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A BILL TO BE ENTITLED
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AN ACT
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relating to measures to enhance graduate medical education in this |
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state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 58A, Education Code, is amended by |
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adding Subchapters D, E, and F to read as follows: |
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SUBCHAPTER D. CRITICAL SHORTAGE PHYSICIAN GRANT PROGRAM |
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Sec. 58A.101. DEFINITIONS. In this subchapter: |
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(1) "Center" means the comprehensive health |
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professions resource center established under Chapter 105, Health |
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and Safety Code. |
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(2) "Graduate medical residency training program" |
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means a residency or other postgraduate medical training program: |
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(A) participation in which may be counted toward |
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certification in a medical specialty or subspecialty; and |
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(B) that: |
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(i) is accredited by the Accreditation |
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Council for Graduate Medical Education or the American Osteopathic |
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Association; or |
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(ii) demonstrates eligibility to apply for |
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and receive an accreditation described by Subparagraph (i). |
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(3) "Program" means the critical shortage physician |
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grant program established under this subchapter. |
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(4) "Teaching hospital" means a teaching hospital |
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affiliated with a medical school that is described as a medical and |
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dental unit under Section 61.003. |
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Sec. 58A.102. ESTABLISHMENT OF PROGRAM. The board shall |
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establish the critical shortage physician grant program to provide |
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grants to teaching hospitals for graduate medical residency |
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training programs to increase the number of physicians in the |
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medical specialties and subspecialties that are determined by the |
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board to be at a critical shortage level in this state. |
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Sec. 58A.103. RULES. (a) The board shall adopt rules to |
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administer the program, including rules regarding: |
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(1) a grant application process; |
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(2) reporting requirements for grant recipients; and |
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(3) requirements and benchmarks for grant recipients |
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to satisfy regarding the granting of additional program funding |
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under Section 58A.106. |
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(b) The rules adopted under Subsection (a) must require |
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grant recipients to submit reports at least quarterly, based on |
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outcome measures established by the board in consultation with the |
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Legislative Budget Board. |
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Sec. 58A.104. ELIGIBILITY. To be eligible to receive a |
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grant under this subchapter, a teaching hospital must: |
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(1) provide a number of graduate medical residency |
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positions in excess of both the cap on the number of positions |
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funded by direct graduate medical education payments made under |
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Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h)), |
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and the cap on the number of positions funded by indirect medical |
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education payments made under Section 1886(d)(5)(B), Social |
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Security Act (42 U.S.C. Section 1395ww(d)(5)(B)); and |
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(2) offer or seek to offer one or more graduate medical |
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residency training programs in a specialty described by Section |
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58.008(a) or in any other medical specialty or subspecialty |
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determined by the board to be at a critical shortage level in this |
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state. |
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Sec. 58A.105. USE OF FUNDS. In each state fiscal year, the |
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board shall award grants for establishing new accredited graduate |
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medical residency training programs or increasing the number of |
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residency positions in existing accredited graduate medical |
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residency training programs in specialties described by Section |
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58.008(a) or in any other medical specialties or subspecialties |
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determined by the board to be at a critical shortage level in this |
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state. |
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Sec. 58A.106. ADDITIONAL USE: START-UP COSTS. (a) If in a |
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state fiscal year excess program funds remain after funds are |
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granted under Section 58A.105, the board may grant additional |
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program funding to teaching hospitals to pay any start-up costs |
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associated with establishing and seeking accreditation for a new |
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graduate medical residency training program in a specialty |
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described by Section 58.008(a) or in any other medical specialty or |
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subspecialty determined by the board to be at a critical shortage |
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level in this state, provided that no other federal or state funding |
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is available for that program. |
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(b) To be eligible for funding under this section, start-up |
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costs must be directly related to the establishment or |
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accreditation of the new program. |
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(c) The board may grant program funding under this section |
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to pay a percentage of the total amount of applicable start-up costs |
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for the teaching hospital, not to exceed 20 percent. |
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Sec. 58A.107. REDUCTION IN FUNDING. The board shall limit |
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or withhold funding from grant recipients that do not comply with |
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reporting requirements or that use grant funds for a purpose not |
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authorized by this subchapter. The board shall seek reimbursement |
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with respect to any grant funds that are not used for purposes |
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authorized by this subchapter. |
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Sec. 58A.108. CRITERIA FOR DETERMINING CRITICAL SHORTAGE |
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LEVELS. (a) For purposes of this subchapter, the board shall |
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determine critical shortage levels for medical specialties and |
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subspecialties in this state according to criteria used by the |
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United States Department of Health and Human Services Health |
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Resources and Services Administration to designate health |
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professional shortage areas. |
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(b) In its methodology for determining critical shortage |
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levels under this section, the board shall include the results of |
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the research conducted by the center under Section 105.009(a)(1), |
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Health and Safety Code, and similar research performed by other |
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appropriate entities. |
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SUBCHAPTER E. TEXAS TEACHING HEALTH CENTER |
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GRADUATE MEDICAL EDUCATION GRANT PROGRAM |
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Sec. 58A.121. DEFINITIONS. In this subchapter: |
