By Rangel H.B. No. 2689
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the distribution of certain fees collected and tuition
1-3 charged at medical schools, the establishment of health care
1-4 accounts, the establishment of medical loan forgiveness accounts,
1-5 the establishment of the medical loan forgiveness program and
1-6 establishing primary care mission statements, strategic plans and
1-7 reporting for 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 51.002(a), Education Code, is amended to
1-12 read as follows:
1-13 (a) Except as provided by Section 51.0085 of this code, the
1-14 <The> governing board of each institution listed in Section 51.001
1-15 of this code may retain control of the following sums of money
1-16 collected at the institution, subject to Section 51.008 of this
1-17 code:
1-18 (1) student fees of all kinds;
1-19 (2) charges for use of rooms and dormitories;
1-20 (3) receipts from meals, cafes, and cafeterias;
1-21 (4) fees on deposit refundable to students under
1-22 certain conditions;
1-23 (5) receipt from school athletic activities;
2-1 (6) income from student publications and other student
2-2 activities;
2-3 (7) receipt from the sale of publication products and
2-4 miscellaneous supplies and equipment;
2-5 (8) students' voluntary deposits of money for
2-6 safekeeping;
2-7 (9) all other fees and local or institutional funds
2-8 arising out of and by virtue of the educational activities,
2-9 research, or demonstrations carried on by the institution; and
2-10 (10) donations and gifts to the institution.
2-11 SECTION 3. Subchapter A, Chapter 51, Education Code, is
2-12 amended by adding Section 51.0085 to read as follows:
2-13 Sec. 51.0085. CERTAIN HOSPITAL, CLINIC, AND DOCTOR FEES. In
2-14 this section: (a) "medically underserved area" means an area
2-15 designated by the United States Secretary of Health and Human
2-16 Services as having:
2-17 (1) a shortage of personal health services or a
2-18 population group that has such a shortage as provided by 42 U.S.C.
2-19 Section 300e-1(7); or
2-20 (2) a health professional shortage as provided by 42
2-21 U.S.C. Section 254e(a)(1).
2-22 (b) A special account known as the health care account is
2-23 created in the general revenue fund.
2-24 (c) The governing board of each medical school, as defined
2-25 by Section 61.501 of this code, shall remit to the state treasurer
3-1 twenty percent (20%) of all hospital, clinic, and doctor fees
3-2 collected by the medical school. The state treasurer shall deposit
3-3 money remitted under this section to the credit of the health care
3-4 account. The percentage of all hospital, clinic and doctor fees
3-5 collected by each medical school and remitted to the health care
3-6 account shall increase by an additional five percent (5%) each year
3-7 commencing in fiscal year 1996 until an individual medical school
3-8 can demonstrate that fifty percent (50%) of their graduates are
3-9 completing residencies and practicing in the primary care
3-10 specialties of family practice, general practice, general internal
3-11 medicine, general pediatric medicine or general obstetrics and
3-12 gynecology.
3-13 (d) The health care account consists of money credited to
3-14 the fund under Subsection (c) of this section, gifts, grants, and
3-15 funds appropriated by the legislature.
3-16 (e) Money in the account may be appropriated only to the
3-17 governing board of each medical school for primary patient care
3-18 personnel and programs, educational personnel and support,
3-19 institutional development and recruitment and new program
3-20 development that encourages health profession students in medicine,
3-21 nursing, dentistry or allied health to specialize in primary care
3-22 delivery in medically underserved areas.
3-23 (f) Money in the account appropriated to the governing board
3-24 of each medical school may not be expended unless the governing
3-25 board of each medical school shall first submit, and have approved
4-1 by the Higher Education Coordinating Board, a plan describing the
4-2 specific uses of funds in the health care account. The plan must
4-3 include, at a minimum, provisions relating to:
4-4 (1) recruitment and admissions of students from
4-5 medically underserved areas and populations;
4-6 (2) promotion, tenure and development of primary care
4-7 faculty;
4-8 (3) team-training for students in all health
4-9 profession degree programs;
4-10 (4) support for third-year clerkships in family
4-11 medicine;
4-12 (5) creation of endowed chairs in primary care,
4-13 preventive and public health in all health profession schools; and,
4-14 (6) establishment of affiliation agreements with
4-15 hospitals and clinics in medically underserved areas that provide
4-16 for rotations of health profession students through these settings.
