1-1 AN ACT
1-2 relating to the creation of the Rural Communities Health Care
1-3 Investment Program to attract and retain rural health care
1-4 professionals.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subsection (a), Section 106.025, Health and
1-7 Safety Code, is amended to read as follows:
1-8 (a) The center shall:
1-9 (1) educate the public and recommend appropriate
1-10 public policies regarding the continued viability of rural health
1-11 care delivery in this state;
1-12 (2) monitor and work with state and federal agencies
1-13 to assess the impact of proposed rules on rural areas;
1-14 (3) provide impact statements of proposed rules as
1-15 considered appropriate by the center;
1-16 (4) streamline regulations to assist in the
1-17 development of service diversification of health care facilities;
1-18 (5) target state and federal programs to rural areas;
1-19 (6) promote and develop community involvement and
1-20 community support in maintaining, rebuilding, or diversifying local
1-21 health services;
1-22 (7) promote and develop diverse and innovative health
1-23 care service models in rural areas;
1-24 (8) encourage the use of advanced communications
1-25 technology to:
2-1 (A) ensure that rural areas receive the maximum
2-2 benefits of telemedicine and distance learning by promoting a
2-3 transmission rate structure that accommodates rural needs and by
2-4 improving the telecommunications infrastructure in rural areas; and
2-5 (B) provide access to specialty expertise,
2-6 clinical consultation, and continuing education;
2-7 (9) assist rural health care providers, communities,
2-8 and individuals in applying for public and private grants and
2-9 programs;
2-10 (10) encourage the development of regional emergency
2-11 transportation networks;
2-12 (11) work with state agencies, universities, and
2-13 private interest groups to conduct and promote research on rural
2-14 health issues, maintain and collect a timely data base, and develop
2-15 and maintain a rural health resource library;
2-16 (12) solicit the assistance of other offices or
2-17 programs of rural health in this state that are university-based to
2-18 carry out the duties of this chapter;
2-19 (13) disseminate information and provide technical
2-20 assistance to communities, health care providers, and individual
2-21 consumers of health care services;
2-22 (14) develop plans to implement a fee-for-service
2-23 health care professional recruitment service and a medical supplies
2-24 group purchasing program within the center;
2-25 (15) develop and initiate, in conjunction with the
2-26 Texas State Board of Medical Examiners, the Board of Nurse
3-1 Examiners, the Texas Department of Health, the Bureau of State
3-2 Health Data and Policy Analysis, the Texas State Board of Physician
3-3 Assistant Examiners, or other appropriate agencies, a study of
3-4 rural health clinics to:
3-5 (A) determine the efficiency and effectiveness
3-6 of rural health clinics;
3-7 (B) review the health outcomes of rural patients
3-8 treated in rural health clinics and report those outcomes in the
3-9 center's biennial report to the legislature;
3-10 (C) identify and address efficiency barriers for
3-11 the professional clinical relationship of physicians, nurses, and
3-12 physician assistants;
3-13 (D) assess the success of attracting primary
3-14 care physicians and allied health professionals to rural areas; and
3-15 (E) assess the appropriateness of the current
3-16 clinic designation process;
3-17 (16) develop and initiate a quality assessment program
3-18 to evaluate the health outcomes of rural patients treated in rural
3-19 health clinics; [and]
3-20 (17) encourage the active participation by physicians
3-21 and other health care providers in the early and periodic
3-22 screening, diagnosis, and treatment program; and
3-23 (18) seek state and federal money available for
3-24 economic development in rural areas for programs under this
3-25 chapter.
3-26 SECTION 2. Chapter 106, Health and Safety Code, is amended
4-1 by adding Subchapter H to read as follows:
4-2 SUBCHAPTER H. RURAL COMMUNITIES HEALTH CARE INVESTMENT PROGRAM
4-3 Sec. 106.301. DEFINITIONS. In this subchapter:
4-4 (1) "Health professional" means a person other than a
4-5 physician who holds a license, certificate, registration, permit,
4-6 or other form of authorization required by law or a state agency
4-7 rule that must be obtained by an individual to practice in a health
4-8 care profession.
4-9 (2) "Medically underserved community" means a
4-10 community that:
4-11 (A) is located in a county with a population of
4-12 50,000 or less;
4-13 (B) has been designated under state or federal
4-14 law as:
4-15 (i) a health professional shortage area;
4-16 or
4-17 (ii) a medically underserved area; or
4-18 (C) has been designated as a medically
4-19 underserved community by the center.
