1-1 By: Berlanga, et al. (Senate Sponsor - Zaffirini) H.B. No. 1511 1-2 (In the Senate - Received from the House April 14, 1997; 1-3 April 16, 1997, read first time and referred to Committee on Health 1-4 and Human Services; May 1, 1997, reported favorably by the 1-5 following vote: Yeas 11, Nays 0; May 1, 1997, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to the administration and allocation of Medicaid and other 1-9 funds used to pay for graduate medical education. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Subchapter B, Chapter 32, Human Resources Code, 1-12 is amended by adding Section 32.0315 to read as follows: 1-13 Sec. 32.0315. FUNDS FOR GRADUATE MEDICAL EDUCATION. 1-14 (a) The department shall establish procedures and formulas for the 1-15 allocation of federal medical assistance funds that are directed to 1-16 be used to support graduate medical education in connection with 1-17 the medical assistance program. 1-18 (b) The department shall allocate the funds in the manner 1-19 the department determines most effectively and equitably achieves 1-20 the purposes for which those federal funds are received, consistent 1-21 with the needs of this state for graduate medical education and the 1-22 training of resident physicians in accredited residency programs in 1-23 appropriate fields and specialties, taking into account other money 1-24 available to support graduate medical education. In determining 1-25 the needs of this state for graduate medical education, the 1-26 department shall give emphasis to graduate medical education in 1-27 primary care specialties. 1-28 (c) The department shall consult with the Texas Higher 1-29 Education Coordinating Board before adopting or revising a formula 1-30 under this section. At the request of the department, the 1-31 coordinating board shall provide the department with any 1-32 information the board possesses to assist the department in 1-33 administering this section. 1-34 (d) The department shall reimburse each teaching hospital 1-35 under this section using the following formula: 1-36 R = GME/P x WNP x MD/TD 1-37 where: 1-38 "R" is the annual amount to be reimbursed; 1-39 "GME" is the hospital's annual cost of training resident 1-40 physicians for the fiscal year; 1-41 "P" is the number of resident physicians for the fiscal year; 1-42 "WNP" is the weighted number of full-time equivalent resident 1-43 physicians trained by the hospital during the fiscal year and 1-44 reported on its Medicaid cost report, adjusted to count each 1-45 full-time equivalent resident in primary care as 1.2 residents and 1-46 each other full-time equivalent resident as 1.0 residents; 1-47 "MD" means the number of patient days for the hospital for 1-48 the fiscal year that are attributable to Medicaid patients; and 1-49 "TD" means the total number of patient days for the hospital 1-50 for the fiscal year. 1-51 (d-1) For purposes of the calculation under Subsection (d) 1-52 made to determine the amount of reimbursement for a teaching 1-53 hospital for the state fiscal year ending August 31, 1998, WNP 1-54 shall be calculated counting each full-time equivalent resident in 1-55 primary care as 1.0 residents and each other full-time equivalent 1-56 resident as 1.0 residents, and a teaching hospital's average annual 1-57 cost for training residents shall be determined using current cost 1-58 reports for the hospital. This subsection expires January 1, 1999. 1-59 (e) To determine a teaching hospital's average annual cost 1-60 for training residents for purposes of this section, the department 1-61 may use the most recent Medicaid cost report submitted to the 1-62 department by the hospital, or may establish alternative procedures 1-63 to determine that cost. 1-64 (f) The department shall make payments under this section in 2-1 equal monthly installments, except that the department may make 2-2 adjustments in any payment or make additional payments as necessary 2-3 to ensure that each teaching hospital or other entity receives the 2-4 appropriate annual amount under this section. 2-5 (g) For purposes of this section, primary care means a field 2-6 or specialty described by Section 58.008(a), Education Code. 2-7 (h) Notwithstanding Subsections (d) and (e), each teaching 2-8 hospital that received federal medical assistance funds for 2-9 training residents in the state fiscal year ending August 31, 1995, 2-10 shall receive an amount under this section that is: 2-11 (1) for the state fiscal year ending August 31, 1999, 2-12 not less than 90 percent of the amount of those funds the hospital 2-13 would have received in that fiscal year under the formulas used to 2-14 determine the amount of federal medical assistance funds for 2-15 training residents the hospital received in that 1995 fiscal year; 2-16 (2) for the state fiscal year ending August 31, 2000, 2-17 not less than 85 percent of the amount of those funds the hospital 2-18 would have received in that fiscal year under the formulas used to 2-19 determine the amount of federal medical assistance funds for 2-20 training residents the hospital received in that 1995 fiscal year; 2-21 (3) for the state fiscal year ending August 31, 2001, 2-22 not less than 80 percent of the amount of those funds the hospital 2-23 would have received in that fiscal year under the formulas used to 2-24 determine the amount of federal medical assistance funds for 2-25 training residents the hospital received in that 1995 fiscal year; 2-26 and 2-27 (4) for the state fiscal year ending August 31, 2002, 2-28 not less than 75 percent of the amount of those funds the hospital 2-29 would have received in that fiscal year under the formulas used to 2-30 determine the amount of federal medical assistance funds for 2-31 training residents the hospital received in that 1995 fiscal year. 2-32 SECTION 2. Subchapter C, Chapter 61, Education Code, is 2-33 amended by adding Section 61.0594 to read as follows: 2-34 Sec. 61.0594. COORDINATED FUNDING OF GRADUATE MEDICAL 2-35 EDUCATION. (a) The board shall administer a program to support 2-36 graduate medical education programs in this state consistent with 2-37 the needs of this state for graduate medical education and the 2-38 training of resident physicians in accredited residency programs in 2-39 appropriate fields and specialties, including primary care 2-40 specialties described by Section 58.008(a). 2-41 (b) From money available to the program, the board may make 2-42 grants or formula distributions to: 2-43 (1) support appropriate graduate medical education 2-44 programs and activities for which adequate funds are not otherwise 2-45 available; or 2-46 (2) foster new or expanded graduate medical education 2-47 programs or activities that the board determines will address the 2-48 state's needs for graduate medical education. 2-49 (c) To be eligible to receive a grant or distribution under 2-50 this section, an institution or other entity must incur the costs 2-51 of faculty supervision and education or the stipend costs of 2-52 resident physicians in accredited clinical residency programs in 2-53 this state. In making grants and distributions under this section, 2-54 the board shall give consideration to the costs incurred by medical 2-55 schools or other entities to support faculty responsible for the 2-56 education or supervision of resident physicians in accredited 2-57 graduate medical education programs, including programs in 2-58 osteopathic medical education. 2-59 (d) The program is funded by appropriations, by gifts, 2-60 grants, and donations made to support the program, and by any other 2-61 funds the board obtains, including federal funds, for the program. 2-62 From program funds, the comptroller of public accounts shall issue 2-63 warrants to each institution or other entity determined by the 2-64 board as eligible to receive a grant or distribution from the 2-65 program in the amount certified by the board. An amount granted to 2-66 an institution or other entity under the program may be used only 2-67 to cover expenses of training residents of the particular program 2-68 or activity for which the award is made in accordance with any 2-69 conditions imposed by the board and may not otherwise be expended 3-1 for the general support of the institution or entity. 3-2 (e) The board shall appoint an advisory committee to advise 3-3 the board regarding the development and administration of the 3-4 program, including considering requests for program grants and 3-5 establishing formulas for distribution of money under the program. 3-6 The advisory committee shall consist of: 3-7 (1) the executive director of the Texas State Board of 3-8 Medical Examiners or the executive director's designee; 3-9 (2) the chair of the Family Practice Residency 3-10 Advisory Committee or the chair's designee; 3-11 (3) the chair of the Primary Care Residency Advisory 3-12 Committee or the chair's designee; 3-13 (4) the commissioner of the Health and Human Services 3-14 Commission or the commissioner's designee; and 3-15 (5) the following members appointed by the board: 3-16 (A) one representative of a teaching hospital 3-17 affiliated with a Texas medical school; 3-18 (B) one representative of a teaching hospital 3-19 not affiliated with a Texas medical school; 3-20 (C) three representatives of medical schools, at 3-21 least one representing a medical school in The University of Texas 3-22 System, and at least one representing a medical school not in The 3-23 University of Texas System; 3-24 (D) two physicians active in private practice, 3-25 one of whom must be a generalist; 3-26 (E) one doctor of osteopathic medicine active in 3-27 private practice; 3-28 (F) one representative of an entity providing 3-29 managed health care; 3-30 (G) three clinical faculty members, at least one 3-31 of whom must be a generalist; 3-32 (H) one resident physician, who is a nonvoting 3-33 member; and 3-34 (I) one medical student, who is a nonvoting 3-35 member. 3-36 (f) The appointed advisory committee members serve staggered 3-37 three-year terms. The board shall make the initial committee 3-38 appointments to terms of one, two, and three years as necessary so 3-39 that one-third of the appointed members' terms expire each year, as 3-40 nearly as practicable. The committee shall elect one of its 3-41 members as presiding officer for a term of one year. The committee 3-42 shall meet at least once each year at the times requested by the 3-43 board or set by the presiding officer of the committee. A member 3-44 of the advisory committee may not be compensated for service on the 3-45 committee but is entitled to be reimbursed by the board for actual 3-46 expenses incurred in the performance of the member's duties as a 3-47 committee member. 3-48 (g) The advisory committee shall: 3-49 (1) review applications for funding of graduate 3-50 medical education programs under this section and make 3-51 recommendations for approval or disapproval of those applications; 3-52 (2) make recommendations relating to the standards and 3-53 criteria used for consideration and approval of grants or for the 3-54 development of formulas for distribution of funding under this 3-55 section; 3-56 (3) recommend to the board an allocation of funds 3-57 among medical schools, teaching hospitals, and other entities that 3-58 may receive funds under this section; and 3-59 (4) perform other duties assigned by the board. 3-60 SECTION 3. (a) This Act takes effect September 1, 1997. 3-61 (b) Section 32.0315, Human Resources Code, as added by this 3-62 Act, applies to the distribution of federal medical assistance 3-63 funds for the support of graduate medical education received on or 3-64 after the effective date of this Act, and to any such federal funds 3-65 received before the effective date of this Act that have not been 3-66 promised, obligated, or otherwise identified for distribution to 3-67 specific entities before the effective date. 3-68 SECTION 4. The importance of this legislation and the 3-69 crowded condition of the calendars in both houses create an 4-1 emergency and an imperative public necessity that the 4-2 constitutional rule requiring bills to be read on three several 4-3 days in each house be suspended, and this rule is hereby suspended. 4-4 * * * * *