By: Sibley S.B. No. 979
A BILL TO BE ENTITLED
AN ACT
1-1 relating to relief programs, family practice residency training
1-2 pilot programs, the repayment of certain physician education loans,
1-3 the medical school tuition set aside for certain loan payments, and
1-4 increasing the number of primary care physicians in medically
1-5 underserved areas of this state through the creation of the
1-6 Medically Underserved Community-State Matching Incentive Program.
1-7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-8 SECTION 1. Title 3, Subtitle A, Chapter 51, Subchapter Z,
1-9 Section 51.918(c), Education Code, is amended to read as follows:
1-10 Section 51.918. RURAL HEALTH; FAMILY PRACTICE RESIDENCY
1-11 PROGRAM.
1-12 (c) The Center for Rural Health Initiatives shall develop
1-13 relief service programs for rural physicians and allied health
1-14 personnel to facilitate ready access to continuing medical
1-15 education or practice coverage for purposes other than continuing
1-16 medical education.
1-17 SECTION 2. Section 61.506, Education Code, is amended to
1-18 read as follows:
1-19 Section 61.506. Family Practice Residency Training Pilot
1-20 Programs.
1-21 (a) The Family Practice Residency Advisory Committee <and a
1-22 statewide advisory committee established by the Texas Board of
1-23 Health under Section 31.017, Health and Safety Code,> shall work
2-1 <together> to enhance approved family practice residency programs
2-2 and to establish three pilot programs to provide a major source of
2-3 indigent health care and <also> to train family practice resident
2-4 physicians.
2-5 (b) Each of the three pilot programs must <be located in>
2-6 provide services to an <area that> economically depressed or rural
2-7 medically underserved area of the state. One pilot program must be
2-8 located in an urban area, one pilot program must be located in a
2-9 rural area, and one pilot program must be located in the border
2-10 region as defined by Section 481.001(3), Government Code <reflects
2-11 the diversity of this state>.
2-12 (c) An approved family practice program that wants to
2-13 participate in or sponsor a pilot program must make a proposal to
2-14 the advisory committee <committees>.
2-15 (d) The advisory committee <committees> shall review all
2-16 proposals submitted under Subsection (c) of this section and shall
2-17 recommend to the board approved family practice residency programs
2-18 to participate in or sponsor pilot programs.
2-19 (e) The board shall select approved family practice
2-20 residency programs to participate in or sponsor pilot programs on
2-21 the basis of each program's commitment to indigent health care and
2-22 to training family practice resident physicians.
2-23 (f) The advisory committee <committees> shall use <the>
2-24 financial reports, audits, and performance evaluations currently
2-25 required under this subchapter or by board rule <and under Section
3-1 31.015, Health and Safety Code,> to assess annually the financial
3-2 feasibility and effective performance of the pilot programs. The
3-3 advisory committee <committees> may require additional reports as
3-4 necessary.
3-5 (g) The advisory committee <committees> shall send copies of
3-6 its <their> annual assessment of the pilot programs to the
3-7 comptroller and the state auditor for review.
3-8 (h) If the advisory committee determines <committees
3-9 determine> that a pilot program is not financially feasible or that
3-10 it does not perform effectively, the advisory committee
3-11 <committees> shall recommend to the board discontinuation of
3-12 funding for the pilot program.
3-13 SECTION 3. Not later than December 1, 1996, the Texas Higher
3-14 Education Coordinating Board shall report to each house of the 75th
3-15 Legislature on the allocation of money to the family practice
3-16 residency training pilot programs established under Section 61.506,
3-17 Education Code, as amended by this Act, and on the progress of
3-18 those programs in training family practice resident physicians and
3-19 in providing indigent health care.
3-20 SECTION 4. Section 61.531, Education Code, is amended by
3-21 adding a new Section 61.531 to read as follows:
3-22 Section 61.531. REPAYMENT AUTHORIZED.
3-23 (a) It is the intent of the legislature that no more than 20
3-24 percent of physicians receiving repayment assistance shall be
3-25 employed by specified state agencies.
4-1 (b) A physician who receives repayment assistance from the
4-2 Physician Education Loan Repayment Program is not eligible to
4-3 receive assistance under the Medically Underserved Community-State
4-4 Match Program (Title 2, Subtitle B, Chapter 46, Health and Safety
4-5 Code) or the Texas Health Service Corps Program (Title 2, Subtitle
4-6 B, Chapter 47, Health and Safety Code).
4-7 SECTION 5. Section 61.532(a), Education Code, is amended to
4-8 read as follows:
4-9 Section 61.532. ELIGIBILITY.
4-10 (a) To be eligible to receive repayment assistance, a
4-11 physician must apply to the coordinating board and have completed
4-12 at least one year of medical practice:
4-13 (1) in private practice in an economically depressed
4-14 or rural medically underserved area of the state;
4-15 (2) for one of the following state agencies:
4-16 (A) Texas Department of Health;
4-17 (B) Texas Department of Mental Health and Mental
4-18 Retardation;
4-19 (C) Texas Department of Corrections; or
4-20 (D) Texas Youth Commission; or
4-21 (3) for one of the following positions in an approved
4-22 family practice residency training program established under
4-23 Subchapter I of this chapter:
4-24 (A) as clinical faculty in an approved family
4-25 practice residency program, having completed training in an
5-1 approved family practice residency program no earlier than July 1,
5-2 1994; or
5-3 (B) as second- or third-year residents.