4-20 Sec. 106.302. ADVISORY PANEL. The center shall appoint an
4-21 advisory panel to assist in the center's duties under this
4-22 subchapter. The advisory panel must consist of at least:
4-23 (1) one representative from the Texas Higher Education
4-24 Coordinating Board;
4-25 (2) one representative from the institutions of higher
4-26 education having degree programs for the health professions
5-1 participating in the programs under this subchapter;
5-2 (3) one representative from a hospital in a medically
5-3 underserved community;
5-4 (4) one physician practicing in a medically
5-5 underserved community;
5-6 (5) one health professional, other than a physician,
5-7 practicing in a medically underserved community; and
5-8 (6) one public representative who resides in a
5-9 medically underserved community.
5-10 Sec. 106.303. LOAN REIMBURSEMENT PROGRAM. The executive
5-11 committee shall establish a program in the center to assist
5-12 communities in recruiting health professionals to practice in
5-13 medically underserved communities by providing loan reimbursement
5-14 for health professionals who serve in those communities.
5-15 Sec. 106.304. STIPEND PROGRAM. (a) The executive committee
5-16 shall establish a program in the center to assist communities in
5-17 recruiting health professionals to practice in medically
5-18 underserved communities by providing a stipend to health
5-19 professionals who agree to serve in those communities.
5-20 (b) A stipend awarded under this section shall be paid in
5-21 periodic installments.
5-22 (c) A health professional who participates in the program
5-23 established under this section must establish an office and
5-24 residency in the medically underserved area before receiving any
5-25 portion of the stipend.
5-26 Sec. 106.305. CONTRACT REQUIRED. (a) A health professional
6-1 may receive assistance under this subchapter only if the health
6-2 professional signs a contract agreeing to provide health care
6-3 services in a medically underserved community.
6-4 (b) A student in a degree program preparing to become a
6-5 health professional may contract with the center for the loan
6-6 reimbursement program under Section 106.303 before obtaining the
6-7 license required to become a health professional.
6-8 (c) The center may contract with a health professional for
6-9 part-time services under the stipend program established under
6-10 Section 106.304.
6-11 (d) A health professional who participates in any loan
6-12 reimbursement program is not eligible for a stipend under Section
6-13 106.304.
6-14 (e) A contract under this section must provide that a health
6-15 professional who does not provide the required services to the
6-16 community or provides those services for less than the required
6-17 time is personally liable to the state for:
6-18 (1) the total amount of assistance the health
6-19 professional received from the center and the medically underserved
6-20 community;
6-21 (2) interest on the amount under Subdivision (1) at a
6-22 rate set by the executive committee;
6-23 (3) the state's reasonable expenses incurred in
6-24 obtaining payment, including reasonable attorney's fees; and
6-25 (4) a penalty as established by the executive
6-26 committee by rule to help ensure compliance with the contract.
7-1 (f) Amounts recovered under Subsection (e) shall be
7-2 deposited in the permanent endowment fund for the rural communities
7-3 health care investment program under Section 106.308.
7-4 Sec. 106.306. POWERS AND DUTIES OF CENTER. (a) The
7-5 executive committee shall adopt rules necessary for the
7-6 administration of this subchapter, including guidelines for:
7-7 (1) developing contracts under which loan
7-8 reimbursement or stipend recipients provide services to qualifying
7-9 communities;
7-10 (2) identifying the duties of the state, state agency,
7-11 loan reimbursement or stipend recipient, and medically underserved
7-12 community under the loan reimbursement or stipend contract;
7-13 (3) determining a rate of interest to be charged under
7-14 Section 106.305(e)(2);
7-15 (4) ensuring that a loan reimbursement or stipend
7-16 recipient provides access to health services to participants in
7-17 government-funded health benefits programs in qualifying
7-18 communities;
7-19 (5) encouraging the use of telecommunications or
7-20 telemedicine, as appropriate;
7-21 (6) prioritizing the provision of loan reimbursements
7-22 and stipends to health professionals who are not eligible for any
7-23 other state loan forgiveness, loan repayment, or stipend program;
7-24 (7) prioritizing the provision of loan reimbursements
7-25 and stipends to health professionals who are graduates of health
7-26 professional degree programs in this state;
8-1 (8) encouraging a medically underserved community
8-2 served by a loan reimbursement or stipend recipient to contribute
8-3 to the cost of the loan reimbursement or stipend when making a
8-4 contribution is feasible; and
8-5 (9) requiring a medically underserved community served
8-6 by a loan reimbursement or stipend recipient to assist the center
8-7 in contracting with the loan reimbursement or stipend recipient who
8-8 will serve that community.
8-9 (b) The executive committee by rule may designate areas of
8-10 the state as medically underserved communities.
8-11 (c) The executive committee shall make reasonable efforts to
8-12 contract with health professionals from a variety of different
8-13 health professions.
