By: Sibley, et al. S.B. No. 979
A BILL TO BE ENTITLED
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
1-24 program must be located in an urban area, one pilot program must be
2-1 located in a rural area, and the remaining pilot program or
2-2 programs must be located in the border region as defined by Section
2-3 481.001, Government Code <area that reflects the diversity of this
2-4 state>.
2-5 (c) An approved family practice residency program that wants
2-6 to participate in or sponsor a pilot program must make a proposal
2-7 to the advisory committee <committees>.
2-8 (d) The advisory committee <committees> shall review all
2-9 proposals submitted under Subsection (c) of this section and shall
2-10 recommend to the board approved family practice residency programs
2-11 to participate in or sponsor pilot programs.
2-12 (e) The board shall select approved family practice
2-13 residency programs to participate in or sponsor pilot programs on
2-14 the basis of each program's commitment to indigent health care and
2-15 to training family practice resident physicians.
2-16 (f) The advisory committee <committees> shall use <the>
2-17 financial reports, audits, and performance evaluations currently
2-18 required under this subchapter or by board rule <and under Section
2-19 31.015, Health and Safety Code,> to assess annually the financial
2-20 feasibility and effective performance of the pilot programs. The
2-21 advisory committee <committees> may require additional reports as
2-22 necessary.
2-23 (g) The advisory committee <committees> shall send copies of
2-24 its <their> annual assessment of the pilot programs to the
2-25 comptroller and the state auditor for review.
2-26 (h) If the advisory committee determines <committees
2-27 determine> that a pilot program is not financially feasible or that
3-1 it does not perform effectively, the advisory committee
3-2 <committees> shall recommend to the board discontinuation of
3-3 funding for the pilot program.
3-4 SECTION 3. Section 61.531, Education Code, is amended to
3-5 read as follows:
3-6 Sec. 61.531. REPAYMENT AUTHORIZED. (a) The coordinating
3-7 board may provide, using funds appropriated for that purpose and in
3-8 accordance with this subchapter and rules of the board, assistance
3-9 in the repayment of student loans for physicians who apply and
3-10 qualify for the assistance.
3-11 (b) Not more than 20 percent of the physicians receiving
3-12 repayment assistance under this subchapter may be employed by the
3-13 state agencies listed in Section 61.532(a)(2).
3-14 (c) A physician who receives repayment assistance under this
3-15 subchapter may not receive assistance under Chapter 46, Health and
3-16 Safety Code.
3-17 SECTION 4. Subsection (a), Section 61.532, Education Code,
3-18 is amended to read as follows:
3-19 (a) To be eligible to receive repayment assistance, a
3-20 physician must apply to the coordinating board and have completed
3-21 at least one year of medical practice:
3-22 (1) in private practice in an economically depressed
3-23 or rural medically underserved area of the state;
3-24 (2) for one of the following state agencies:
3-25 (A) Texas Department of Health;
3-26 (B) Texas Department of Mental Health and Mental
3-27 Retardation;
4-1 (C) Texas Department of Corrections; or
4-2 (D) Texas Youth Commission; or
4-3 (3) for an approved family practice residency training
4-4 program established under Subchapter I of this chapter as a:
4-5 (A) clinical faculty member and have completed
4-6 training in an approved family practice residency training program
4-7 on or after July 1, 1994; or
4-8 (B) resident.
4-9 SECTION 5. Subsection (b), Section 61.539, Education Code,
4-10 is amended to read as follows:
4-11 (b) The amount set aside shall be transferred to the
4-12 comptroller of public accounts to be maintained in the state
4-13 treasury for the sole purpose of repayment of student loans of
4-14 physicians serving in designated state agencies or economically
4-15 depressed or rural medically underserved areas of the state as
4-16 specified by this subchapter. Sections 403.094(h) and 403.095,
4-17 Government Code, do not apply to the amount set aside by this
4-18 section.
4-19 SECTION 6. Subtitle B, Title 2, Health and Safety Code, is
4-20 amended by adding Chapter 46 to read as follows:
4-21 CHAPTER 46. MEDICALLY UNDERSERVED COMMUNITY-STATE
4-22 MATCHING INCENTIVE PROGRAM
4-23 Sec. 46.001. DEFINITIONS. In this chapter:
4-24 (1) "Medically underserved community" means:
4-25 (A) a community located in an area in this state
4-26 with a medically underserved population;
4-27 (B) a community located in an area in this state
5-1 designated by the United States Secretary of Health and Human
5-2 Services as an area with a shortage of personal health services;
5-3 (C) a population group designated by the United
5-4 States Secretary of Health and Human Services as having a shortage
5-5 of personal health services; or
5-6 (D) a community that meets criteria adopted by
5-7 the board by rule, considering relevant demographic, geographic,
5-8 and environmental factors.
5-9 (2) "Physician" means a person licensed to practice
5-10 medicine in this state.
