By Rangel H.B. No. 1951
76R5782 JSA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the distribution of certain fees collected at medical
1-3 schools, the establishment of a health care account for certain
1-4 health education purposes, and the establishment of primary care
1-5 mission statements, strategic plans, and reporting for medical
1-6 schools.
1-7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-8 SECTION 1. This Act may be cited as the Omnibus Health
1-9 Professional Shortage Act.
1-10 SECTION 2. Subchapter A, Chapter 51, Education Code, is
1-11 amended by adding Section 51.0085 to read as follows:
1-12 Sec. 51.0085. CERTAIN HOSPITAL, CLINIC, AND DOCTOR FEES.
1-13 (a) In this section:
1-14 (1) "Medical school" has the meaning assigned by
1-15 Section 61.501.
1-16 (2) "Medically underserved area" means an area
1-17 designated by the United States secretary of health and human
1-18 services as:
1-19 (A) an area having a medically underserved
1-20 population as provided by 42 U.S.C. Section 300e-1(7); or
1-21 (B) a health professional shortage area as
1-22 provided by 42 U.S.C. Section 254e(a)(1).
1-23 (b) A special account known as the health care account is
1-24 created in the general revenue fund.
2-1 (c) The governing board of each medical school shall remit
2-2 to the comptroller 20 percent of all hospital, clinic, and doctor
2-3 fees collected by the medical school. The comptroller shall
2-4 deposit money remitted under this subsection to the credit of the
2-5 health care account. The percentage of all hospital, clinic, and
2-6 doctor fees collected by each medical school required to be
2-7 remitted to the health care account is increased by five percent
2-8 each year beginning in the state fiscal year that begins September
2-9 1, 2000, until the medical school demonstrates that at least 55
2-10 percent of its graduates are completing residencies and practicing
2-11 in the primary care specialties of family practice, general
2-12 practice, general internal medicine, general pediatric medicine, or
2-13 general obstetrics and gynecology.
2-14 (d) The health care account consists of money credited to
2-15 the fund under Subsection (c), gifts, grants, and funds
2-16 appropriated by the legislature.
2-17 (e) Money in the account may be appropriated only to the
2-18 governing board of a medical school for primary patient care
2-19 personnel and programs, educational personnel and support,
2-20 institutional development and recruitment, and new program
2-21 development that encourages health profession students in medicine,
2-22 nursing, dentistry, or allied health to specialize in primary care
2-23 delivery in medically underserved areas.
2-24 (f) Money appropriated from the health care account to the
2-25 governing board of a medical school may not be expended until the
2-26 governing board of the medical school submits to and has had
2-27 approved by the Texas Higher Education Coordinating Board a plan
3-1 describing the specific uses of money appropriated to the governing
3-2 board from the health care account. The plan must include, at a
3-3 minimum, provisions relating to:
3-4 (1) recruitment and admissions of students from
3-5 medically underserved areas;
3-6 (2) promotion, tenure, and development of primary care
3-7 faculty;
3-8 (3) team-training for students in all health
3-9 profession degree programs;
3-10 (4) support for third-year clerkships in family
3-11 medicine;
3-12 (5) creation of endowed chairs in primary care,
3-13 preventive care, and public health in health profession schools;
3-14 and
3-15 (6) establishment of affiliation agreements with
3-16 hospitals and clinics in medically underserved areas that provide
3-17 for rotations of health profession students through these settings.
3-18 (g) The initial annual plan required by Subsection (f) must
3-19 be submitted not later than April 1, 2000, and approved for
3-20 implementation not later than July 1, 2000.
3-21 SECTION 3. Section 51.009(c), Education Code, is amended to
3-22 read as follows:
3-23 (c) Each of the following shall be accounted for as
3-24 educational and general funds: net tuition, special course fees
3-25 charged under Sections 54.051(e) and (l), Education Code, lab fees,
3-26 student teaching fees, hospital, [and] clinic, and doctor fees,
3-27 organized activity fees, proceeds from the sale of educational and
4-1 general equipment, and indirect cost recovery fees.