8-14 Sec. 106.307. USE OF TELECOMMUNICATION AND TELEMEDICINE. A
8-15 health professional who participates in a program under this
8-16 subchapter may not use telecommunication technology, including
8-17 telemedicine, as the sole or primary method of providing services
8-18 and may not use telecommunication technology as a substitute for
8-19 providing health care services in person. A health professional
8-20 who participates in a program under this subchapter may use
8-21 telecommunication technology only to supplement or enhance the
8-22 health care services provided by the health professional.
8-23 Sec. 106.308. PERMANENT ENDOWMENT FUND. (a) The permanent
8-24 endowment fund for the rural communities health care investment
8-25 program is a special fund in the treasury outside the general
8-26 revenue fund.
9-1 (b) The fund is composed of:
9-2 (1) money transferred to the fund at the direction of
9-3 the legislature;
9-4 (2) gifts and grants contributed to the fund;
9-5 (3) the returns received from investment of money in
9-6 the fund; and
9-7 (4) amounts recovered under Section 106.305(e).
9-8 Sec. 106.309. ADMINISTRATION AND USE OF FUND. (a) The
9-9 center may administer the permanent endowment fund for the rural
9-10 communities health care investment program. If the center elects
9-11 not to administer the fund, the comptroller shall administer the
9-12 fund.
9-13 (b) The administrator of the fund shall invest the fund in a
9-14 manner intended to preserve the purchasing power of the fund's
9-15 assets and the fund's annual distributions. The administrator may
9-16 acquire, exchange, sell, supervise, manage, or retain, through
9-17 procedures and subject to restrictions the administrator considers
9-18 appropriate, any kind of investment of the fund's assets that
9-19 prudent investors, exercising reasonable care, skill, and caution,
9-20 would acquire or retain in light of the purposes, terms,
9-21 distribution requirements, and other circumstances of the fund then
9-22 prevailing, taking into consideration the investment of all the
9-23 assets of the fund rather than a single investment.
9-24 (c) The comptroller or the center may solicit and accept
9-25 gifts and grants to the fund.
9-26 (d) Annual distributions for the fund shall be determined by
10-1 the investment and distribution policy adopted by the administrator
10-2 of the fund for the fund's assets.
10-3 (e) Except as provided by Subsection (f), money in the fund
10-4 may not be used for any purpose.
10-5 (f) The amount available for distribution from the fund,
10-6 including any gift or grant, may be appropriated only for providing
10-7 stipends and loan reimbursement under the programs authorized by
10-8 this subchapter and to pay the expenses of managing the fund. The
10-9 expenditure of a gift or grant is subject to any limitation or
10-10 requirement placed on the gift or grant by the donor or granting
10-11 entity.
10-12 (g) Sections 403.095 and 404.071, Government Code, do not
10-13 apply to the fund. Section 404.094(d), Government Code, applies to
10-14 the fund.
10-15 Sec. 106.310. REPORTING REQUIREMENT. The center shall
10-16 provide a report on the permanent endowment fund for the rural
10-17 communities health care investment program to the Legislative
10-18 Budget Board not later than November 1 of each year. The report
10-19 must include the total amount of money the center received from the
10-20 fund, the purpose for which the money was used, and any additional
10-21 information that may be requested by the Legislative Budget Board.
10-22 SECTION 3. Subchapter C, Chapter 61, Education Code, is
10-23 amended by adding Section 61.0899 to read as follows:
10-24 Sec. 61.0899. ASSISTANCE IN CERTAIN RURAL HEALTH CARE LOAN
10-25 REIMBURSEMENT AND STIPEND PROGRAMS. The board shall, in
10-26 cooperation with the Center for Rural Health Initiatives and the
11-1 center's advisory panel established under Section 106.302, Health
11-2 and Safety Code, ensure that the board seeks to obtain the maximum
11-3 amount of funds from any source, including federal funds, to
11-4 support programs to provide student loan reimbursement or stipends
11-5 for graduates of degree programs in this state who practice or
11-6 agree to practice in a medically underserved community.
11-7 SECTION 4. This Act takes effect immediately if it receives
11-8 a vote of two-thirds of all the members elected to each house, as
11-9 provided by Section 39, Article III, Texas Constitution. If this
11-10 Act does not receive the vote necessary for immediate effect, this
11-11 Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 126 passed the Senate on
February 13, 2001, by the following vote: Yeas 30, Nays 0, one
present, not voting; and that the Senate concurred in House
amendment on May 15, 2001, by the following vote: Yeas 30, Nays 0,
one present, not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 126 passed the House, with
amendment, on May 8, 2001, by the following vote: Yeas 147,
Nays 0, two present, not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor