LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 77th Regular Session
  
                            February 26, 2001
  
  
          TO:  Honorable Patricia Gray, Chair, House Committee on Public
               Health
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  HB246  by Turner, Bob (Relating to the creation and
               funding of the Rural Communities Health Care Investment
               Program to attract and retain rural health care
               professionals.), As Introduced
  
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*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  HB246, As Introduced:  an impact of $0 through the biennium ending    *
*  August 31, 2003, for both an immediate effective date and a           *
*  September 1, 2001, effective date.                                    *
*                                                                        *
*  The bill would make no appropriation but could provide the legal      *
*  basis for an appropriation of funds to implement the provisions of    *
*  the bill.                                                             *
**************************************************************************
  
All Funds, Six-Year Impact:
  
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*Fiscal        Probable         Probable Revenue    Change in Number of  *
* Year    Savings/(Cost) from   Gain/(Loss) from   State Employees from  *
*          Rural Communities    Rural Communities         FY 2001        *
*             Health Care          Health Care                           *
*         Investment Program   Investment Program                        *
*             Trust Fund           Trust Fund                            *
*  2001                     $0                   $0                  0.0 *
*  2002              (400,000)              400,000                  1.0 *
*  2003              (400,000)              400,000                  1.0 *
*  2004              (400,000)              400,000                  1.0 *
*  2005              (400,000)              400,000                  1.0 *
*  2006              (400,000)              400,000                  1.0 *
**************************************************************************
  
The table above assumes an immediate effective date.  A three month
implementation period is assumed.



All Funds, Five-Year Impact:

The table below assumes a September 1, 2001, effective date.  Again, a
three month implementation period is assumed.
  
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*Fiscal        Probable         Probable Revenue    Change in Number of  *
* Year    Savings/(Cost) from   Gain/(Loss) from   State Employees from  *
*          Rural Communities    Rural Communities         FY 2001        *
*             Health Care          Health Care                           *
*         Investment Program   Investment Program                        *
*             Trust Fund           Trust Fund                            *
*  2002             $(300,000)             $300,000                  0.8 *
*  2003              (400,000)              400,000                  1.0 *
*  2004              (400,000)              400,000                  1.0 *
*  2005              (400,000)              400,000                  1.0 *
*  2006              (400,000)              400,000                  1.0 *
**************************************************************************
  
Fiscal Analysis
  
The bill would amend Chapter 106, by adding Subchapter H, of the Health
and Safety Code to create and fund the Rural Communities Health Care
Investment Program.  The purpose of the program would be to attract and
retain rural health care professionals, not necessarily physicians. The
bill would create the Rural Communities Health Care Investment Program
Trust Fund, a dedicated general revenue account, to award stipends and
loan reimbursements which would be administered by the Center for Rural
Health Initiatives (CRHI).  The bill would have an immediate effective
date if it receives the necessary two-thirds vote in each chamber.
Otherwise, the bill would have an effective date of September 1, 2001.
  
  
Methodology
  
The bill would establish the Loan Reimbursement and Stipend Programs
under the CRHI to provide loan reimbursements and stipends to health
professionals who agree to serve in medically underserved communities.
The health professional would be required to sign a contract, outlining
the time period to be served and provisions for noncompliance, with the
CRHI for the loan reimbursement or stipend.  An initial implementation
period of three months is assumed for both effective dates.  According to
the CRHI, one full-time equivalent (FTE) would be required to implement
and administer these programs.  Total salary of one FTE for the 2002-003
biennium is $75,784 with an immediate effective date, and $66,451 with a
September 1, 2001, effective date. Other operating costs, including
travel, rent, and employee benefits for the biennium total $41,231 with
an immediate effective date and $36,117 with a September 1, 2001,
effective date.  Equipment costs are estimated at $3,000 in FY2002 only.

Revenues to the Rural Communities Health Care Investment Program Trust
Fund could be derived from public and private gifts and grants.  It is
assumed the trust fund could receive $400,000 per year in revenue, except
with a September 1, 2001, effective date where $300,000 in revenue in
FY2002 is assumed because of start-up.  Total revenues and expenditures
for the 2002-03 biennium are estimated to be $800,000 for immediate
effect and $700,000 for a September 1, 2001, effective date.

The bill would create an advisory committee to assist in the CRHI's
duties related to the Rural Communities Health Care Investment Program.
Reimbursement for travel and related expenses for the advisory committee
would have to be authorized in the General Appropriations Act.
  
  
Local Government Impact
  
No fiscal implication to units of local government is anticipated,
however, the bill states the CRHI may encourage a medically underserved
community served by a program recipient to contribute to the cost of the
loan reimbursement or stipend, when feasible.
  
  
Source Agencies:   50A   Center for Rural Health Initiatives, 304
                   Comptroller of Public Accounts, 781   Texas Higher
                   Education Coordinating Board
LBB Staff:         JK, HD, RM