5-4 SECTION 6. Section 61.539(b), Education Code, is amended to
5-5 read as follows:
5-6 (b) The amount set aside shall be transferred to the
5-7 comptroller of public accounts to be maintained in the state
5-8 treasury for the sole purpose of repayment of student loans of
5-9 physicians serving in designated state agencies or economically
5-10 depressed or rural medically underserved areas of the state as
5-11 specified by this subchapter. Sections 403.094(h) and 403.095,
5-12 Government Code, do not apply to the funds set aside in this
5-13 section.
5-14 SECTION 7. Title 2, Subtitle B, Health and Safety Code, is
5-15 amended by adding Chapter 46 to read as follows:
5-16 Chapter 46. MEDICALLY UNDERSERVED COMMUNITY-STATE MATCHING
5-17 INCENTIVE PROGRAM.
5-18 Section 46.001. DEFINITIONS. In this chapter:
5-19 (1) "Start-up Funds" means any payment made by a
5-20 medically underserved community for reasonable costs incurred by a
5-21 physician to establish a medical office and ancillary facilities
5-22 for diagnosing and treating patients.
5-23 (2) "Medically underserved community" means a
5-24 community located in an area in Texas with a medically underserved
5-25 population or an urban or rural area designated by the secretary of
6-1 health and human services as an area in Texas with a shortage of
6-2 personal health services or a population group designated by the
6-3 secretary as having a shortage of such services (as defined by
6-4 U.S.C. Section 300(3)-1(7) or as defined by the Texas Department of
6-5 Health by rule which is based upon Texas specific demographics,
6-6 geographic factors that affect access to health care, and
6-7 environmental health factors.
6-8 (3) "Physician" means a person licensed to practice
6-9 medicine in the state of Texas, and
6-10 (4) "Primary Care" means physician services in family
6-11 practice, general practice, internal medicine, pediatrics, or
6-12 obstetrics and gynecology.
6-13 Section 46.002. MEDICALLY UNDERSERVED COMMUNITY-STATE MATCH
6-14 PROGRAM.
6-15 (a) The board shall establish and administer a matching fund
6-16 program in accordance with this chapter to increase the number of
6-17 physicians providing primary care in medically underserved
6-18 communities.
6-19 (b) Under the program, an eligible community may sponsor a
6-20 physician who has agreed to provide primary care in the community
6-21 by contributing to start-up funds for the physician and having that
6-22 contribution matched in whole or in part by state funds
6-23 appropriated to the board for that purpose.
6-24 (c) Under the program, a participating medically underserved
6-25 community may provide start-up funds to an eligible physician over
7-1 a twenty-four month period.
7-2 (c) The board may not provide matching funds to more than
7-3 ten communities in each year of the program.
7-4 (d) The board may not pay more than $25,000 to a community
7-5 in any fiscal year, unless the board makes a specific finding of
7-6 need by the community.
7-7 Section 46.004. ELIGIBILITY.
7-8 (a) To be eligible to receive funds from the board, a
7-9 medically underserved community must apply for such funds and
7-10 provide evidence satisfactory to the board that it has entered into
7-11 an agreement with a physician that the physician provide primary
7-12 care in the community for a period of at least two years.
7-13 (b) A physician who receives repayment assistance from the
7-14 Medically Underserved Community-State Match Program is not eligible
7-15 to receive assistance under the Physician Education Loan Repayment
7-16 Program (Subchapter J, Chapter 61, Education Code) or the Texas
7-17 Health Service Corps Program (Title 2, Subtitle B, Chapter 47,
7-18 Health and Safety Code).
7-19 Section 46.004. RULES. The board may adopt rules necessary
7-20 for the administration of this subchapter, including but not
7-21 limited to:
7-22 (1) eligibility criteria for a medically underserved
7-23 community;
7-24 (2) eligibility criteria for a physician;
7-25 (3) minimum and maximum community contributions to the
8-1 start-up funds for a physician that will be matched with state
8-2 funds;
8-3 (4) conditions under which state funds must be repaid
8-4 by a community or physician;
8-5 (5) procedures for disbursement of funds by the board;
8-6 (6) the form and manner in which a community must make
8-7 its contribution to the start-up funds; and
8-8 (7) the contents of any standard agreement to be
8-9 entered into by the parties.
8-10 Section 46.005. FUNDING. The board may accept gifts,
8-11 grants, and donations for the purposes of this subchapter.
8-12 Section 46.006. ADVISORY COMMITTEE. The board may appoint
8-13 an advisory committee to advise the board in its administration of
8-14 this subchapter.
8-15 SECTION 8. This Act takes effect September 1, 1995.
8-16 SECTION 9. The importance of this legislation and the
8-17 crowded condition of the calendars in both houses create an
8-18 emergency and an imperative public necessity that the
8-19 constitutional rule requiring bills to be read on three several
8-20 days in each house be suspended, and this rule is hereby suspended,
8-21 and that this Act take effect and be in force from and after its
8-22 passage, and it is so enacted.