4-2 SECTION 4. Chapter 61, Education Code, is amended by adding
4-3 Subchapter V to read as follows:
4-4 SUBCHAPTER V. PRIMARY CARE MISSION STATEMENTS,
4-5 STRATEGIC PLANS, AND REPORTING
4-6 Sec. 61.851. DEFINITIONS. In this subchapter:
4-7 (1) "Medical school" has the meaning assigned by
4-8 Section 61.501.
4-9 (2) "Medically underserved area" means an area
4-10 designated by the United States secretary of health and human
4-11 services as:
4-12 (A) an area having a medically underserved
4-13 population as provided by 42 U.S.C. Section 300e-1(7); or
4-14 (B) a health professional shortage area as
4-15 provided by 42 U.S.C. Section 254e(a)(1).
4-16 (3) "Primary care physician" means a physician in the
4-17 specialty of family practice, general practice, general internal
4-18 medicine, general pediatrics, or general obstetrics and gynecology.
4-19 Sec. 61.852. ROLE AND MISSION STATEMENT. The role and
4-20 mission of each medical school shall:
4-21 (1) reflect the school's responsibility and
4-22 accountability for providing at least 55 percent of its graduates
4-23 as primary care physicians;
4-24 (2) reflect that the production of family and general
4-25 practitioners must be at least 25 percent of its graduates; and
4-26 (3) recognize the school's responsibility and
4-27 accountability for providing physicians from communities and
5-1 backgrounds that are significantly underrepresented among
5-2 physicians, primary care research, and the provision of primary
5-3 care physicians to provide primary medical care to medically
5-4 underserved areas.
5-5 Sec. 61.853. STRATEGIC PLAN. (a) The governing board of
5-6 each medical school shall develop a strategic plan that reflects
5-7 the requirements of Section 61.852.
5-8 (b) The strategic plan must contain, at least, the following
5-9 quantifiable outcome measures:
5-10 (1) 55 percent of the total number of medical school
5-11 graduates should complete residencies in primary care specialties
5-12 in this state;
5-13 (2) at least 40 percent of the members of the
5-14 admissions committee of the medical school should be primary care
5-15 physicians and include primary care physicians in private practice;
5-16 and
5-17 (3) at least 55 percent of the members of the
5-18 curriculum committee of the medical school should be primary care
5-19 physicians.
5-20 Sec. 61.854. CONTENTS OF STRATEGIC PLAN. (a) The strategic
5-21 plan of each medical school must include, at least, the following
5-22 baseline information:
5-23 (1) the statistical information concerning the
5-24 practice specialties and location of the medical school's graduates
5-25 for each academic year starting with students graduating in 1991;
5-26 (2) the statistical information concerning students
5-27 admitted after 1991, including socioeconomic background, racial or
6-1 ethnic composition, county of origin, sex, and financial aid
6-2 provided;
6-3 (3) the composition of admission and curriculum
6-4 committees by specialty for each academic year after the 1994-1995
6-5 academic year;
6-6 (4) the number, specialty, and location of affiliated
6-7 residency programs, number of positions in each program by
6-8 postgraduate year, and number of filled positions by postgraduate
6-9 year starting in the 1991-1992 academic year;
6-10 (5) the number of full-time salaried faculty by
6-11 specialty, sex, ethnicity, race, tenure, and faculty rank; and
6-12 (6) the total budget and sources of funds by
6-13 department within the medical school.
