84R4796 KEL-D
By: Howard H.B. No. 1489
A BILL TO BE ENTITLED
AN ACT
relating to measures to enhance graduate medical education in this
state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 58A, Education Code, is amended by
adding Subchapters D, E, and F to read as follows:
SUBCHAPTER D. CRITICAL SHORTAGE PHYSICIAN GRANT PROGRAM
Sec. 58A.101. DEFINITIONS. In this subchapter:
(1) "Center" means the comprehensive health
professions resource center established under Chapter 105, Health
and Safety Code.
(2) "Graduate medical residency training program"
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
Association; or
(ii) demonstrates eligibility to apply for
and receive an accreditation described by Subparagraph (i).
(3) "Program" means the critical shortage physician
grant program established under this subchapter.
(4) "Teaching hospital" means a teaching hospital
affiliated with a medical school that is described as a medical and
dental unit under Section 61.003.
Sec. 58A.102. ESTABLISHMENT OF PROGRAM. The board shall
establish the critical shortage physician grant program to provide
grants to teaching hospitals for graduate medical residency
training programs to increase the number of physicians in the
medical specialties and subspecialties that are determined by the
board to be at a critical shortage level in this state.
Sec. 58A.103. RULES. (a) The board shall adopt rules to
administer the program, including rules regarding:
(1) a grant application process;
(2) reporting requirements for grant recipients; and
(3) requirements and benchmarks for grant recipients
to satisfy regarding the granting of additional program funding
under Section 58A.106.
(b) The rules adopted under Subsection (a) must require
grant recipients to submit reports at least quarterly, based on
outcome measures established by the board in consultation with the
Legislative Budget Board.
Sec. 58A.104. ELIGIBILITY. To be eligible to receive a
grant under this subchapter, a teaching hospital must:
(1) provide a number of graduate medical residency
positions in excess of both the cap on the number of positions
funded by direct graduate medical education payments made under
Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h)),
and the cap on the number of positions funded by indirect medical
education payments made under Section 1886(d)(5)(B), Social
Security Act (42 U.S.C. Section 1395ww(d)(5)(B)); and
(2) offer or seek to offer one or more graduate medical
residency training programs in a specialty described by Section
58.008(a) or in any other medical specialty or subspecialty
determined by the board to be at a critical shortage level in this
state.
Sec. 58A.105. USE OF FUNDS. In each state fiscal year, the
board shall award grants for establishing new accredited graduate
medical residency training programs or increasing the number of
residency positions in existing accredited graduate medical
residency training programs in specialties described by Section
58.008(a) or in any other medical specialties or subspecialties
determined by the board to be at a critical shortage level in this
state.
Sec. 58A.106. ADDITIONAL USE: START-UP COSTS. (a) If in a
state fiscal year excess program funds remain after funds are
granted under Section 58A.105, the board may grant additional
program funding to teaching hospitals to pay any start-up costs
associated with establishing and seeking accreditation for a new
graduate medical residency training program in a specialty
described by Section 58.008(a) or in any other medical specialty or
subspecialty determined by the board to be at a critical shortage
level in this state, provided that no other federal or state funding
is available for that program.
(b) To be eligible for funding under this section, start-up
costs must be directly related to the establishment or
accreditation of the new program.
(c) The board may grant program funding under this section
to pay a percentage of the total amount of applicable start-up costs
for the teaching hospital, not to exceed 20 percent.
Sec. 58A.107. REDUCTION IN FUNDING. The board shall limit
or withhold funding from grant recipients that do not comply with
reporting requirements or that use grant funds for a purpose not
authorized by this subchapter. The board shall seek reimbursement
with respect to any grant funds that are not used for purposes
authorized by this subchapter.
Sec. 58A.108. CRITERIA FOR DETERMINING CRITICAL SHORTAGE
LEVELS. (a) For purposes of this subchapter, the board shall
determine critical shortage levels for medical specialties and
subspecialties in this state according to criteria used by the
United States Department of Health and Human Services Health
Resources and Services Administration to designate health
professional shortage areas.
(b) In its methodology for determining critical shortage
levels under this section, the board shall include the results of
the research conducted by the center under Section 105.009(a)(1),
Health and Safety Code, and similar research performed by other
appropriate entities.
