BILL ANALYSIS
S.B. 979
By: Sibley (Berlanga)
04-28-95
Committee Report (Amended)
BACKGROUND
Finding convenient health care is a struggle for many Texans in
rural an other underserved communities. Currently, 25 Texas
counties are without a primary care physician and 229 Texas
counties are designated medically underserved areas/medically
underserved populations by the federal government. Furthermore,
Texas has 134 full and partial counties which are federally
designated primary care health professional shortage areas.
PURPOSE
S.B. 979 creates the Medically Underserved Community-State Matching
Incentive Program to help increase the number of primary care
physicians in medically underserved areas of this state.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill grants additional
rulemaking authority to the Texas Board of Health in Sections 2 and
6 of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Sec. 51.918(c), Education Code, to require the
Center for Rural Health Initiatives to develop relief service
programs for rural physicians and allied health personnel. Deletes
the language stating that the programs are to facilitate ready
access to continuing medical education, thereby requiring the
Center to develop the programs.
SECTION 2. Amends Sec. 61.506, Education Code, as follows:
(a) Requires the Family Practice Residency Advisory Committee
(advisory committee) to work to enhance approved family
practice residency programs and to establish not less than
three or more than five pilot programs to provide a major
source of indigent health care and to train family practice
resident physicians. Deletes a reference to the advisory
committee working with a statewide advisory committee
established by the Texas Board of Health (Board).
(b) Requires each of the programs to provide services to an
economically depressed or rural medically underserved area of
the state. Requires one program to be located in an urban
area, one program to be located in a rural area, and one
program to be located in the border region as defined by
Section 481.001, Government Code. Deletes the language
requiring the three pilot programs to be located in an area
that reflects the diversity of the state.
Subsections (c) and (d) make conforming changes to reflect the
deletion in Subsection (a) of the statewide advisory
committee.
(f) Adds "or by board rule" and deletes the reference to
"under Section 31.015, Health and Safety Code" in regard to
the provision that the advisory committee must use financial
reports, audits, and performance evaluations currently
required under this subchapter, or by board rule, to annually
assess the financial feasibility and effective performance of
the pilot programs.
Subsections (g) and (h) make conforming changes to reflect the
deletion in subsection (a) of the statewide advisory
committee.
SECTION 3. Adds Sec. 61.531(b) and (c), Education Code, as follows:
(b) States that not more than 20 percent of physicians
receiving repayment assistance may be employed by the state
agencies listed in Section 61.532(a)(2), Education Code.
(c) Prohibits a physician who receives repayment assistance
from receiving assistance under Chapter 46, Health and Safety
Code.
SECTION 4. Amends Sec. 61.532(a), Education Code, to add a
requirement that to be eligible to receive payment assistance, a
physician must apply to the Texas Higher Education Coordinating
Board (coordinating board) and complete at least one year of
medical practice for an approved family practice residency training
program as a clinical faculty member and have completed training
in an approved program by July 1, 1994, or as a resident.
SECTION 5. Amends Sec. 61.539(b), Education Code, to provide that
Sections 403.094(h) and 403.095, Government Code, do not apply to
the funds set aside in this section.
SECTION 6. Adds Chapter 46 to Title 2B, Health and Safety Code, as
follows:
CHAPTER 46. MEDICALLY UNDERSERVED COMMUNITY-STATE MATCHING
INCENTIVE PROGRAM
Sec. 46.001. DEFINITIONS. Defines "medically underserved
community," "physician," "primary care," and "start-up money."
Sec. 46.002. PROGRAM. (a) Requires the Texas Board of Health
(Board) to establish and administer a program under this
chapter to increase the number of physicians providing primary
care in medically underserved communities.
(b) Allows an eligible community to sponsor a physician who
has agreed to provide primary care in the community by
contributing to start-up money for the physician and having
that contribution matched in whole or in part by state money
appropriated to the Board for that purpose.
(c) Allows a participating community to provide start-up money
to an eligible physician over a two-year period.
(d) Prohibits the Board from paying more than $25,000 to a
community in any fiscal year, unless the Board makes a
specific finding on need by the community.
Sec. 46.003. ELIGIBILITY. (a) Requires a community to apply
for money and provide evidence satisfactory to the Board that
it has entered into an agreement with a physician that the
physician provide primary care in the community for a period
of at least two years to be eligible to receive funds from the
Board.
Sec. 46.004. RULES. Allows the Board to adopt rules necessary
for the administration of this subchapter, including specified
eligibility criteria and conditions; procedures for
disbursement of money by the Board; the form and manner in
which a community must make its contribution to the start-up
money; and the contents of an agreement to be entered into by
the parties.
Sec. 46.005. FUNDING. Allows the Board to accept gifts,
grants, and donations for the purposes of this chapter.
SECTION 7. Requires the Texas Higher Education Coordinating Board
to report to the legislature by December 1, 1996, on the allocation
of money to the family practice residency training pilot programs,
and the progress in those programs in specified areas.
SECTION 8. Effective date: September 1, 1995.
SECTION 9. Emergency clause.
EXPLANATION OF AMENDMENT
Committee Amendment #1 amends S.B. 979 as follows:
(1) Amends Section 61.537(a), Education Code, to authorize the
Family Practice Residency Advisory Committee to consider, among
other criteria, whether the physician is or will be providing
service in a medically underserved area, when the advisory
committee is establishing priorities among eligible physicians for
repayment assistance.
(2) Clarifies Sec. 46.002, Subtitle B, Title 2, Health and Safety
Code, by striking the words "an eligible," for which there is no
definition in this chapter, and substituting "a medically
underserved," which is defined. This language is used regarding the
type of communities in which the programs will be established.
(3) Amends Sec. 46.002, Subtitle B, Title 2, Health and Safety
Code, to state that an eligible community may sponsor a physician
who has completed a primary care residency program within seven
years of application to this program. This clause was added because
studies have shown that if a physician is going to move, the move
is done within six years of completion of the residency program.
(4) Adds Sec. 46.002(e), Subtitle B, Title 2, Health and Safety
Code, to require the Board to prioritize the communities eligible
for assistance under this chapter in order to assure that the
neediest communities are provided grants. Approximately 88% of
Texas counties are currently designated as totally or partially
underserved, and by prioritizing the areas, the money will go where
it is most needed.
(5) Amends Sec. 46.004, Subtitle B, Title 2, Health and Safety
Code, to require the Board to adopt the rules necessary for the
administration of this chapter, rather than allow the Board to do
so. This simply guarantees the administration of the programs set
forth in this chapter.
(6) Amends Sec. 46.004, Subtitle B, Title 2, Health and Safety
Code, to add to the standards of the rules to be adopted by the
Board. Adds that the contents of the agreement to be entered into
by the parties must include at least a credit check, community
retention of property and equipment for seven years, and the
requirement that the participating physicians practice full-time.
Because this is a financial sponsorship, these requirements provide
protection for the communities.
SUMMARY OF COMMITTEE ACTION
S.B. 979 was considered by the Public Health Committee in a formal
meeting on April 28, 1995.
The committee considered one amendment to the bill. The amendment
was adopted without objection.
The bill was reported favorably as amended, with the recommendation
that it do pass and be printed, by a record vote of 7 AYES, 0 NAYS,
0 PNV, and 2 ABSENT.