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(1) "Graduate medical residency training program" |
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means a residency or other postgraduate medical training program: |
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(A) participation in which may be counted toward |
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certification in a medical specialty or subspecialty; and |
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(B) that: |
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(i) is accredited by the Accreditation |
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Council for Graduate Medical Education or the American Osteopathic |
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Association; or |
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(ii) demonstrates eligibility to apply for |
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and receive an accreditation described by Subparagraph (i). |
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(2) "Primary care residency program" means a graduate |
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medical residency training program in a specialty described by |
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Section 58.008(a). |
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(3) "Program" means the Texas teaching health center |
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graduate medical education grant program established under this |
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subchapter. |
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(4) "Teaching health center" means a community-based, |
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ambulatory patient care center that operates a primary care |
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residency program. The term includes: |
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(A) a federally qualified health center, as |
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defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C. |
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Section 1396d(l)(2)(B)); |
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(B) a community mental health center, as defined |
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by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section |
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1395x(ff)(3)(B)); |
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(C) a rural health clinic, as defined by Section |
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1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2)); |
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(D) a health center operated by the Indian Health |
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Service, an Indian tribe or tribal organization, or an urban Indian |
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organization, as defined by Section 4, Indian Health Care |
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Improvement Act (25 U.S.C. Section 1603); and |
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(E) an entity receiving funds under Title X, |
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Public Health Service Act (42 U.S.C. Section 300 et seq.). |
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Sec. 58A.122. ESTABLISHMENT OF PROGRAM. The board shall |
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establish the Texas teaching health center graduate medical |
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education grant program to award grants to teaching health centers |
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for the purpose of establishing new primary care residency programs |
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or increasing the number of residency positions in existing primary |
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care residency programs. |
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Sec. 58A.123. RULES. (a) The board shall adopt rules to |
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administer the program, including rules regarding: |
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(1) a grant application process; |
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(2) reporting requirements for grant recipients under |
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Section 58A.128; and |
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(3) the amount of the payments for direct expenses and |
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indirect expenses, as defined by and calculated in the same manner |
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as those expenses are calculated under the federal rules described |
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by Subsection (b). |
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(b) The rules adopted under this subchapter must be based as |
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nearly as possible on the rules adopted under the federal teaching |
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health centers development grant program established under Section |
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5508, Patient Protection and Affordable Care Act of 2010 (Pub. L. |
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No. 111-148). |
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(c) The rules adopted in relation to the reporting |
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requirements under Section 58A.128 must also: |
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(1) authorize the board to conduct audits of grant |
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recipients to the extent necessary to ensure the accuracy and |
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completeness of their annual reports; and |
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(2) specify a mandatory amount of reduction in grant |
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funds under Section 58A.127 for a failure to submit an accurate or |
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complete report. |
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Sec. 58A.124. AMOUNT AND DURATION OF GRANT. Subject to |
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Section 58A.127, the board may award grants under this subchapter |
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for a term of not more than three years, and the maximum award to a |
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recipient may not exceed $500,000 during each state fiscal year. |
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Sec. 58A.125. RELATIONSHIP OF GRANTS TO OTHER FEDERAL |
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PAYMENTS FOR GRADUATE MEDICAL EDUCATION. A grant awarded by the |
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board under this subchapter is in addition to any payments for: |
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(1) direct graduate medical education costs under |
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Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h)); |
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(2) indirect medical education costs under Section |
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1886(d)(5)(B), Social Security Act (42 U.S.C. Section |
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1395ww(d)(5)(B)); and |
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(3) direct costs of medical education under Section |
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1886(k), Social Security Act (42 U.S.C. Section 1395ww(k)). |
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Sec. 58A.126. USE OF FUNDS. A grant awarded under this |
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subchapter may be used only to cover the costs of establishing a new |
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primary care residency program at a teaching health center or the |
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costs of increasing the number of residency positions in an |
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existing primary care residency program, including costs |
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associated with: |
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(1) curriculum development; |
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(2) recruitment, training, and retention of residents |
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and faculty; |
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(3) obtaining accreditation by the Accreditation |
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Council for Graduate Medical Education or the American Osteopathic |
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Association; and |
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(4) faculty salaries during the development phase. |
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Sec. 58A.127. REDUCTION IN FUNDING. The board shall limit |
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or withhold funding from grant recipients that do not comply with |
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reporting requirements or that use grant funds for a purpose not |
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authorized by this subchapter. The board shall seek reimbursement |
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with respect to any grant funds that are not used for purposes |
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authorized by this subchapter. |
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Sec. 58A.128. REPORTING. (a) A grant recipient shall |
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submit an annual report that fully accounts for the use of a grant |
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awarded under this subchapter. |
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(b) The annual report must be made in the form and manner |
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specified by the board and must include the following information |
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for the most recent residency academic year completed immediately |
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before the applicable state fiscal year: |
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(1) the types of primary care residency programs that |
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the grant recipient provided for residents; |
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(2) the number of approved training positions in those |
