BILL ANALYSIS
C.S.H.B. 2311
By: Rangel
04-19-95
Committee Report (Substituted)
BACKGROUND
Texas has the largest shortage of primary care physicians of
any state in the nation, with more than 250 additional physicians
currently needed to obtain a ratio of 1 primary care physician to
every 4,500 Texans. Primary care physicians are physicians who
after completing three-year residencies in internal medicine,
pediatrics, or family practice pursue a general practice in those
specialties. Currently, there are no family/general practitioners
in 27 counties, no pediatricians in 162 counties, no general
internal medicine practitioners in 133 counties and no
obstetrician/gynecologists in 169 counties. In addition, 90.2
percent of all Texas counties are totally or partially designated
as medically underserved areas.
By the year 2000, 35 percent of all current family practice
physicians will retire. In rural areas, 43 percent of all
family/general practice physicians will retire. These numbers
change on an almost daily basis, and it is a matter which requires
immediate attention.
Although Texas has the highest number of publicly funded
medical schools in the nation and was ranked third among the most
populous states in number of residents-in-training in 1994, the
state has not sufficiently utilized its current physician-training
resources to fill the growing need for primary care practitioners.
While the total number of residents increased between 1987 and the
present, AAMC data indicate that the production of generalist
primary care physicians increased in one medical school, remained
fairly stagnant in other schools and decreased in another school.
PURPOSE
This bill establishes a program to recruit health professionals
into medically underserved areas.
RULEMAKING AUTHORITY
It is the committee's opinion that Section 1 of this bill expressly
grants additional rulemaking authority to the Texas Board of Health
(in Sec. 107.002 and Sec. 107.003 of the Health and Safety Code).
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Subtitle E, Title 2, Health and Safety Code, by
adding Chapter 107, HEALTH PROFESSIONAL RECRUITMENT PROGRAM, as
follows:
Sec. 107.001 DEFINITIONS.
(1) Defines "health care professional" to mean (a) a resident
physician in certain primary care specialties, (b) a nurse
practitioner in certain specialties or (c) a student enrolled
in the final year of an approved bachelor's or master's level
physician assistant program.
(2) Defines "medically underserved area" by reference to
federal statute.
Sec. 107.002. HEALTH PROFESSIONAL RECRUITMENT PROGRAM.
(a) Requires the Texas Board of Health (Board) to establish a
program within the Texas Department of Health (Department) to
assist communities in recruiting and retaining health
professionals to practice in medically underserved areas.
(b) Requires the Board, by rule, to establish eligibility
criteria, grant application procedures, grant amounts, and
procedures for evaluating applications.
(c) Requires the Board, by rule, to establish as system of
priorities relating to geographic areas covered, classes of
health professionals eligible to receive funding under the
program, and level of stipend support for each type of health
professional.
Sec. 107.003. ADMINISTRATION.
(a) Requires the Board to adopt all necessary rules to
administer this chapter, and requires the Department to
administer the program in accordance with board rules.
(b) Stipulates that the Department, in conjunction with the
Center for Rural Health Initiatives, shall conduct field
research regarding the need for the program.
Sec. 107.004. STIPENDS.
(a) States that an eligible health professional who enters
into a contract in accordance with Sec. 107.005 to provide
services in a medically underserved area may apply to
participate in the program.
(b) Requires the Department to award stipends for one-year
periods, and prohibits a stipend from exceeding $15,000 each
year.
(c) Allows the Department to renew a stipend.
(d) States that a health professional is not eligible for a
stipend for a period longer than is ordinarily and customarily
required for the course of study or the completion of
residency training.
(e) Prohibits a health professional who is receiving a stipend
from receiving assistance under any state educational loan
repayment program or other state incentive program.
Sec. 107.005. REQUIRED CONTRACT.
(a) Allows the Department to pay a stipend to a health
professional only if that person signs a contract to provide
services in a medically underserved area for at least one year
for each year that the health professional receives a stipend.
(b) Requires the contract to stipulate that the health
professional is personally liable to the state for the total
amount of the stipend, interest on that amount, and the
state's reasonable expenses incurred in obtaining payment if
the health professional does not provide the required services
or provides those services for less than the required period
of time.
Sec. 107.006. FUNDING. Allows the Board to seek, receive and
spend funding from a variety of sources to administer the
chapter.
SECTION 2. Requires the Board to report to the 75th Legislature
not later than February 1, 1997, on the allocation of funds to the
health professional recruitment program established under Chapter
107, Health and Safety Code, and on the progress of the program in
recruiting and retaining resident physicians to practice in
medically underserved areas.
SECTION 3. States that the sums of $330,000 for the fiscal year
beginning September 1, 1995, and $330,000 for the fiscal year
beginning September 1, 1996, are appropriated from general revenue
funds to the Department to administer the program. Limits
administration costs of the program to 10 percent of amount of
funds appropriated.
SECTION 4. Emergency Clause. Effective immediately.
COMPARISON OF ORIGINAL TO SUBSTITUTE
A basic difference between the substitute for H.B. 2311 and the
bill as filed is in the organizational structure of the proposed
program. The substitute requires the Department to provide stipends
directly to eligible health professionals who participate in the
program. As filed, the Department would offer grants to non-profit,
community-based organizations to assist them in recruiting and
retaining health professionals to provide services in medically
underserved areas. The difference in the program's administrative
organization necessitated numerous changes in the bill's language
and in administrative procedures outlined in the substitute.
In addition, the substitute:
Establishes a varying interest rate based on Federal Reserve
Board information, plus 5 percent a year, instead of setting
a flat rate of 12 percent, as the original bill does.
Adds a provision appropriating $330,000 for each of two
fiscal years and setting a ceiling on costs used for
administering the program.
Adds a provision prohibiting a stipend recipient from
receiving assistance under any other state educational loan
repayment program or other state incentive program.
SUMMARY OF COMMITTEE ACTION
H.B. 2311 was considered by the Public Health Committee in a public
hearing on April 19, 1995.
The committee considered a complete substitute for the bill. The
substitute was adopted without objection.
The following person testified in favor of the bill:
Jose E. Camacho, representing Texas Association of Community
Health Centers.
The bill was reported favorably as substituted, with the
recommendation that it do pass and be printed, by a record vote of
7 Ayes, 0 Nays, 0 PNV, and 2 Absent.