1-23 medical disciplinary authority of another jurisdiction;
2-1 (4) applies to the board in the manner prescribed by
2-2 the board; and,
2-3 (5) pays the required fee.
2-4 (b) The board may not require an examination for a license
2-5 issued under this section.
2-6 (c) The board may not issue a license under this section if
2-7 the National Practitioner Data Bank contains information about the
2-8 physician that indicates the existence of;
2-9 (1) adverse licensure actions;
2-10 (2) medical malpractice payments;
2-11 (3) adverse clinical privileges actions; or,
2-12 (4) adverse membership actions.
2-13 (d) A license issued under this section expires on the
2-14 earlier of;
2-15 (1) the date the physician ceases to <be employed by a
2-16 rural hospital of the Texas Department of Mental Health and Mental
2-17 Retardation> meets the requirements of subsection (a)(2) of this
2-18 Section; or,
2-19 (2) the second anniversary of the issuance of the
2-20 license.
2-21 (e) A license issued under this section that has expired may
2-22 not be renewed.
2-23 (f) In this section:
2-24 (1) "Federally Qualified Health Center" means a
2-25 federally qualified health center, as that term is defined by 42
3-1 U.S.C. Sec. 1396d.
3-2 (2) "Medically underserved area" means: an area
3-3 designated by the United States Secretary of Health and Human
3-4 Services as having:
3-5 (a) a shortage of personal health services or a
3-6 population group that has such a shortage as provided by 42 U.S.C.
3-7 Section 300e-1(7); or,
3-8 (b) a health professional shortage as provided by 42
3-9 U.S.C. Section 254e(a)(1).
3-10 <(1)> (3) "National Practitioner Data Bank" means the
3-11 National Practitioner Data Bank established by the United States
3-12 Department of Health and Human Services under Title 45, Code of
3-13 Federal Regulations, Part 60.
3-14 <(2)> (4) "Rural hospital" means a hospital located
3-15 in a county that has a population of 35,000 or less, according to
3-16 the most recent federal decennial census.
3-17 SECTION 3. Subchapter B, Chapter 12, Health and Safety Code,
3-18 is amended by adding Section 12.017 to read as follows:
3-19 Sec. 12.017. MONITORING THE PROVISION OF RURAL HEALTH CARE.
3-20 (a) The department shall monitor the relationship in a rural area
3-21 between a hospital and other health care providers that provide
3-22 health care services outside of that hospital and shall annually
3-23 make a determination concerning their compliance with federal
3-24 regulations regarding that relationship.
3-25 (b) Not later than 30 days after the department makes its
4-1 determination under Subsection (a), the department shall notify the
4-2 hospital and the health care provider of its determination. If the
4-3 department determines that a hospital and health care provider are
4-4 not complying with federal regulations regarding their
4-5 relationship, the department shall notify the hospital and the
4-6 health care provider of the problem area.
4-7 SECTION 4. Subtitle B, Title 2, Health and Safety Code, is
4-8 amended by adding Chapter 45 to read as follows:
4-9 CHAPTER 45. HEALTH PROFESSIONAL RECRUITMENT
4-10 Sec. 45.001. DEFINITION. In this chapter; (a) "health
4-11 professional" means:
4-12 (1) a resident physician who is enrolled in an
4-13 accredited residency training program in Texas in the specialties
4-14 of family practice, general practice, general internal medicine,
4-15 general pediatric medicine, or general obstetrics and gynecology;
4-16 (2) a registered nurse who is enrolled in an
4-17 accredited advanced nurse practitioner program in Texas leading to
4-18 registration with the Board of Nurse Examiners as an advanced nurse
4-19 practitioner in general pediatrics, family, school, gerontological
4-20 or women's health or as a certified nurse midwife; or,
4-21 (3) a student enrolled in the final year of a
4-22 bachelor's or in a master's level physician assistant program
4-23 approved by the Council on Allied Health Education.
4-24 (4) A person may not be considered a health
4-25 professional eligible for a grant under this chapter for a period
5-1 of time longer than is ordinarily and customarily required for the
5-2 course of study or the completion of training.
5-3 (b) "Medically underserved area" means an area designated by
5-4 the United States Secretary of Health and Human Services as having:
5-5 (1) a shortage of personal health services or a
5-6 population group that has such a shortage as provided by 42 U.S.C.