5-11 (3) "Primary care" means physician services in family
5-12 practice, general practice, internal medicine, pediatrics,
5-13 obstetrics, or gynecology.
5-14 (4) "Start-up money" means a payment made by a
5-15 medically underserved community for reasonable costs incurred by a
5-16 physician to establish a medical office and ancillary facilities
5-17 for diagnosing and treating patients.
5-18 Sec. 46.002. PROGRAM. (a) The board shall establish and
5-19 administer a program under this chapter to increase the number of
5-20 physicians providing primary care in medically underserved
5-21 communities.
5-22 (b) An eligible community may sponsor a physician who has
5-23 agreed to provide primary care in the community by contributing to
5-24 start-up money for the physician and having that contribution
5-25 matched in whole or in part by state money appropriated to the
5-26 board for that purpose.
5-27 (c) A participating medically underserved community may
6-1 provide start-up money to an eligible physician over a two-year
6-2 period.
6-3 (d) The board may not pay more than $25,000 to a community
6-4 in a fiscal year unless the board makes a specific finding of need
6-5 by the community.
6-6 Sec. 46.003. ELIGIBILITY. To be eligible to receive money
6-7 from the board, a medically underserved community must:
6-8 (1) apply for the money; and
6-9 (2) provide evidence satisfactory to the board that it
6-10 has entered into an agreement with a physician for the physician to
6-11 provide primary care in the community for at least two years.
6-12 Sec. 46.004. RULES. The board may adopt rules necessary for
6-13 the administration of this chapter, including:
6-14 (1) eligibility criteria for a medically underserved
6-15 community;
6-16 (2) eligibility criteria for a physician;
6-17 (3) minimum and maximum community contributions to the
6-18 start-up money for a physician to be matched with state money;
6-19 (4) conditions under which state money must be repaid
6-20 by a community or physician;
6-21 (5) procedures for disbursement of money by the board;
6-22 (6) the form and manner in which a community must make
6-23 its contribution to the start-up money; and
6-24 (7) the contents of an agreement to be entered into by
6-25 the parties.
6-26 Sec. 46.005. FUNDING. The board may accept gifts, grants,
6-27 and donations for the purposes of this chapter.
7-1 SECTION 7. Not later than December 1, 1996, the Texas Higher
7-2 Education Coordinating Board shall report to the legislature on:
7-3 (1) the allocation of money to the family practice
7-4 residency training pilot programs established under Section 61.506,
7-5 Education Code, as amended by this Act; and
7-6 (2) the progress of those programs in:
7-7 (A) training family practice resident
7-8 physicians; and
7-9 (B) providing indigent health care.
7-10 SECTION 8. This Act takes effect September 1, 1995.
7-11 SECTION 9. The importance of this legislation and the
7-12 crowded condition of the calendars in both houses create an
7-13 emergency and an imperative public necessity that the
7-14 constitutional rule requiring bills to be read on three several
7-15 days in each house be suspended, and this rule is hereby suspended.
7-16 COMMITTEE AMENDMENT NO. 1
7-17 Amend S.B. No. 979 as follows:
7-18 (1)(a) On page 4, line 14, add a new Section 5 to read as
7-19 follows:
7-20 SECTION 5. Subsection (a), Section 61.537, Education Code,
7-21 is amended to read as follows:
7-22 (a) The coordinating board shall adopt rules necessary for
7-23 the administration of this subchapter, including a rule that sets a
7-24 maximum amount of repayment assistance that may be received by a
7-25 physician in one year and a rule that authorizes the Family
7-26 Practice Residency Advisory Committee to establish priorities among
7-27 eligible physicians for repayment assistance, by taking into
8-1 account the degree of physician shortage, geographic locations,
8-2 whether the physician is or will be providing service in a
8-3 medically underserved area, and other criteria the committee
8-4 considers appropriate.
8-5 (b) Renumber all subsequent sections accordingly.
8-6 (2) On page 6, line 4, strike the words "An eligible" and
8-7 substitute "A medically underserved".
8-8 (3) On page 6, line 4, following the word "has" add:
8-9 "completed a primary care residency program within seven
8-10 years of application to this program and has".
8-11 (4) On page 6, line 15, add a new Subsection (e) to Section
8-12 46.002 to read as follows:
8-13 "(e) The board shall prioritize the communities eligible for
8-14 assistance under this chapter in order to assure that the neediest
8-15 communities are provided grants."
8-16 (5) On page 6, line 21, strike the word "may" and substitute
8-17 "shall".
8-18 (6) On page 7, line 9, after the word "parties" add:
8-19 "to include at least:
8-20 (A) a credit check for an eligible physician;
8-21 (B) community retention of interest in any
8-22 property, equipment, or durable goods for seven years; and
8-23 (C) the requirement of full-time clinical
8-24 practice for participating physicians"
8-25 Berlanga