Texas 2015 - 84th Regular

Texas House Bill HB1489 Compare Versions

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1	1	84R4796 KEL-D
2	2	By: Howard H.B. No. 1489
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to measures to enhance graduate medical education in this
8	8	state.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 58A, Education Code, is amended by
11	11	adding Subchapters D, E, and F to read as follows:
12	12	SUBCHAPTER D. CRITICAL SHORTAGE PHYSICIAN GRANT PROGRAM
13	13	Sec. 58A.101. DEFINITIONS. In this subchapter:
14	14	(1) "Center" means the comprehensive health
15	15	professions resource center established under Chapter 105, Health
16	16	and Safety Code.
17	17	(2) "Graduate medical residency training program"
18	18	means a residency or other postgraduate medical training program:
19	19	(A) participation in which may be counted toward
20	20	certification in a medical specialty or subspecialty; and
21	21	(B) that:
22	22	(i) is accredited by the Accreditation
23	23	Council for Graduate Medical Education or the American Osteopathic
24	24	Association; or
25	25	(ii) demonstrates eligibility to apply for
26	26	and receive an accreditation described by Subparagraph (i).
27	27	(3) "Program" means the critical shortage physician
28	28	grant program established under this subchapter.
29	29	(4) "Teaching hospital" means a teaching hospital
30	30	affiliated with a medical school that is described as a medical and
31	31	dental unit under Section 61.003.
32	32	Sec. 58A.102. ESTABLISHMENT OF PROGRAM. The board shall
33	33	establish the critical shortage physician grant program to provide
34	34	grants to teaching hospitals for graduate medical residency
35	35	training programs to increase the number of physicians in the
36	36	medical specialties and subspecialties that are determined by the
37	37	board to be at a critical shortage level in this state.
38	38	Sec. 58A.103. RULES. (a) The board shall adopt rules to
39	39	administer the program, including rules regarding:
40	40	(1) a grant application process;
41	41	(2) reporting requirements for grant recipients; and
42	42	(3) requirements and benchmarks for grant recipients
43	43	to satisfy regarding the granting of additional program funding
44	44	under Section 58A.106.
45	45	(b) The rules adopted under Subsection (a) must require
46	46	grant recipients to submit reports at least quarterly, based on
47	47	outcome measures established by the board in consultation with the
48	48	Legislative Budget Board.
49	49	Sec. 58A.104. ELIGIBILITY. To be eligible to receive a
50	50	grant under this subchapter, a teaching hospital must:
51	51	(1) provide a number of graduate medical residency
52	52	positions in excess of both the cap on the number of positions
53	53	funded by direct graduate medical education payments made under
54	54	Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h)),
55	55	and the cap on the number of positions funded by indirect medical
56	56	education payments made under Section 1886(d)(5)(B), Social
57	57	Security Act (42 U.S.C. Section 1395ww(d)(5)(B)); and
58	58	(2) offer or seek to offer one or more graduate medical
59	59	residency training programs in a specialty described by Section
60	60	58.008(a) or in any other medical specialty or subspecialty
61	61	determined by the board to be at a critical shortage level in this
62	62	state.
63	63	Sec. 58A.105. USE OF FUNDS. In each state fiscal year, the
64	64	board shall award grants for establishing new accredited graduate
65	65	medical residency training programs or increasing the number of
66	66	residency positions in existing accredited graduate medical
67	67	residency training programs in specialties described by Section
68	68	58.008(a) or in any other medical specialties or subspecialties
69	69	determined by the board to be at a critical shortage level in this
70	70	state.
71	71	Sec. 58A.106. ADDITIONAL USE: START-UP COSTS. (a) If in a
72	72	state fiscal year excess program funds remain after funds are
73	73	granted under Section 58A.105, the board may grant additional
74	74	program funding to teaching hospitals to pay any start-up costs
75	75	associated with establishing and seeking accreditation for a new
76	76	graduate medical residency training program in a specialty
77	77	described by Section 58.008(a) or in any other medical specialty or
78	78	subspecialty determined by the board to be at a critical shortage
79	79	level in this state, provided that no other federal or state funding
80	80	is available for that program.
81	81	(b) To be eligible for funding under this section, start-up
82	82	costs must be directly related to the establishment or
83	83	accreditation of the new program.