6-14 (b) Each strategic plan shall address, at least, the medical
6-15 school's plan:
6-16 (1) to ensure that the medical school's admission
6-17 policies, structure, and function address the need to admit and
6-18 recruit more students who are inclined to select primary care
6-19 specialties;
6-20 (2) to ensure that the medical school's admission
6-21 policies, structure, and function reflect the need to recruit and
6-22 admit more students from economically and educationally
6-23 disadvantaged groups to the medical school;
6-24 (3) to ensure that the medical school's departments
6-25 and faculty composition are balanced, with increased representation
6-26 of primary care physicians, full-time salaried physicians from
6-27 underrepresented communities and backgrounds, and other primary
7-1 care providers from community settings;
7-2 (4) to ensure a system of advancement and tenure that
7-3 rewards faculty members who are primary care generalists with
7-4 demonstrated excellence in teaching in the same manner as other
7-5 faculty members;
7-6 (5) to involve community-based primary care physicians
7-7 and other providers as preceptors, faculty, and role models for
7-8 medical students and residents and to provide recognition and
7-9 incentives to those providers for their participation;
7-10 (6) to incorporate basic sciences within a clinical
7-11 context throughout the preclinical curriculum;
7-12 (7) to ensure that preclinical and clinical training
7-13 in social, behavioral, and humanistic aspects of health and health
7-14 care delivery are provided by faculty, researchers, and clinicians
7-15 in fields such as nursing, psychology, public health, medical
7-16 sociology, medical education, health services delivery, and
7-17 bioethics;
7-18 (8) to provide preclinical and clinical training that
7-19 emphasizes the importance of the team approach to health care
7-20 delivery and that includes experience in working as a team member
7-21 with other health care professionals and training in using the
7-22 skills and expertise of nurses, pharmacists, public health
7-23 professionals, social workers, and other health care professionals
7-24 and ancillary personnel;
7-25 (9) to ensure that curricula and clinical rotations
7-26 provide all students and residents with a balance between
7-27 hospital-based subspecialty training and community-based primary
8-1 care training, including the establishment of affiliation
8-2 agreements with hospitals and clinics in medically underserved
8-3 areas that provide for rotations of students through these
8-4 settings;
8-5 (10) to ensure that community-based educational
8-6 experiences are developed and managed with significant community
8-7 participation and involvement;
8-8 (11) to provide financial support for third-year
8-9 clerkships in family medicine; and
8-10 (12) to plan for the creation of endowed chairs for
8-11 primary care physicians.
8-12 Sec. 61.855. ADOPTION OF STRATEGIC PLAN; ANNUAL UPDATE. (a)
8-13 The initial strategic plan approved for a medical school under this
8-14 section shall be used as a baseline to assess progress toward each
8-15 medical school's goals in subsequent years.
8-16 (b) The governing board of each medical school, at least
8-17 annually, shall update the strategic plan required by this
8-18 subchapter and shall file the plan for comment with the Texas
8-19 Higher Education Coordinating Board and the Legislative Budget
8-20 Board not later than July 1 of each year. The governing board
8-21 shall approve for implementation the strategic plan filed for
8-22 comment under this subsection, with any changes the governing board
8-23 considers appropriate after comment by the coordinating board or
8-24 Legislative Budget Board, before September 1 of each year.
8-25 (c) Each annual strategic plan must assess the medical
8-26 school's progress toward the outcome measures under Section 61.853.
8-27 (d) Until the governing board of a medical school files the
9-1 strategic plan for the medical school as required by Subsection (b)
9-2 and approves the plan for implementation as required by Subsection
9-3 (b), the governing board may not spend money appropriated by the
9-4 legislature for the medical school in the state fiscal year that
9-5 begins on the September 1 before which the plan is required to be
9-6 approved for implementation.
9-7 (e) The governing board of each medical school must submit
9-8 its initial strategic plan required by this subchapter for comment
9-9 with the coordinating board and the Legislative Budget Board not
9-10 later than September 1, 1999. A strategic plan must be approved
9-11 for implementation by the governing board of each medical school
9-12 not later than October 31, 2000.
9-13 SECTION 5. Section 51.0085, Education Code, as added by this
9-14 Act, applies to fees collected on or after September 1, 1999. A
9-15 fee collected before that date is governed by the law in effect
9-16 when the fee is collected, and that law is continued in effect for
9-17 that purpose.
9-18 SECTION 6. The importance of this legislation and the
9-19 crowded condition of the calendars in both houses create an
9-20 emergency and an imperative public necessity that the
9-21 constitutional rule requiring bills to be read on three several
9-22 days in each house be suspended, and this rule is hereby suspended,
9-23 and that this Act take effect and be in force from and after its
9-24 passage, and it is so enacted.