5-7 Section 300e-1(7); or
5-8 (2) a health professional shortage as provided by 42
5-9 U.S.C. Section 254e(a)(1).
5-10 Sec. 45.002. HEALTH PROFESSIONAL RECRUITMENT PROGRAM.
5-11 (a) The board shall establish a grant program in the department to
5-12 assist nonprofit, community-based organizations in recruiting and
5-13 retaining health professionals to practice in medically underserved
5-14 areas.
5-15 (b) The board by rule shall establish:
5-16 (1) eligibility criteria for applicants;
5-17 (2) grant application procedures;
5-18 (3) guidelines relating to grant amounts; and
5-19 (4) procedures for evaluating grant applications.
5-20 (c) The board by rule shall establish a system of priorities
5-21 relating to the types of services provided, organizations eligible,
5-22 geographic areas covered, or classes of health professions eligible
5-23 to receive grant money.
5-24 Sec. 45.003. ADMINISTRATION. (a) The board shall adopt
5-25 rules necessary to administer this chapter, and the department
6-1 shall administer the program in accordance with board rules.
6-2 (b) The department shall, in conjunction with the Center for
6-3 Rural Health Initiatives, conduct field research, collect data, and
6-4 prepare statistical and other reports relating to the need for the
6-5 program.
6-6 Sec. 45.004. GRANTS. (a) A nonprofit, community-based
6-7 organization located in a medically underserved area may apply for
6-8 one or more grants under this chapter.
6-9 (b) An organization may use a grant awarded under this
6-10 section only to assist the organization in paying for the salary or
6-11 expenses of a health professional who will provide services to the
6-12 organization, in accordance with Section 45.005, in one or more of
6-13 the following:
6-14 (1) family practice;
6-15 (2) general practice;
6-16 (3) general internal medicine;
6-17 (4) general pediatric medicine;
6-18 (5) general obstetrics and gynecology;
6-19 (6) school health;
6-20 (7) geriatric health; or
6-21 (8) women's health.
6-22 (c) The department shall award grants that continue for one
6-23 year. A grant awarded under this section may not exceed $15,000
6-24 per year.
6-25 (d) At the end of the grant period, an organization shall
7-1 return to the department any unused grant money, regardless of the
7-2 reason the money was not used.
7-3 (e) The department may renew a grant used to assist a
7-4 particular health professional, and may continue to award grants to
7-5 an organization to assist other health professionals.
7-6 Sec. 45.005. REQUIRED CONTRACT. (a) An organization may
7-7 pay grant money to a health professional only if the health
7-8 professional signs a contract agreeing to provide services to the
7-9 organization in accordance with Section 45.004 for at least one
7-10 year for each year that the health professional received a grant
7-11 under this chapter.
7-12 (b) The contract must provide that if the health
7-13 professional does not provide the required services to the
7-14 organization or provides those services for less than the required
7-15 term, the health professional is personally liable to the state
7-16 for:
7-17 (1) the total amount of grant money the health
7-18 professional received;
7-19 (2) interest on that total amount at a rate of 12
7-20 percent for the period beginning on the date the health
7-21 professional signs the contract and ending on the date the health
7-22 professional repays the grant amount; and
7-23 (3) the state's reasonable expenses incurred in
7-24 obtaining payment, including reasonable attorney's fees.
7-25 Sec. 45.006. FUNDING. The board may seek, receive, and
8-1 spend funds received through an appropriation, grant, donation, or
8-2 reimbursement from any public or private source to administer this
8-3 chapter.
8-4 SECTION 5. Chapters 58, 61.097-61.099 of the Texas Education
8-5 Code, Compensation of Resident Physicians, are repealed.
8-6 SECTION 6. Section 51.002(a), Education Code, is amended to
8-7 read as follows:
8-8 (a) Except as provided by Section 51.0085 of this code, the
8-9 <The> governing board of each institution listed in Section 51.001
8-10 of this code may retain control of the following sums of money
8-11 collected at the institution, subject to Section 51.008 of this
8-12 code:
8-13 (1) student fees of all kinds;
8-14 (2) charges for use of rooms and dormitories;
8-15 (3) receipts from meals, cafes, and cafeterias;
8-16 (4) fees on deposit refundable to students under
8-17 certain conditions;
8-18 (5) receipts from school athletic activities;
8-19 (6) income from student publications and other student
8-20 activities;
8-21 (7) receipts from the sale of publication products and
8-22 miscellaneous supplies and equipment;
8-23 (8) students' voluntary deposits of money for
8-24 safekeeping;
8-25 (9) all other fees and local or institutional funds
9-1 arising out of and by virtue of the educational activities,
9-2 research, or demonstrations carried on by the institution; and
9-3 (10) donations and gifts to the institution.