84	84	(c) The board may grant program funding under this section
85	85	to pay a percentage of the total amount of applicable start-up costs
86	86	for the teaching hospital, not to exceed 20 percent.
87	87	Sec. 58A.107. REDUCTION IN FUNDING. The board shall limit
88	88	or withhold funding from grant recipients that do not comply with
89	89	reporting requirements or that use grant funds for a purpose not
90	90	authorized by this subchapter. The board shall seek reimbursement
91	91	with respect to any grant funds that are not used for purposes
92	92	authorized by this subchapter.
93	93	Sec. 58A.108. CRITERIA FOR DETERMINING CRITICAL SHORTAGE
94	94	LEVELS. (a) For purposes of this subchapter, the board shall
95	95	determine critical shortage levels for medical specialties and
96	96	subspecialties in this state according to criteria used by the
97	97	United States Department of Health and Human Services Health
98	98	Resources and Services Administration to designate health
99	99	professional shortage areas.
100	100	(b) In its methodology for determining critical shortage
101	101	levels under this section, the board shall include the results of
102	102	the research conducted by the center under Section 105.009(a)(1),
103	103	Health and Safety Code, and similar research performed by other
104	104	appropriate entities.
105	105	SUBCHAPTER E. TEXAS TEACHING HEALTH CENTER
106	106	GRADUATE MEDICAL EDUCATION GRANT PROGRAM
107	107	Sec. 58A.121. DEFINITIONS. In this subchapter:
108	108	(1) "Graduate medical residency training program"
109	109	means a residency or other postgraduate medical training program:
110	110	(A) participation in which may be counted toward
111	111	certification in a medical specialty or subspecialty; and
112	112	(B) that:
113	113	(i) is accredited by the Accreditation
114	114	Council for Graduate Medical Education or the American Osteopathic
115	115	Association; or
116	116	(ii) demonstrates eligibility to apply for
117	117	and receive an accreditation described by Subparagraph (i).
118	118	(2) "Primary care residency program" means a graduate
119	119	medical residency training program in a specialty described by
120	120	Section 58.008(a).
121	121	(3) "Program" means the Texas teaching health center
122	122	graduate medical education grant program established under this
123	123	subchapter.
124	124	(4) "Teaching health center" means a community-based,
125	125	ambulatory patient care center that operates a primary care
126	126	residency program. The term includes:
127	127	(A) a federally qualified health center, as
128	128	defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C.
129	129	Section 1396d(l)(2)(B));
130	130	(B) a community mental health center, as defined
131	131	by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section
132	132	1395x(ff)(3)(B));
133	133	(C) a rural health clinic, as defined by Section
134	134	1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2));
135	135	(D) a health center operated by the Indian Health
136	136	Service, an Indian tribe or tribal organization, or an urban Indian
137	137	organization, as defined by Section 4, Indian Health Care
138	138	Improvement Act (25 U.S.C. Section 1603); and
139	139	(E) an entity receiving funds under Title X,
140	140	Public Health Service Act (42 U.S.C. Section 300 et seq.).
141	141	Sec. 58A.122. ESTABLISHMENT OF PROGRAM. The board shall
142	142	establish the Texas teaching health center graduate medical
143	143	education grant program to award grants to teaching health centers
144	144	for the purpose of establishing new primary care residency programs
145	145	or increasing the number of residency positions in existing primary
146	146	care residency programs.
147	147	Sec. 58A.123. RULES. (a) The board shall adopt rules to
148	148	administer the program, including rules regarding:
149	149	(1) a grant application process;
150	150	(2) reporting requirements for grant recipients under
151	151	Section 58A.128; and
152	152	(3) the amount of the payments for direct expenses and
153	153	indirect expenses, as defined by and calculated in the same manner
154	154	as those expenses are calculated under the federal rules described
155	155	by Subsection (b).
156	156	(b) The rules adopted under this subchapter must be based as
157	157	nearly as possible on the rules adopted under the federal teaching
158	158	health centers development grant program established under Section
159	159	5508, Patient Protection and Affordable Care Act of 2010 (Pub. L.
160	160	No. 111-148).
161	161	(c) The rules adopted in relation to the reporting
162	162	requirements under Section 58A.128 must also:
163	163	(1) authorize the board to conduct audits of grant
164	164	recipients to the extent necessary to ensure the accuracy and
165	165	completeness of their annual reports; and
166	166	(2) specify a mandatory amount of reduction in grant
167	167	funds under Section 58A.127 for a failure to submit an accurate or
168	168	complete report.
169	169	Sec. 58A.124. AMOUNT AND DURATION OF GRANT. Subject to
170	170	Section 58A.127, the board may award grants under this subchapter
171	171	for a term of not more than three years, and the maximum award to a
172	172	recipient may not exceed $500,000 during each state fiscal year.
173	173	Sec. 58A.125. RELATIONSHIP OF GRANTS TO OTHER FEDERAL
174	174	PAYMENTS FOR GRADUATE MEDICAL EDUCATION. A grant awarded by the
175	175	board under this subchapter is in addition to any payments for:
176	176	(1) direct graduate medical education costs under
177	177	Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h));
178	178	(2) indirect medical education costs under Section
179	179	1886(d)(5)(B), Social Security Act (42 U.S.C. Section
180	180	1395ww(d)(5)(B)); and
181	181	(3) direct costs of medical education under Section
182	182	1886(k), Social Security Act (42 U.S.C. Section 1395ww(k)).
183	183	Sec. 58A.126. USE OF FUNDS. A grant awarded under this
184	184	subchapter may be used only to cover the costs of establishing a new
185	185	primary care residency program at a teaching health center or the
186	186	costs of increasing the number of residency positions in an
187	187	existing primary care residency program, including costs
188	188	associated with:
189	189	(1) curriculum development;
190	190	(2) recruitment, training, and retention of residents
191	191	and faculty;
192	192	(3) obtaining accreditation by the Accreditation
193	193	Council for Graduate Medical Education or the American Osteopathic
194	194	Association; and
195	195	(4) faculty salaries during the development phase.
196	196	Sec. 58A.127. REDUCTION IN FUNDING. The board shall limit
197	197	or withhold funding from grant recipients that do not comply with
198	198	reporting requirements or that use grant funds for a purpose not
199	199	authorized by this subchapter. The board shall seek reimbursement
200	200	with respect to any grant funds that are not used for purposes
201	201	authorized by this subchapter.
202	202	Sec. 58A.128. REPORTING. (a) A grant recipient shall
203	203	submit an annual report that fully accounts for the use of a grant
204	204	awarded under this subchapter.
205	205	(b) The annual report must be made in the form and manner
206	206	specified by the board and must include the following information
207	207	for the most recent residency academic year completed immediately
208	208	before the applicable state fiscal year:
209	209	(1) the types of primary care residency programs that
210	210	the grant recipient provided for residents;
211	211	(2) the number of approved training positions in those
212	212	programs for part-time or full-time residents;
213	213	(3) the number of part-time or full-time residents
214	214	who:
215	215	(A) completed their residency training in those
216	216	programs at the end of the residency academic year; and
217	217	(B) care for vulnerable populations living in
218	218	underserved areas; and
219	219	(4) any other information considered appropriate by
220	220	the board.
221	221	SUBCHAPTER F. GRADUATE MEDICAL EDUCATION
222	222	PARTNERSHIP GRANT PROGRAM
223	223	Sec. 58A.151. DEFINITIONS. In this subchapter:
224	224	(1) "Graduate medical education partnership" means a
225	225	partnership entered into by a teaching health center and an
226	226	accredited graduate medical residency training program offered by a
227	227	hospital or medical school.
228	228	(2) "Graduate medical residency training program"
229	229	means a residency or other postgraduate medical training program:
230	230	(A) participation in which may be counted toward
231	231	certification in a medical specialty or subspecialty; and
232	232	(B) that:
233	233	(i) is accredited by the Accreditation
234	234	Council for Graduate Medical Education or the American Osteopathic
235	235	Association; or
236	236	(ii) demonstrates eligibility to apply for
237	237	and receive an accreditation described by Subparagraph (i).
238	238	(3) "Primary care residency program" means a graduate
239	239	medical residency training program in a specialty described by
240	240	Section 58.008(a).
241	241	(4) "Program" means the graduate medical education
242	242	partnership grant program established under this subchapter.
243	243	(5) "Teaching health center" means a community-based,
244	244	ambulatory patient care center that operates a primary care
245	245	residency program. The term includes:
246	246	(A) a federally qualified health center, as
247	247	defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C.
248	248	Section 1396d(l)(2)(B));
249	249	(B) a community mental health center, as defined
250	250	by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section
251	251	1395x(ff)(3)(B));
252	252	(C) a rural health clinic, as defined by Section
253	253	1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2));
254	254	(D) a health center operated by the Indian Health
255	255	Service, an Indian tribe or tribal organization, or an urban Indian
256	256	organization, as defined by Section 4, Indian Health Care
257	257	Improvement Act (25 U.S.C. Section 1603); and
258	258	(E) an entity receiving funds under Title X,
259	259	Public Health Service Act (42 U.S.C. Section 300 et seq.).
260	260	Sec. 58A.152. ESTABLISHMENT OF PROGRAM. The board shall
261	261	establish the graduate medical education partnership grant program
262	262	to allow a teaching health center that is establishing and seeking
263	263	accreditation for a new primary care residency program to partner
264	264	with an accredited graduate medical residency training program
265	265	offered by a hospital or medical school.
266	266	Sec. 58A.153. RULES. The board shall adopt rules to
267	267	administer the program, including rules regarding a grant
268	268	application process and reporting requirements for grant
269	269	recipients.
270	270	Sec. 58A.154. USE OF FUNDS. The board shall award grants to
271	271	each participant in a graduate medical education partnership to:
272	272	(1) facilitate a mentoring relationship between
273	273	partners that will provide information and guidance for the
274	274	participating teaching health center during the accreditation
275	275	process; and
276	276	(2) assist the partners in building a collaborative
277	277	working relationship for the future.
278	278	Sec. 58A.155. REDUCTION IN FUNDING. The board shall limit
279	279	or withhold funding from grant recipients that do not comply with
280	280	reporting requirements or that use grant funds for a purpose not
281	281	authorized by this subchapter. The board shall seek reimbursement
282	282	for any grant funds that are not used for purposes authorized by
283	283	this subchapter.
284	284	SECTION 2. Chapter 105, Health and Safety Code, is amended
285	285	by adding Section 105.009 to read as follows:
286	286	Sec. 105.009. RESEARCH REGARDING GRADUATE MEDICAL
287	287	EDUCATION SYSTEM. (a) The comprehensive health professions
288	288	resource center shall conduct research:
289	289	(1) to identify:
290	290	(A) the ratio of primary care to non-primary care
291	291	physicians that is necessary and appropriate to meet the current
292	292	and future health care needs of this state; and
293	293	(B) all medical specialties and subspecialties
294	294	that are at critical shortage levels in this state, together with
295	295	the geographic location of the physicians in those specialties and
296	296	subspecialties; and
297	297	(2) regarding the overall supply of physicians in this
298	298	state and any other issues that are relevant to the status of the
299	299	state's graduate medical education system and the ability of that
300	300	system to meet the current and future health care needs of this
301	301	state.
302	302	(b) Not later than August 31 of each even-numbered year, the
303	303	council shall report the results of the center's research to the
304	304	Legislative Budget Board, the Texas Higher Education Coordinating
305	305	Board, the office of the governor, and the standing committees of
306	306	each house of the legislature with primary jurisdiction over state
307	307	finance or appropriations.
308	308	SECTION 3. (a) Not later than December 31, 2015, the Texas
309	309	Higher Education Coordinating Board shall adopt rules for the
310	310	critical shortage physician grant program, the Texas teaching
311	311	health center graduate medical education grant program, and the
312	312	graduate medical education partnership grant program established
313	313	under Subchapters D, E, and F, Chapter 58A, Education Code,
314	314	respectively, as added by this Act.
315	315	(b) The board shall award grants under the programs
316	316	described by Subsection (a) of this section beginning with the
317	317	state fiscal year ending August 31, 2016.
318	318	SECTION 4. This Act takes effect immediately if it receives
319	319	a vote of two-thirds of all the members elected to each house, as
320	320	provided by Section 39, Article III, Texas Constitution. If this
321	321	Act does not receive the vote necessary for immediate effect, this
322	322	Act takes effect September 1, 2015.