By Berlanga, Glaze, Coleman, Hirschi, H.B. No. 1511
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the administration and allocation of Medicaid and other
1-3 funds used to pay for graduate medical education.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
1-6 is amended by adding Section 32.0315 to read as follows:
1-7 Sec. 32.0315. FUNDS FOR GRADUATE MEDICAL EDUCATION.
1-8 (a) The department shall establish procedures and formulas for the
1-9 allocation of federal medical assistance funds that are directed to
1-10 be used to support graduate medical education in connection with
1-11 the medical assistance program.
1-12 (b) The department shall allocate the funds in the manner
1-13 the department determines most effectively and equitably achieves
1-14 the purposes for which those federal funds are received, consistent
1-15 with the needs of this state for graduate medical education and the
1-16 training of resident physicians in accredited residency programs in
1-17 appropriate fields and specialties, taking into account other money
1-18 available to support graduate medical education. In determining
1-19 the needs of this state for graduate medical education, the
1-20 department shall give emphasis to graduate medical education in
1-21 primary care specialties.
1-22 (c) The department shall consult with the Texas Higher
1-23 Education Coordinating Board before adopting or revising a formula
1-24 under this section. At the request of the department, the
1-25 coordinating board shall provide the department with any
2-1 information the board possesses to assist the department in
2-2 administering this section.
2-3 (d) The department shall reimburse each teaching hospital
2-4 under this section using the following formula:
2-6 where:
2-7 "R" is the annual amount to be reimbursed;
2-8 "GME" is the hospital's annual cost of training resident
2-9 physicians for the fiscal year;
2-10 "P" is the number of resident physicians for the fiscal year;
2-11 "WNP" is the weighted number of full-time equivalent resident
2-12 physicians trained by the hospital during the fiscal year and
2-13 reported on its Medicaid cost report, adjusted to count each
2-14 full-time equivalent resident in primary care as 1.2 residents and
2-15 each other full-time equivalent resident as 1.0 residents;
2-16 "MD" means the number of patient days for the hospital for
2-17 the fiscal year that are attributable to Medicaid patients; and
2-18 "TD" means the total number of patient days for the hospital
2-19 for the fiscal year.
2-20 (d-1) For purposes of the calculation under Subsection (d)
2-21 made to determine the amount of reimbursement for a teaching
2-22 hospital for the state fiscal year ending August 31, 1998, WNP
2-23 shall be calculated counting each full-time equivalent resident in
2-24 primary care as 1.0 residents and each other full-time equivalent
2-25 resident as 1.0 residents, and a teaching hospital's average annual
2-26 cost for training residents shall be determined using current cost
2-27 reports for the hospital. This subsection expires January 1, 1999.
3-1 (e) To determine a teaching hospital's average annual cost
3-2 for training residents for purposes of this section, the department
3-3 may use the most recent Medicaid cost report submitted to the
3-4 department by the hospital, or may establish alternative procedures
3-5 to determine that cost.
3-6 (f) The department shall make payments under this section in
3-7 equal monthly installments, except that the department may make
3-8 adjustments in any payment or make additional payments as necessary
3-9 to ensure that each teaching hospital or other entity receives the
3-10 appropriate annual amount under this section.
3-11 (g) For purposes of this section, primary care means a field
3-12 or specialty described by Section 58.008(a), Education Code.
3-13 (h) Notwithstanding Subsections (d) and (e), each teaching
3-14 hospital that received federal medical assistance funds for
3-15 training residents in the state fiscal year ending August 31, 1995,
3-16 shall receive an amount under this section that is:
3-17 (1) for the state fiscal year ending August 31, 1999,
3-18 not less than 90 percent of the amount of those funds the hospital
3-19 would have received in that fiscal year under the formulas used to
3-20 determine the amount of federal medical assistance funds for
3-21 training residents the hospital received in that 1995 fiscal year;
3-22 (2) for the state fiscal year ending August 31, 2000,
3-23 not less than 85 percent of the amount of those funds the hospital
3-24 would have received in that fiscal year under the formulas used to
3-25 determine the amount of federal medical assistance funds for
3-26 training residents the hospital received in that 1995 fiscal year;
3-27 (3) for the state fiscal year ending August 31, 2001,
4-1 not less than 80 percent of the amount of those funds the hospital
4-2 would have received in that fiscal year under the formulas used to
4-3 determine the amount of federal medical assistance funds for
4-4 training residents the hospital received in that 1995 fiscal year;
4-5 and
4-6 (4) for the state fiscal year ending August 31, 2002,
4-7 not less than 75 percent of the amount of those funds the hospital
4-8 would have received in that fiscal year under the formulas used to
4-9 determine the amount of federal medical assistance funds for
4-10 training residents the hospital received in that 1995 fiscal year.
4-11 SECTION 2. Subchapter C, Chapter 61, Education Code, is
4-12 amended by adding Section 61.0594 to read as follows:
4-13 Sec. 61.0594. COORDINATED FUNDING OF GRADUATE MEDICAL
4-14 EDUCATION. (a) The board shall administer a program to support
4-15 graduate medical education programs in this state consistent with
4-16 the needs of this state for graduate medical education and the
4-17 training of resident physicians in accredited residency programs in
4-18 appropriate fields and specialties, including primary care
4-19 specialties described by Section 58.008(a).
