S.B. No. 979
AN ACT
1-1 relating to programs to increase the number of primary care
1-2 physicians and allied health personnel in medically underserved
1-3 areas of this state.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (c), Section 51.918, Education Code,
1-6 is amended to read as follows:
1-7 (c) The Center for Rural Health Initiatives shall develop
1-8 relief service programs for rural physicians and allied health
1-9 personnel <to facilitate ready access to continuing medical
1-10 education>.
1-11 SECTION 2. Section 61.506, Education Code, is amended to
1-12 read as follows:
1-13 Sec. 61.506. FAMILY PRACTICE RESIDENCY TRAINING PILOT
1-14 PROGRAMS. (a) The Family Practice Residency Advisory Committee
1-15 <and a statewide advisory committee established by the Texas Board
1-16 of Health under Section 31.017, Health and Safety Code,> shall work
1-17 <together> to enhance approved family practice residency programs
1-18 and to establish not less than three or more than five pilot
1-19 programs to provide a major source of indigent health care and
1-20 <also> to train family practice resident physicians.
1-21 (b) Each of the <three> pilot programs must provide
1-22 services to <be located in> an economically depressed
1-23 or rural medically underserved area of the state. One pilot
2-1 program must be located in an urban area, one pilot program must be
2-2 located in a rural area, and the remaining pilot program or
2-3 programs must be located in the border region as defined by Section
2-4 481.001, Government Code <area that reflects the diversity of this
2-5 state>.
2-6 (c) An approved family practice residency program that wants
2-7 to participate in or sponsor a pilot program must make a proposal
2-8 to the advisory committee <committees>.
2-9 (d) The advisory committee <committees> shall review all
2-10 proposals submitted under Subsection (c) of this section and shall
2-11 recommend to the board approved family practice residency programs
2-12 to participate in or sponsor pilot programs.
2-13 (e) The board shall select approved family practice
2-14 residency programs to participate in or sponsor pilot programs on
2-15 the basis of each program's commitment to indigent health care and
2-16 to training family practice resident physicians.
2-17 (f) The advisory committee <committees> shall use <the>
2-18 financial reports, audits, and performance evaluations currently
2-19 required under this subchapter or by board rule <and under Section
2-20 31.015, Health and Safety Code,> to assess annually the financial
2-21 feasibility and effective performance of the pilot programs. The
2-22 advisory committee <committees> may require additional reports as
2-23 necessary.
2-24 (g) The advisory committee <committees> shall send copies of
2-25 its <their> annual assessment of the pilot programs to the
3-1 comptroller and the state auditor for review.
3-2 (h) If the advisory committee determines <committees
3-3 determine> that a pilot program is not financially feasible or that
3-4 it does not perform effectively, the advisory committee
3-5 <committees> shall recommend to the board discontinuation of
3-6 funding for the pilot program.
3-7 SECTION 3. Section 61.531, Education Code, is amended to
3-8 read as follows:
3-9 Sec. 61.531. REPAYMENT AUTHORIZED. (a) The coordinating
3-10 board may provide, using funds appropriated for that purpose and in
3-11 accordance with this subchapter and rules of the board, assistance
3-12 in the repayment of student loans for physicians who apply and
3-13 qualify for the assistance.
3-14 (b) Not more than 20 percent of the physicians receiving
3-15 repayment assistance under this subchapter may be employed by the
3-16 state agencies listed in Section 61.532(a)(2).
3-17 (c) A physician who receives repayment assistance under this
3-18 subchapter may not receive assistance under Chapter 46, Health and
3-19 Safety Code.
3-20 SECTION 4. Subsection (a), Section 61.532, Education Code,
3-21 is amended to read as follows:
3-22 (a) To be eligible to receive repayment assistance, a
3-23 physician must apply to the coordinating board and have completed
3-24 at least one year of medical practice:
3-25 (1) in private practice in an economically depressed
4-1 or rural medically underserved area of the state;
4-2 (2) for one of the following state agencies:
4-3 (A) Texas Department of Health;
4-4 (B) Texas Department of Mental Health and Mental
4-5 Retardation;
4-6 (C) Texas Department of Corrections; or
4-7 (D) Texas Youth Commission; or
4-8 (3) for an approved family practice residency training
4-9 program established under Subchapter I of this chapter as a:
4-10 (A) clinical faculty member and have completed
4-11 training in an approved family practice residency training program
4-12 on or after July 1, 1994; or
4-13 (B) resident.
4-14 SECTION 5. Subsection (a), Section 61.537, Education Code,
4-15 is amended to read as follows:
4-16 (a) The coordinating board shall adopt rules necessary for
4-17 the administration of this subchapter, including a rule that sets a
4-18 maximum amount of repayment assistance that may be received by a
4-19 physician in one year and a rule that authorizes the Family
4-20 Practice Residency Advisory Committee to establish priorities among
4-21 eligible physicians for repayment assistance, by taking into
4-22 account the degree of physician shortage, geographic locations,
4-23 whether the physician is or will be providing service in a
4-24 medically underserved area, and other criteria the committee
4-25 considers appropriate.
5-1 SECTION 6. Subsection (b), Section 61.539, Education Code,
5-2 is amended to read as follows:
5-3 (b) The amount set aside shall be transferred to the
5-4 comptroller of public accounts to be maintained in the state
5-5 treasury for the sole purpose of repayment of student loans of
5-6 physicians serving in designated state agencies or economically
5-7 depressed or rural medically underserved areas of the state as
5-8 specified by this subchapter. Sections 403.094(h) and 403.095,
5-9 Government Code, do not apply to the amount set aside by this
5-10 section.
5-11 SECTION 7. Subtitle B, Title 2, Health and Safety Code, is
5-12 amended by adding Chapter 46 to read as follows:
5-13 CHAPTER 46. MEDICALLY UNDERSERVED COMMUNITY-STATE
5-14 MATCHING INCENTIVE PROGRAM
5-15 Sec. 46.001. DEFINITIONS. In this chapter:
5-16 (1) "Medically underserved community" means:
5-17 (A) a community located in an area in this state
5-18 with a medically underserved population;
5-19 (B) a community located in an area in this state
5-20 designated by the United States Secretary of Health and Human
5-21 Services as an area with a shortage of personal health services;
5-22 (C) a population group designated by the United
5-23 States Secretary of Health and Human Services as having a shortage
5-24 of personal health services; or
5-25 (D) a community that meets criteria adopted by
6-1 the board by rule, considering relevant demographic, geographic,
6-2 and environmental factors.
6-3 (2) "Physician" means a person licensed to practice
6-4 medicine in this state.
6-5 (3) "Primary care" means physician services in family
6-6 practice, general practice, internal medicine, pediatrics,
6-7 obstetrics, or gynecology.
6-8 (4) "Start-up money" means a payment made by a
6-9 medically underserved community for reasonable costs incurred by a
6-10 physician to establish a medical office and ancillary facilities
6-11 for diagnosing and treating patients.
6-12 Sec. 46.002. PROGRAM. (a) The board shall establish and
6-13 administer a program under this chapter to increase the number of
6-14 physicians providing primary care in medically underserved
6-15 communities.
6-16 (b) A medically underserved community may sponsor a
6-17 physician who has completed a primary care residency program within
6-18 seven years of application to this program and has agreed to
6-19 provide primary care in the community by contributing to start-up
6-20 money for the physician and having that contribution matched in
6-21 whole or in part by state money appropriated to the board for that
6-22 purpose.
6-23 (c) A participating medically underserved community may
6-24 provide start-up money to an eligible physician over a two-year
6-25 period.
7-1 (d) The board may not pay more than $25,000 to a community
7-2 in a fiscal year unless the board makes a specific finding of need
7-3 by the community.
7-4 (e) The board shall prioritize the communities eligible for
7-5 assistance under this chapter in order to assure that the neediest
7-6 communities are provided grants.
7-7 Sec. 46.003. ELIGIBILITY. To be eligible to receive money
7-8 from the board, a medically underserved community must:
7-9 (1) apply for the money; and
7-10 (2) provide evidence satisfactory to the board that it
7-11 has entered into an agreement with a physician for the physician to
7-12 provide primary care in the community for at least two years.
7-13 Sec. 46.004. RULES. The board shall adopt rules necessary
7-14 for the administration of this chapter, including:
7-15 (1) eligibility criteria for a medically underserved
7-16 community;
7-17 (2) eligibility criteria for a physician;
7-18 (3) minimum and maximum community contributions to the
7-19 start-up money for a physician to be matched with state money;
7-20 (4) conditions under which state money must be repaid
7-21 by a community or physician;
7-22 (5) procedures for disbursement of money by the board;
7-23 (6) the form and manner in which a community must make
7-24 its contribution to the start-up money; and
7-25 (7) the contents of an agreement to be entered into by
8-1 the parties to include at least:
8-2 (A) a credit check for an eligible physician;
8-3 (B) community retention of interest in any
8-4 property, equipment, or durable goods for seven years; and
8-5 (C) the requirement of full-time clinical
8-6 practice for participating physicians.
8-7 Sec. 46.005. FUNDING. The board may accept gifts, grants,
8-8 and donations for the purposes of this chapter.
8-9 SECTION 8. Not later than December 1, 1996, the Texas Higher
8-10 Education Coordinating Board shall report to the legislature on:
8-11 (1) the allocation of money to the family practice
8-12 residency training pilot programs established under Section 61.506,
8-13 Education Code, as amended by this Act; and
8-14 (2) the progress of those programs in:
8-15 (A) training family practice resident
8-16 physicians; and
8-17 (B) providing indigent health care.
8-18 SECTION 9. This Act takes effect September 1, 1995.
8-19 SECTION 10. The importance of this legislation and the
8-20 crowded condition of the calendars in both houses create an
8-21 emergency and an imperative public necessity that the
8-22 constitutional rule requiring bills to be read on three several
8-23 days in each house be suspended, and this rule is hereby suspended.