4-17 (g) The initial annual plan required in subsection (f) must
4-18 be submitted no later than April 1, 1996, and approved for
4-19 implementation by no later than July 1, 1996.
4-20 SECTION 4. Section 51.009(c), Education Code, is amended to
4-21 read as follows:
4-22 (c) Each of the following shall be accounted for as
4-23 educational and general funds: net tuition, special course fees
4-24 charged under Sections 54.051(e) and (l), Education Code, lab fees,
4-25 student teaching fees, hospital, <and> clinic, and doctor fees,
5-1 organized activity fees, proceeds from the sale of educational and
5-2 general equipment, and indirect cost recovery fees.
5-3 SECTION 5. Section 51.008(b), Education Code, is amended to
5-4 read as follows:
5-5 (b) Except as provided by Section 51.0085 of this code, the
5-6 <The> governing board of every state institution of higher
5-7 education shall deposit in the state treasury all cash receipts
5-8 accruing to any college or university under its control that may be
5-9 derived from all sources except auxiliary enterprises,
5-10 noninstructional services, agency, designated, and restricted
5-11 funds, endowment and other gift funds, student loan funds, funds
5-12 retained under Chapter 145 of this code, and Constitutional College
5-13 Building Amendment funds. The state treasurer is directed to
5-14 credit such receipts deposited by each such institution to a
5-15 separate fund account for the institution depositing the receipts,
5-16 but he shall not be required to keep separate accounts of types of
5-17 funds deposited by each institution. For the purpose of
5-18 facilitating the transferring of such institutional receipts to the
5-19 state treasury, each institution shall open in a local depository
5-20 bank a clearing account to which it shall deposit daily all such
5-21 receipts, and shall, not less often than every seven days, make
5-22 remittances therefrom to the state treasurer of all except $500 of
5-23 the total balance in said clearing account by the duly authorized
5-24 officers of the institution, and no disbursements other than
5-25 remittances to the state treasury shall be made from such clearing
6-1 account. All money so deposited in the state treasury shall be
6-2 paid out on warrants drawn by the comptroller of public accounts as
6-3 provided by law.
6-4 SECTION 6. Subchapter A, Chapter 51, Education Code, is
6-5 amended by adding Section 51.0085 to read as follows:
6-6 Sec. 51.0085. NET MEDICAL SCHOOL TUITION. (a) A special
6-7 account known as the medical loan forgiveness account is created in
6-8 the general revenue fund.
6-9 (b) The governing body of each medical school, as defined by
6-10 Section 61.501, shall remit to the state treasurer five percent
6-11 (5%) of the net tuition collected at the medical school. The state
6-12 treasurer shall deposit money remitted under this section to the
6-13 credit of the medical loan forgiveness account.
6-14 (c) The medical loan forgiveness account consists of money
6-15 credited to the account under Subsection (b) of this section,
6-16 gifts, grants, and funds appropriated by the legislature.
6-17 (d) Money in the medical loan forgiveness account may be
6-18 appropriated only to the Texas Higher Education Coordinating Board
6-19 for the purpose of supporting administrative expenses incurred in
6-20 administering the Medical Loan Forgiveness Program.
6-21 SECTION 7. Subchapter B, Chapter 54, Education Code, is
6-22 amended by adding Section 54.066 to read as follows:
6-23 Sec. 54.066 MEDICAL LOAN FORGIVENESS PROGRAM. (a) There is
6-24 hereby created the Medical Loan Forgiveness Program. The purpose
6-25 of the program shall be to enable Texas residents who desire to
7-1 become physicians to obtain a deferment of the tuition and other
7-2 expenses incurred in obtaining a medical education.
7-3 (b) The Higher Education Coordinating Board shall establish
7-4 rules necessary to administer this section. The rules shall
7-5 provide the eligibility criteria for receiving deferment and the
7-6 maximum annual number of deferments deferment which may be made
7-7 under this program at an amount not to exceed the cost of tuition
7-8 and other expenses. Deferment granted pursuant to this section may
7-9 not exceed the length of time required to complete the degree
7-10 requirements.
7-11 (c) Students under this program shall be eligible for
7-12 deferment of their tuition and other expenses incurred during
7-13 attendance as full-time medical students approved by the Higher
7-14 Education Coordinating Board. No interest shall accrue on the
7-15 amount deferred until one (1) month after graduation, completion of
7-16 residency or termination of full-time student status.
7-17 (d) Deferments made to students shall be made and based upon
7-18 the following options for repayment or conversion to interest-free
7-19 scholarships:
7-20 (1) Payment in full of principal and interest must be
7-21 made in sixty (60) or less equal monthly installments, commencing
7-22 one (1) month after graduation, completion of residency or
7-23 termination of full-time student status. Repayment under this
7-24 option shall convert the amount deferred to a loan which will
7-25 accrue interest on the total amount at the rate of 12% for the
8-1 period beginning on the date the student graduates, completes
8-2 residency training or terminates full-time medical student status.
8-3 (2) In lieu of payment in full of both the principal
8-4 deferred and any interest accrued, a student may elect to repay the
8-5 amount deferred by entry into the practice of medicine in a primary
8-6 health care field located in a medically underserved area of the
8-7 state for a period of one year for each year the student receives a
8-8 deferment of their tuition and other expenses. Repayment under
8-9 this option shall convert the amount deferred to a scholarship and
8-10 discharge the same on the basis of one (1) year's service for one
8-11 (1) year's deferment, or the appropriate proportion of the total
8-12 outstanding balance of principal and interest, as established by
8-13 rule of the Higher Education Coordinating Board. If at any time
8-14 prior to the repayment in full of the total obligation the student
8-15 abandons or abrogates repayment under this option, the provision of
8-16 Section (d)(4) shall apply.
8-17 (3) In lieu of payment in full of both the principal
8-18 deferred and any interest accrued, a student may elect to repay the
8-19 amount deferred by entry in the practice of medicine in a primary
8-20 health care field at a federally qualified health center within the
8-21 state for a period of one year for each year the student receives a
8-22 deferment of their tuition and expenses. Repayment under this
8-23 option shall convert the amount deferred to a scholarship and
8-24 discharge the same on the basis of one (1) year's service to the
8-25 appropriate portion of the total outstanding balance of principal
9-1 and interest, as established by rule of the Higher Education
9-2 Coordinating Board. If at any time prior to the repayment in full
9-3 of the total obligation the student abandons or abrogates repayment
9-4 under this option, the provision of section (d)(4) apply.
9-5 (4) If the student abandons or abrogates the options
9-6 for repayment as provided for in Sections (d)(2) or (3), the
9-7 remaining balance of unpaid or undischarged principal and interest
9-8 shall become due and payable over the remaining period of time as
9-9 if the option provided by Section (d)(1) had been elected upon
9-10 graduation, completion of residency or termination of full time
9-11 student status.
9-12 (5) If a student does not provide the required
9-13 service, provides those services for less than the required term or
9-14 fails to make payments pursuant to option (d)(1), the student
9-15 shall, in addition to any principle and interest, be personally
9-16 liable to the state for the state's reasonable expenses incurred in
9-17 obtaining payment, including reasonable attorney's fees.
9-18 (e) In this section:
9-19 (1) "Federally Qualified Health Center" means a
9-20 federally qualified health center, as that term is defined by 42
9-21 U.S.C. Sec. 1396d.
9-22 (2) "Medically underserved area" means: an area
9-23 designated by the Unites States Secretary of Health and Human
9-24 Services as having:
9-25 (a) a shortage of personal health services or a
10-1 population group that has such a shortage as provided by 42 U.S.C.
10-2 Section 300e-1(7); or,
10-3 (b) a health professional shortage as provided by 42
10-4 U.S.C. Section 254e(a)(1).
10-5 (3) Primary health care practice means a practice in
10-6 the specialties of family practice, general practice, general
10-7 internal medicine, general pediatric medicine or general obstetrics
10-8 and gynecology.
10-9 SECTION 8. Chapter 61, Education Code, is amended by adding
10-10 Subchapter O to read as follows:
10-11 SUBCHAPTER O. PRIMARY CARE MISSION STATEMENTS,
10-12 STRATEGIC PLANS AND REPORTING
10-13 Sec. 61.781. DEFINITION. In this subchapter:
10-14 (1) "Generalist primary care physician" means a
10-15 physician in the specialties of family practice, general practice,
10-16 general internal medicine, general pediatrics or general obstetrics
10-17 and gynecology.
10-18 (2) "Medical school" has the meaning assigned by
10-19 Section 61.501 of this code.
10-20 (3) "Medically underserved area" means: an area
10-21 designated by the United States Secretary of Health and Human
10-22 Services as having:
10-23 (a) a shortage of personal health services or a
10-24 population group that has such a shortage as provided by 42 U.S.C.
10-25 Section 300e-1(7); or,
11-1 (b) a health professional shortage as provided by 42
11-2 U.S.C. Section 254e(a)(1).
11-3 Sec. 61.782. ROLES AND MISSION STATEMENT. The role and
11-4 mission of each medical school shall:
11-5 (1) reflect the school's responsibility and
11-6 accountability for providing at least fifty-three percent of its
11-7 graduates as generalist primary care physicians;
11-8 (2) reflect that the production of family and general
11-9 practitioners shall be at least 25 percent of its graduates and
11-10 that the production of general obstetrics and gynecology physicians
11-11 shall not exceed three percent of its total graduates; and,
11-12 (3) Recognize the school's responsibility and
11-13 accountability for providing underrepresented minority physicians,
11-14 primary care research and the provision of generalist primary care
11-15 physicians to provide primary medical care to medically underserved
11-16 areas.
11-17 Sec. 61.783. STRATEGIC PLAN. (a) Each medical school shall
11-18 develop a strategic plan that reflects the requirements of Section
11-19 61.782 of this code.
11-20 (b) The strategic plan must contain, at least, the following
11-21 quantifiable outcome measures:
11-22 (1) 53 percent of the total number of medical school
11-23 graduates in residencies in generalist primary care specialties and
11-24 in practice in generalist primary care specialties in this state;
11-25 (2) the admissions committee of the medical school
12-1 should be composed of at least 40 percent generalist primary care
12-2 physicians and include generalist primary care physicians in
12-3 private practice; and,
12-4 (3) the curriculum committee of the medical school
12-5 should be composed of at least 53 percent of generalist primary
12-6 care physicians.
12-7 Sec. 61.784. (a) Each strategic plan shall include, at
12-8 least, the following baseline information:
12-9 (1) the statistical information concerning the
12-10 practice specialties and location of the medical school graduates
12-11 for each academic year starting with students graduating in 1987;
12-12 (2) statistical information concerning students
12-13 admitted after 1987 including minority status, county of origin,
12-14 sex and financial aid provided;
12-15 (3) composition of admission and curriculum committees
12-16 by specialty for each academic year after 1987;
12-17 (4) number, specialty and location of affiliated
12-18 residency programs, number of positions in each program by post
12-19 graduate year and number of filled positions by post graduate year
12-20 starting in the academic year 1987;
12-21 (5) number of full-time, salaried faculty by
12-22 specialty, sex, ethnicity, race, tenure and faculty rank; and,
12-23 (6) Total budget and sources of funds by department
12-24 within the medical school.