SUBCHAPTER E. TEXAS TEACHING HEALTH CENTER
GRADUATE MEDICAL EDUCATION GRANT PROGRAM
Sec. 58A.121. DEFINITIONS. In this subchapter:
(1) "Graduate medical residency training program"
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
Association; or
(ii) demonstrates eligibility to apply for
and receive an accreditation described by Subparagraph (i).
(2) "Primary care residency program" means a graduate
medical residency training program in a specialty described by
Section 58.008(a).
(3) "Program" means the Texas teaching health center
graduate medical education grant program established under this
subchapter.
(4) "Teaching health center" means a community-based,
ambulatory patient care center that operates a primary care
residency program. The term includes:
(A) a federally qualified health center, as
defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C.
Section 1396d(l)(2)(B));
(B) a community mental health center, as defined
by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section
1395x(ff)(3)(B));
(C) a rural health clinic, as defined by Section
1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2));
(D) a health center operated by the Indian Health
Service, an Indian tribe or tribal organization, or an urban Indian
organization, as defined by Section 4, Indian Health Care
Improvement Act (25 U.S.C. Section 1603); and
(E) an entity receiving funds under Title X,
Public Health Service Act (42 U.S.C. Section 300 et seq.).
Sec. 58A.122. ESTABLISHMENT OF PROGRAM. The board shall
establish the Texas teaching health center graduate medical
education grant program to award grants to teaching health centers
for the purpose of establishing new primary care residency programs
or increasing the number of residency positions in existing primary
care residency programs.
Sec. 58A.123. RULES. (a) The board shall adopt rules to
administer the program, including rules regarding:
(1) a grant application process;
(2) reporting requirements for grant recipients under
Section 58A.128; and
(3) the amount of the payments for direct expenses and
indirect expenses, as defined by and calculated in the same manner
as those expenses are calculated under the federal rules described
by Subsection (b).
(b) The rules adopted under this subchapter must be based as
nearly as possible on the rules adopted under the federal teaching
health centers development grant program established under Section
5508, Patient Protection and Affordable Care Act of 2010 (Pub. L.
No. 111-148).
(c) The rules adopted in relation to the reporting
requirements under Section 58A.128 must also:
(1) authorize the board to conduct audits of grant
recipients to the extent necessary to ensure the accuracy and
completeness of their annual reports; and
(2) specify a mandatory amount of reduction in grant
funds under Section 58A.127 for a failure to submit an accurate or
complete report.
Sec. 58A.124. AMOUNT AND DURATION OF GRANT. Subject to
Section 58A.127, the board may award grants under this subchapter
for a term of not more than three years, and the maximum award to a
recipient may not exceed $500,000 during each state fiscal year.
Sec. 58A.125. RELATIONSHIP OF GRANTS TO OTHER FEDERAL
PAYMENTS FOR GRADUATE MEDICAL EDUCATION. A grant awarded by the
board under this subchapter is in addition to any payments for:
(1) direct graduate medical education costs under
Section 1886(h), Social Security Act (42 U.S.C. Section 1395ww(h));
(2) indirect medical education costs under Section
1886(d)(5)(B), Social Security Act (42 U.S.C. Section
1395ww(d)(5)(B)); and
(3) direct costs of medical education under Section
1886(k), Social Security Act (42 U.S.C. Section 1395ww(k)).
Sec. 58A.126. USE OF FUNDS. A grant awarded under this
subchapter may be used only to cover the costs of establishing a new
primary care residency program at a teaching health center or the
costs of increasing the number of residency positions in an
existing primary care residency program, including costs
associated with:
(1) curriculum development;
(2) recruitment, training, and retention of residents
and faculty;
(3) obtaining accreditation by the Accreditation
Council for Graduate Medical Education or the American Osteopathic
Association; and
(4) faculty salaries during the development phase.
Sec. 58A.127. REDUCTION IN FUNDING. The board shall limit
or withhold funding from grant recipients that do not comply with
reporting requirements or that use grant funds for a purpose not
authorized by this subchapter. The board shall seek reimbursement
with respect to any grant funds that are not used for purposes
authorized by this subchapter.
Sec. 58A.128. REPORTING. (a) A grant recipient shall
submit an annual report that fully accounts for the use of a grant
awarded under this subchapter.