9-4 SECTION 7. Subchapter A, Chapter 51, Education Code, is
9-5 amended by adding Section 51.0085 to read as follows:
9-6 Sec. 51.0085. CERTAIN HOSPITAL, CLINIC, AND DOCTOR FEES. In
9-7 this section: (a) "medically underserved area" means an area
9-8 designated by the United States Secretary of Health and Human
9-9 Services as having:
9-10 (1) a shortage of personal health services or a
9-11 population group that has such a shortage as provided by 42 U.S.C.
9-12 Section 300e-1(7); or
9-13 (2) a health professional shortage as provided by 42
9-14 U.S.C. Section 254e(a)(1).
9-15 (b) A special account known as the health care account is
9-16 created in the general revenue fund.
9-17 (c) The governing board of each medical school, as defined
9-18 by Section 61.501 of this code, shall remit to the state treasurer
9-19 twenty percent (20%) of all hospital, clinic, and doctor fees
9-20 collected by the medical school. The state treasurer shall deposit
9-21 money remitted under this section to the credit of the health care
9-22 account. The percentage of all hospital, clinic and doctor fees
9-23 collected by each medical school and remitted to the health care
9-24 account shall increase by an additional five percent (5%) each year
9-25 commencing in fiscal year 1995 until an individual medical school
10-1 can demonstrate that fifty percent (50%) of their graduates are
10-2 completing residencies and practicing in the primary care
10-3 specialties of family practice, general practice, general internal
10-4 medicine, general pediatric medicine or general obstetrics and
10-5 gynecology.
10-6 (d) The health care account consists of money credited to
10-7 the fund under Subsection (c) of this section, gifts, grants, and
10-8 funds appropriated by the legislature.
10-9 (e) Money in the account may be appropriated only to the
10-10 governing board of each medical school for primary patient care
10-11 personnel and programs, educational personnel and support,
10-12 institutional development and recruitment and new program
10-13 development that encourages health profession students in medicine,
10-14 nursing, dentistry or allied health to specialize in primary care
10-15 delivery in medically underserved areas.
10-16 (f) Money in the account appropriated to the governing board
10-17 of each medical school may not be expended unless the governing
10-18 board of each medical school shall first submit, and have approved
10-19 by the Higher Education Coordinating Board, a plan describing the
10-20 specific uses of funds in the health care account. The plan must
10-21 include, at a minimum, provisions relating to:
10-22 (1) recruitment and admissions of students from
10-23 medically underserved areas and populations;
10-24 (2) promotion, tenure and development of primary care
10-25 faculty;
11-1 (3) team-training for students in all health
11-2 profession degree programs;
11-3 (4) support for third-year clerkships in family
11-4 medicine;
11-5 (5) creation of endowed chairs in primary care,
11-6 preventive and public health in all health profession schools; and,
11-7 (6) establishment of affiliation agreements with
11-8 hospitals and clinics in medically underserved areas that provide
11-9 for rotations of health profession students through these settings.
11-10 (g) The initial annual plan required in subsection (f) must
11-11 be submitted no later than April 1, 1994, and approved for
11-12 implementation by no later than July 1, 1994.
11-13 SECTION 8. Section 51.009(c), Education Code, is amended to
11-14 read as follows:
11-15 (c) Each of the following shall be accounted for as
11-16 educational and general funds: net tuition, special course fees
11-17 charged under Sections 54.051(e) and (l), Education Code, lab fees,
11-18 student teaching fees, hospital, <and> clinic, and doctor fees,
11-19 organized activity fees, proceeds from the sale of educational and
11-20 general equipment, and indirect cost recovery fees.
11-21 SECTION 9. Section 54.051(f), Education Code, is amended to
11-22 read as follows:
11-23 (f) Tuition for a resident student enrolled in a program
11-24 leading to an M.D. or D.O. degree is <$6,550 per academic year.