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programs for part-time or full-time residents; |
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(3) the number of part-time or full-time residents |
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who: |
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(A) completed their residency training in those |
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programs at the end of the residency academic year; and |
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(B) care for vulnerable populations living in |
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underserved areas; and |
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(4) any other information considered appropriate by |
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the board. |
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SUBCHAPTER F. GRADUATE MEDICAL EDUCATION |
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PARTNERSHIP GRANT PROGRAM |
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Sec. 58A.151. DEFINITIONS. In this subchapter: |
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(1) "Graduate medical education partnership" means a |
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partnership entered into by a teaching health center and an |
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accredited graduate medical residency training program offered by a |
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hospital or medical school. |
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(2) "Graduate medical residency training program" |
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means a residency or other postgraduate medical training program: |
|
|
(A) participation in which may be counted toward |
|
|
certification in a medical specialty or subspecialty; and |
|
|
(B) that: |
|
|
(i) is accredited by the Accreditation |
|
|
Council for Graduate Medical Education or the American Osteopathic |
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Association; or |
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(ii) demonstrates eligibility to apply for |
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and receive an accreditation described by Subparagraph (i). |
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(3) "Primary care residency program" means a graduate |
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medical residency training program in a specialty described by |
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Section 58.008(a). |
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(4) "Program" means the graduate medical education |
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partnership grant program established under this subchapter. |
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(5) "Teaching health center" means a community-based, |
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ambulatory patient care center that operates a primary care |
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residency program. The term includes: |
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(A) a federally qualified health center, as |
|
|
defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C. |
|
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Section 1396d(l)(2)(B)); |
|
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(B) a community mental health center, as defined |
|
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by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section |
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1395x(ff)(3)(B)); |
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(C) a rural health clinic, as defined by Section |
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1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2)); |
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(D) a health center operated by the Indian Health |
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Service, an Indian tribe or tribal organization, or an urban Indian |
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organization, as defined by Section 4, Indian Health Care |
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Improvement Act (25 U.S.C. Section 1603); and |
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(E) an entity receiving funds under Title X, |
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Public Health Service Act (42 U.S.C. Section 300 et seq.). |
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Sec. 58A.152. ESTABLISHMENT OF PROGRAM. The board shall |
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establish the graduate medical education partnership grant program |
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to allow a teaching health center that is establishing and seeking |
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accreditation for a new primary care residency program to partner |
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with an accredited graduate medical residency training program |
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offered by a hospital or medical school. |
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Sec. 58A.153. RULES. The board shall adopt rules to |
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administer the program, including rules regarding a grant |
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application process and reporting requirements for grant |
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recipients. |
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Sec. 58A.154. USE OF FUNDS. The board shall award grants to |
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each participant in a graduate medical education partnership to: |
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(1) facilitate a mentoring relationship between |
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partners that will provide information and guidance for the |
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participating teaching health center during the accreditation |
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process; and |
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(2) assist the partners in building a collaborative |
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working relationship for the future. |
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Sec. 58A.155. REDUCTION IN FUNDING. The board shall limit |
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or withhold funding from grant recipients that do not comply with |
|
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reporting requirements or that use grant funds for a purpose not |
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authorized by this subchapter. The board shall seek reimbursement |
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for any grant funds that are not used for purposes authorized by |
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this subchapter. |
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SECTION 2. Chapter 105, Health and Safety Code, is amended |
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by adding Section 105.009 to read as follows: |
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Sec. 105.009. RESEARCH REGARDING GRADUATE MEDICAL |
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EDUCATION SYSTEM. (a) The comprehensive health professions |
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resource center shall conduct research: |
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(1) to identify: |
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(A) the ratio of primary care to non-primary care |
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physicians that is necessary and appropriate to meet the current |
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and future health care needs of this state; and |
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(B) all medical specialties and subspecialties |
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that are at critical shortage levels in this state, together with |
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the geographic location of the physicians in those specialties and |
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subspecialties; and |
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(2) regarding the overall supply of physicians in this |
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state and any other issues that are relevant to the status of the |
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state's graduate medical education system and the ability of that |
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system to meet the current and future health care needs of this |
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state. |
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(b) Not later than August 31 of each even-numbered year, the |
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council shall report the results of the center's research to the |
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Legislative Budget Board, the Texas Higher Education Coordinating |
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Board, the office of the governor, and the standing committees of |
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each house of the legislature with primary jurisdiction over state |
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finance or appropriations. |
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SECTION 3. (a) Not later than December 31, 2015, the Texas |
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Higher Education Coordinating Board shall adopt rules for the |
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critical shortage physician grant program, the Texas teaching |
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health center graduate medical education grant program, and the |
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graduate medical education partnership grant program established |
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under Subchapters D, E, and F, Chapter 58A, Education Code, |
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respectively, as added by this Act. |
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(b) The board shall award grants under the programs |
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described by Subsection (a) of this section beginning with the |
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state fiscal year ending August 31, 2016. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
|
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Act takes effect September 1, 2015. |