12-25 (b) Each strategic plan shall address, at least, the
13-1 institution's plan:
13-2 (1) to ensure that the medical schools' admission
13-3 policies, structure and function address the need to admit and
13-4 recruit more students who are inclined to select generalist primary
13-5 care specialties;
13-6 (2) to ensure that the medical schools' admission
13-7 policies, structure and function reflect the need to recruit and
13-8 admit more minority students to the medical school;
13-9 (3) to ensure that the medical schools' departments
13-10 and faculty composition are balanced, with increased representation
13-11 of primary care generalist physicians, full-time salaried minority
13-12 physicians and other primary care generalist providers from
13-13 community settings;
13-14 (4) to ensure a system of advancement and tenure that
13-15 rewards primary care generalists faculty with demonstrated
13-16 excellence in teaching, in the same manner as other faculty
13-17 members;
13-18 (5) to involve community-based primary care generalist
13-19 physicians and other providers as preceptors, faculty, and role
13-20 models for medical students and residents, and the recognition and
13-21 incentives to be provided to these providers for their
13-22 participation;
13-23 (6) to incorporate basic sciences within a clinical
13-24 context throughout the pre-clinical curriculum;
13-25 (7) to ensure that pre-clinical and clinical training
14-1 in social, behavioral, and humanistic aspects of health and health
14-2 care delivery are provided by faculty, researchers, and clinicians
14-3 in fields such as nursing, psychology, public health, medical
14-4 sociology, medical education, health services delivery and
14-5 bioethics;
14-6 (8) to provide pre-clinical and clinical training that
14-7 emphasizes the importance of the team approach to health care
14-8 delivery and that includes experience in working as a team member
14-9 with other health care professionals and training in using the
14-10 skills and expertise of nurses, pharmacists, public health
14-11 professionals, social workers and other health care professionals
14-12 and ancillary personnel;
14-13 (9) to ensure that curricula and clinical rotations
14-14 provide all students and residents with a balance between
14-15 hospital-based, subspecialty training and community-based primary
14-16 care training, including the establishment of affiliation
14-17 agreements with hospitals and clinics in medically underserved
14-18 areas that provide for rotations of students through these
14-19 settings;
14-20 (10) to ensure that community-based educational
14-21 experiences are developed and managed with significant community
14-22 participation and involvement;
14-23 (11) to provide financial support for third-year
14-24 clerkships in family medicine; and,
14-25 (12) to plan for the creation of endowed chairs for
15-1 generalist primary care physicians.
15-2 Sec. 61.785. (a) The initial strategic plan required under
15-3 Secs. 61.782 - 61.784 must be filed for comment with the Higher
15-4 Education Coordinating Board and the Legisltive Budget Board not
15-5 later than September 1, 1995, and approved for implementation by
15-6 the Governing Board of each medical school no later than October
15-7 31, 1995.
15-8 (b) The first strategic plan filed under this section shall
15-9 be used as a baseline to assess progress toward each medical
15-10 school's goals in subsequent years.
15-11 (c) Each medical school, at least annually, shall update the
15-12 strategic plan required under this section and shall file for
15-13 comment with the Higher Education Coordinating Board and the
15-14 Legislative Budget Board not later than July 1 of each year. The
15-15 Governing Board of each medical school shall approve for
15-16 implementation the strategic plan filed for comment under this
15-17 subsection not later than August 31 of each year.
15-18 (d) All strategic plans must assess the school's progress
15-19 toward the outcome measures under Subsection (b) of this Section.
15-20 (e) All agencies that have a public medical school covered
15-21 under Article III of the Appropriations for the state shall not
15-22 expend funds if the strategic plan required under sections 61.782 -
15-23 61.784 of this subchapter have not been filed and approved by
15-24 August 31 of each year.
15-25 SECTION 9. This Act takes effect September 1, 1995. The
16-1 Amendments to Sections 54.066, Education Code, apply only to
16-2 tuition that becomes due beginning with the fall semester in 1995.
16-3 Tuition that became due before that semester is governed by the law
16-4 in effect at the time the tuition became due, and that law is
16-5 continued in effect for this purpose only.
16-6 SECTION 10. The importance of this legislation and the
16-7 crowded condition of the calendars in both houses create an
16-8 emergency and an imperative public necessity that the
16-9 constitutional rule requiring bills to be read on three several
16-10 days in each house be suspended, and this rule is hereby suspended,
16-11 and that this Act take effect and be in force from and after its
16-12 passage, and it so enacted.