11-25 Tuition for a nonresident student enrolled in a program leading to
12-1 an M.D. or D.O. degree is an amount per year equal to three times
12-2 the rate that a resident student enrolled in a program leading to
12-3 an M.D. or D.O. degree would pay during the corresponding academic
12-4 year.> an amount equal to thirty percent (30%) of the
12-5 appropriation per medical student in the most recent fiscal year as
12-6 determined by the Texas Higher Education Coordinating Board.
12-7 SECTION 10. Section 51.008(b), Education Code, is amended to
12-8 read as follows:
12-9 (b) Except as provided by Section 51.0085 of this code, the
12-10 <The> governing board of every state institution of higher
12-11 education shall deposit in the state treasury all cash receipts
12-12 accruing to any college or university under its control that may be
12-13 derived from all sources except auxiliary enterprises,
12-14 noninstructional services, agency, designated, and restricted
12-15 funds, endowment and other gift funds, student loan funds, funds
12-16 retained under Chapter 145 of this code, and Constitutional College
12-17 Building Amendment funds. The state treasurer is directed to
12-18 credit such receipts deposited by each such institution to a
12-19 separate fund account for the institution depositing the receipts,
12-20 but he shall not be required to keep separate accounts of types of
12-21 funds deposited by each institution. For the purpose of
12-22 facilitating the transferring of such institutional receipts to the
12-23 state treasury, each institution shall open in a local depository
12-24 bank a clearing account to which it shall deposit daily all such
12-25 receipts, and shall, not less often than every seven days, make
13-1 remittances therefrom to the state treasurer of all except $500 of
13-2 the total balance in said clearing account by the duly authorized
13-3 officers of the institution, and no disbursements other than
13-4 remittances to the state treasury shall be made from such clearing
13-5 account. All money so deposited in the state treasury shall be
13-6 paid out on warrants drawn by the comptroller of public accounts as
13-7 provided by law.
13-8 SECTION 11. Subchapter A, Chapter 51, Education Code, is
13-9 amended by adding Section 51.0085 to read as follows:
13-10 Sec. 51.0085. NET MEDICAL SCHOOL TUITION. (a) A
13-11 special account known as the medical loan forgiveness account is
13-12 created in the general revenue fund.
13-13 (b) The governing body of each medical school, as defined by
13-14 Section 61.501, shall remit to the state treasurer five percent
13-15 (5%) of the net tuition collected at the medical school. The state
13-16 treasurer shall deposit money remitted under this section to the
13-17 credit of the medical loan forgiveness account.
13-18 (c) The medical loan forgiveness account consists of money
13-19 credited to the account under Subsection (b) of this section,
13-20 gifts, grants, and funds appropriated by the legislature.
13-21 (d) Money in the medical loan forgiveness account may be
13-22 appropriated only to the Texas Higher Education Coordinating Board
13-23 for the purpose of supporting administrative expenses incurred in
13-24 administering the Medical Loan Forgiveness Program.
13-25 SECTION 12. Subchapter B, Chapter 54, Education Code, is
14-1 amended by adding Section 54.066 to read as follows:
14-2 Sec. 54.066 MEDICAL LOAN FORGIVENESS PROGRAM
14-3 (a) There is hereby created the Medical Loan Forgiveness
14-4 Program. The purpose of the program shall be to enable Texas
14-5 residents who desire to become physicians to obtain a deferment of
14-6 the tuition and other expenses incurred in obtaining a medical
14-7 education.
14-8 (b) The Higher Education Coordinating Board shall establish
14-9 rules necessary to administer this section. The rules shall
14-10 provide the maximum annual deferment which may be made under this
14-11 program at an amount not to exceed the cost of tuition and other
14-12 expenses. Deferment granted pursuant to this section may not
14-13 exceed the length of time required to complete the degree
14-14 requirements.
14-15 (c) Students under this program shall be eligible for
14-16 deferment of their tuition and other expenses incurred during
14-17 attendance as full-time medical students approved by the Higher
14-18 Education Coordinating Board. No interest shall accrue on the
14-19 amount deferred until one (1) month after graduation, completion of
14-20 residency or termination of full-time student status.