(b) The annual report must be made in the form and manner
specified by the board and must include the following information
for the most recent residency academic year completed immediately
before the applicable state fiscal year:
(1) the types of primary care residency programs that
the grant recipient provided for residents;
(2) the number of approved training positions in those
programs for part-time or full-time residents;
(3) the number of part-time or full-time residents
who:
(A) completed their residency training in those
programs at the end of the residency academic year; and
(B) care for vulnerable populations living in
underserved areas; and
(4) any other information considered appropriate by
the board.
SUBCHAPTER F. GRADUATE MEDICAL EDUCATION
PARTNERSHIP GRANT PROGRAM
Sec. 58A.151. DEFINITIONS. In this subchapter:
(1) "Graduate medical education partnership" means a
partnership entered into by a teaching health center and an
accredited graduate medical residency training program offered by a
hospital or medical school.
(2) "Graduate medical residency training program"
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
Association; or
(ii) demonstrates eligibility to apply for
and receive an accreditation described by Subparagraph (i).
(3) "Primary care residency program" means a graduate
medical residency training program in a specialty described by
Section 58.008(a).
(4) "Program" means the graduate medical education
partnership grant program established under this subchapter.
(5) "Teaching health center" means a community-based,
ambulatory patient care center that operates a primary care
residency program. The term includes:
(A) a federally qualified health center, as
defined by Section 1905(l)(2)(B), Social Security Act (42 U.S.C.
Section 1396d(l)(2)(B));
(B) a community mental health center, as defined
by Section 1861(ff)(3)(B), Social Security Act (42 U.S.C. Section
1395x(ff)(3)(B));
(C) a rural health clinic, as defined by Section
1861(aa)(2), Social Security Act (42 U.S.C. Section 1395x(aa)(2));
(D) a health center operated by the Indian Health
Service, an Indian tribe or tribal organization, or an urban Indian
organization, as defined by Section 4, Indian Health Care
Improvement Act (25 U.S.C. Section 1603); and
(E) an entity receiving funds under Title X,
Public Health Service Act (42 U.S.C. Section 300 et seq.).
Sec. 58A.152. ESTABLISHMENT OF PROGRAM. The board shall
establish the graduate medical education partnership grant program
to allow a teaching health center that is establishing and seeking
accreditation for a new primary care residency program to partner
with an accredited graduate medical residency training program
offered by a hospital or medical school.
Sec. 58A.153. RULES. The board shall adopt rules to
administer the program, including rules regarding a grant
application process and reporting requirements for grant
recipients.
Sec. 58A.154. USE OF FUNDS. The board shall award grants to
each participant in a graduate medical education partnership to:
(1) facilitate a mentoring relationship between
partners that will provide information and guidance for the
participating teaching health center during the accreditation
process; and
(2) assist the partners in building a collaborative
working relationship for the future.
Sec. 58A.155. REDUCTION IN FUNDING. The board shall limit
or withhold funding from grant recipients that do not comply with
reporting requirements or that use grant funds for a purpose not
authorized by this subchapter. The board shall seek reimbursement
for any grant funds that are not used for purposes authorized by
this subchapter.
SECTION 2. Chapter 105, Health and Safety Code, is amended
by adding Section 105.009 to read as follows:
Sec. 105.009. RESEARCH REGARDING GRADUATE MEDICAL
EDUCATION SYSTEM. (a) The comprehensive health professions
resource center shall conduct research:
(1) to identify:
(A) the ratio of primary care to non-primary care
physicians that is necessary and appropriate to meet the current
and future health care needs of this state; and
(B) all medical specialties and subspecialties
that are at critical shortage levels in this state, together with
the geographic location of the physicians in those specialties and
subspecialties; and
(2) regarding the overall supply of physicians in this
state and any other issues that are relevant to the status of the
state's graduate medical education system and the ability of that
system to meet the current and future health care needs of this
state.
(b) Not later than August 31 of each even-numbered year, the
council shall report the results of the center's research to the
Legislative Budget Board, the Texas Higher Education Coordinating
Board, the office of the governor, and the standing committees of
each house of the legislature with primary jurisdiction over state
finance or appropriations.
SECTION 3. (a) Not later than December 31, 2015, the Texas
Higher Education Coordinating Board shall adopt rules for the
critical shortage physician grant program, the Texas teaching
health center graduate medical education grant program, and the
graduate medical education partnership grant program established
under Subchapters D, E, and F, Chapter 58A, Education Code,
respectively, as added by this Act.
(b) The board shall award grants under the programs
described by Subsection (a) of this section beginning with the
state fiscal year ending August 31, 2016.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.