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.