4-20 (b) From money available to the program, the board may make
4-21 grants or formula distributions to:
4-22 (1) support appropriate graduate medical education
4-23 programs and activities for which adequate funds are not otherwise
4-24 available; or
4-25 (2) foster new or expanded graduate medical education
4-26 programs or activities that the board determines will address the
4-27 state's needs for graduate medical education.
5-1 (c) To be eligible to receive a grant or distribution under
5-2 this section, an institution or other entity must incur the costs
5-3 of faculty supervision and education or the stipend costs of
5-4 resident physicians in accredited clinical residency programs in
5-5 this state. In making grants and distributions under this section,
5-6 the board shall give consideration to the costs incurred by medical
5-7 schools or other entities to support faculty responsible for the
5-8 education or supervision of resident physicians in accredited
5-9 graduate medical education programs, including programs in
5-10 osteopathic medical education.
5-11 (d) The program is funded by appropriations, by gifts,
5-12 grants, and donations made to support the program, and by any other
5-13 funds the board obtains, including federal funds, for the program.
5-14 From program funds, the comptroller of public accounts shall issue
5-15 warrants to each institution or other entity determined by the
5-16 board as eligible to receive a grant or distribution from the
5-17 program in the amount certified by the board. An amount granted to
5-18 an institution or other entity under the program may be used only
5-19 to cover expenses of training residents of the particular program
5-20 or activity for which the award is made in accordance with any
5-21 conditions imposed by the board and may not otherwise be expended
5-22 for the general support of the institution or entity.
5-23 (e) The board shall appoint an advisory committee to advise
5-24 the board regarding the development and administration of the
5-25 program, including considering requests for program grants and
5-26 establishing formulas for distribution of money under the program.
5-27 The advisory committee shall consist of:
6-1 (1) the executive director of the Texas State Board of
6-2 Medical Examiners or the executive director's designee;
6-3 (2) the chair of the Family Practice Residency
6-4 Advisory Committee or the chair's designee;
6-5 (3) the chair of the Primary Care Residency Advisory
6-6 Committee or the chair's designee;
6-7 (4) the commissioner of the Health and Human Services
6-8 Commission or the commissioner's designee; and
6-9 (5) the following members appointed by the board:
6-10 (A) one representative of a teaching hospital
6-11 affiliated with a Texas medical school;
6-12 (B) one representative of a teaching hospital
6-13 not affiliated with a Texas medical school;
6-14 (C) three representatives of medical schools, at
6-15 least one representing a medical school in The University of Texas
6-16 System, and at least one representing a medical school not in The
6-17 University of Texas System;
6-18 (D) two physicians active in private practice,
6-19 one of whom must be a generalist;
6-20 (E) one doctor of osteopathic medicine active in
6-21 private practice;
6-22 (F) one representative of an entity providing
6-23 managed health care;
6-24 (G) three clinical faculty members, at least one
6-25 of whom must be a generalist;
6-26 (H) one resident physician, who is a nonvoting
6-27 member; and
7-1 (I) one medical student, who is a nonvoting
7-2 member.
7-3 (f) The appointed advisory committee members serve staggered
7-4 three-year terms. The board shall make the initial committee
7-5 appointments to terms of one, two, and three years as necessary so
7-6 that one-third of the appointed members' terms expire each year, as
7-7 nearly as practicable. The committee shall elect one of its
7-8 members as presiding officer for a term of one year. The committee
7-9 shall meet at least once each year at the times requested by the
7-10 board or set by the presiding officer of the committee. A member
7-11 of the advisory committee may not be compensated for service on the
7-12 committee but is entitled to be reimbursed by the board for actual
7-13 expenses incurred in the performance of the member's duties as a
7-14 committee member.
7-15 (g) The advisory committee shall:
7-16 (1) review applications for funding of graduate
7-17 medical education programs under this section and make
7-18 recommendations for approval or disapproval of those applications;
7-19 (2) make recommendations relating to the standards and
7-20 criteria used for consideration and approval of grants or for the
7-21 development of formulas for distribution of funding under this
7-22 section;
7-23 (3) recommend to the board an allocation of funds
7-24 among medical schools, teaching hospitals, and other entities that
7-25 may receive funds under this section; and
7-26 (4) perform other duties assigned by the board.
7-27 SECTION 3. (a) This Act takes effect September 1, 1997.
8-1 (b) Section 32.0315, Human Resources Code, as added by this
8-2 Act, applies to the distribution of federal medical assistance
8-3 funds for the support of graduate medical education received on or
8-4 after the effective date of this Act, and to any such federal funds
8-5 received before the effective date of this Act that have not been
8-6 promised, obligated, or otherwise identified for distribution to
8-7 specific entities before the effective date.
8-8 SECTION 4. The importance of this legislation and the
8-9 crowded condition of the calendars in both houses create an
8-10 emergency and an imperative public necessity that the
8-11 constitutional rule requiring bills to be read on three several
8-12 days in each house be suspended, and this rule is hereby suspended.