14-21 (d) Deferments made to students shall be made and based upon
14-22 the following options for repayment or conversion to interest-free
14-23 scholarships:
14-24 (1) Payment in full of principal and interest must be
14-25 made in sixty (60) or less equal monthly installments, commencing
15-1 one (1) month after graduation, completion of residency or
15-2 termination of full-time student status. Repayment under this
15-3 option shall convert the amount deferred to a loan which will
15-4 accrue interest on the total amount at the rate of 12% for the
15-5 period beginning on the date the student graduates, completes
15-6 residency training or terminates full-time medical student status.
15-7 (2) In lieu of payment in full of both the principal
15-8 deferred and any interest accrued, a student may elect to repay the
15-9 amount deferred by entry into the practice of medicine in a primary
15-10 health care field located in a medically underserved area of the
15-11 state for a period of one year for each year the student receives a
15-12 deferment of their tuition and other expenses. Repayment under
15-13 this option shall convert the amount deferred to a scholarship and
15-14 discharge the same on the basis of one (1) year's service for one
15-15 (1) year's deferment, or the appropriate proportion of the total
15-16 outstanding balance of principal and interest, as established by
15-17 rule of the Higher Education Coordinating Board. If at any time
15-18 prior to the repayment in full of the total obligation the student
15-19 abandons or abrogates repayment under this option, the provision of
15-20 Section (d)(4) shall apply.
15-21 (3) In lieu of payment in full of both the principal
15-22 deferred and any interest accrued, a student may elect to repay the
15-23 amount deferred by entry in the practice of medicine in a primary
15-24 health care field at a federally qualified health center within the
15-25 state for a period of three (3) years. Repayment under this option
16-1 shall convert the amount deferred to a scholarship and discharge
16-2 the same on the basis of one (1) year's service to the appropriate
16-3 portion of the total outstanding balance of principal and interest,
16-4 as established by rule of the Higher Education Coordinating Board.
16-5 If at any time prior to the repayment in full of the total
16-6 obligation the student abandons or abrogates repayment under this
16-7 option, the provision of section (d)(4) apply.
16-8 (4) If the student abandons or abrogates the options
16-9 for repayment as provided for in Sections (d)(2) or (3), the
16-10 remaining balance of unpaid or undischarged principal and interest
16-11 shall become due and payable over the remaining period of time as
16-12 if the option provided by Section (d)(1) had been elected upon
16-13 graduation, completion of residency or termination of full time
16-14 student status.
16-15 (5) If a student does not provide the required
16-16 service, provides those services for less than the required term or
16-17 fails to make payments pursuant to option (d)(1), the student
16-18 shall, in addition to any principal and interest, be personally
16-19 liable to the state for the state's reasonable expenses incurred in
16-20 obtaining payment, including reasonable attorney's fees.
16-21 (e) In this section:
16-22 (1) "Federally Qualified Health Center" means a
16-23 federally qualified health center, as that term is defined by 42
16-24 U.S.C. Sec. 1396d.
16-25 (2) "Medically underserved area" means: an area
17-1 designated by the United States Secretary of Health and Human
17-2 Services as having:
17-3 (a) a shortage of personal health services or a
17-4 population group that has such a shortage as provided by 42 U.S.C.
17-5 Section 300e-1(7); or,
17-6 (b) a health professional shortage as provided by 42
17-7 U.S.C. Section 254e(a)(1).
17-8 (3) Primary health care practice means a practice in
17-9 the specialties of family practice, general practice, general
17-10 internal medicine, general pediatric medicine or general obstetrics
17-11 and gynecology.
17-12 SECTION 13. This Act takes effect September 1, 1993. The
17-13 Amendments to Sections 54.051(f) and 54.066, Education Code, apply
17-14 only to tuition that becomes due beginning with the fall semester
17-15 in 1993. Tuition that became due before that semester is governed
17-16 by the law in effect at the time the tuition became due, and that
17-17 law is continued in effect for this purpose only.
17-18 SECTION 14. The importance of this legislation and the
17-19 crowded condition of the calendars in both houses create an
17-20 emergency and an imperative public necessity that the
17-21 constitutional rule requiring bills to be read on three several
17-22 days in each house be suspended, and this rule is hereby suspended,
17-23 and that this Act take effect and be in force from and after its
17-24 passage, and it is so enacted.