HBA-MPM C.S.H.B. 2528 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2528 By: Van de Putte Higher Education 5/10/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE The shortage of pharmacists in Texas is due to several factors, including the following: _an aging population which requires more prescription drugs; _the introduction of drug options which keep patients out of hospitals and nursing homes; _a shift in pharmacy education from a five to six-year program; _an increase in the number of Texans covered by insurance programs offering prescription benefits; and _pharmacy graduates who leave Texas to participate in out-of-state residency programs. Currently, there are limited federal grants available to fund pharmacy residency programs, however, additional grants alone may not solve the pharmacist shortage, as they only fund programs in hospital settings. The effect of the shortage is especially severe in rural areas, many of which do not have hospitals. C.S.H.B. 2528 establishes the Roberta High Memorial Pharmacy Residency Program, which provides funding by state stipend to aid pharmacy residencies in community settings and creates more residencies in hospital settings. This bill also provides that the cost of each residency will be shared by the state, the employer, and the college of pharmacy, with the state's share not to exceed $10,000 per residency site. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 61, Education Code, by adding Subchapter T, as follows: SUBCHAPTER T. ROBERTA HIGH MEMORIAL PHARMACY RESIDENCY PROGRAM Sec. 61.851. DEFINITIONS. Defines, for the purpose of this subchapter, the following terms: "college of pharmacy," "community pharmacy," "compensation," "institutional pharmacy," "nuclear pharmacy," "pharmacy residency program," "primary teaching pharmacy," "residency preceptor," and "resident pharmacist." Sec. 61.852. COMPENSATION OF RESIDENT PHARMACIST. Requires a school of pharmacy to compensate each resident pharmacist (resident) being educated, trained, developed, and prepared for a career in pharmacy while undergoing education, training, development, and preparation at or under the direction and supervision of the college. Sec. 61.853. NUMBER OF AVAILABLE RESIDENT PHARMACIST POSITIONS. Prohibits the total number of compensated first-year residents from exceeding the total number of persons in the preceding year's combined or graduating classes of all colleges of pharmacy in each year. Provides that at least 50 percent of the combined total number of resident positions to be in community pharmacy practice. Sec. 61.854. PREFERENCE TO APPLICANT FOR PRACTICE IN MEDICALLY UNDERSERVED AREAS. Requires each college to give priority consideration to an applicant for a resident position who demonstrates a willingness to practice pharmacy in medically underserved areas of this state, as defined by the Texas Department of Health. Sec. 61.855. DURATION OF PHARMACIST RESIDENCY. Prohibits a person from holding a resident position for more than two years, or for a period longer than that usually required for a resident to complete a graduate pharmacy education program approved by the Texas State Board of Pharmacy (board) for the specialty in which the resident seeks certification. Sec. 61.856. PROGRAM FUNDING. Authorizes the legislature to appropriate revenue to the board to fund the pharmacy residency program. Prohibits funds appropriated and distributed under this subchapter from being transferred or diverted from the pharmacy resident program. Requires the comptroller of public accounts to issue a warrant to the college of pharmacy or other entity designated by the board to receive funds under this subchapter. Prohibits general revenue funds from being used to fund pharmacy residencies other than in the manner prescribed by this subchapter after August 31, 2001. Sec. 61.857. STATE SUPPORT OF RESIDENT PHARMACIST COMPENSATION. (a) Authorizes the board, to supplement compensation of residents, to provide grants to colleges of pharmacy in amounts that do not exceed $10,000 per fiscal year for each resident position the board approves and that is filled by the applicable college for that year. (b) Authorizes a college of pharmacy to receive funds under this section for a resident position in any year only if the college and primary teaching pharmacy each contribute at least $10,000 toward the compensation of the resident for that year. (c) Requires a college of pharmacy to reduce proportionately the compensation paid to a resident who does not perform in that capacity during an entire fiscal year to cover only the part of the year during which the person performed duties as a resident. (d) Requires a college of pharmacy, if a person is compensated by an agency or institution of the federal government or by any other agency or institution, other than a primary teaching pharmacy, to reduce the compensation that would otherwise be paid the person by an amount equal to that received by the person from the agency or institution. (e) Provides that if the college receives from an agency or institution of the federal government or from any other agency or institution, compensation for a person's performance of the person's duties as a resident to or for the benefit of the agency or institution, the compensation that may be paid to the resident from funds awarded for that position is reduced by the amount received from the other agency or institution. (f) Specifies that a resident must enroll for at least nine semester credit hours (hours) each fall and spring semester and for at least six hours each summer term in graduate pharmacy education experiential courses to qualify for supplemental compensation provided under this section. Exempts the resident from fees required for enrollment, other than tuition. Sec. 61.858. PLACEMENT OF RESIDENT PHARMACISTS IF FULL FUNDING NOT AVAILABLE. (a) Authorizes a college of pharmacy to assign and place for education and training a resident who cannot be supported adequately with available funds in a primary teaching pharmacy with which the college has a resident affiliation agreement if the college determines that it does not have sufficient available funds from legislative appropriations and other sources to adequately support the full number of residents the college considers necessary to carry out its purposes. (b) Requires a resident to receive compensation primarily from a primary teaching pharmacy during the period for which the resident is assigned and placed in a pharmacy under this section. (c) Provides that a resident pharmacist affiliation agreement between the college of pharmacy and the primary teaching pharmacy must describe the exact method and manner of compensating the resident. Sec. 61.859. ADDITIONAL FUNDING TO SUPPORT GRADUATE PHARMACY EDUCATION PROGRAMS. (a) Requires the board to administer a program to support graduate pharmacy education programs in this state consistent with the state's needs for graduate pharmacy education and the training of residents in appropriate fields and specialties. (b) Authorizes the board, from available funds, to make grants or formula distributions to a college of pharmacy or other entity to achieve certain goals. (c) Provides that in order to be eligible for a grant or distribution under this section a college of pharmacy or other entity must incur the costs of faculty education or supervision in a graduate pharmacy education program or the costs of compensating a resident in the program. Requires the board to take those incurred costs into account when making grants or formula distributions under this section. (d) Provides that the program is funded by appropriations, gifts, grants, and donations made to support the program, and by any other funds the board obtains, including federal grants. (e) Authorizes an amount granted or distributed to a college of pharmacy or other entity under the program to be used only to cover expenses of training residents participating in the particular program or activity for which the grant or distribution is made in accordance with conditions imposed by the board. Prohibits this amount from being spent for the general support of the college or other entity. Sec. 61.860. ADVISORY COMMITTEE. (a) Requires the board to establish an advisory committee (committee) to advise the board regarding the development and administration of the pharmacy residency program, including evaluating requests for grants and establishing formulas for distribution of funds under the program. (b) Sets forth the composition of the committee. (c) Provides that of the members of the committee who are pharmacists in private practice, two must be in community pharmacy practice and two must be active in hospital pharmacy practice. (d) Specifies that the appointed members of the committee serve staggered three-year terms. Requires the Texas Board of Medical Examiners to appoint certain members to serve certain terms, so that one-third of the appointed members' terms expire each year, as nearly as practicable. (e) Requires the committee to elect one member as presiding officer for a one-year term. (f) Requires the committee to meet at least once yearly and as often as requested by the board or called into meeting by the presiding officer. (g) Prohibits a committee member from receiving compensation for committee service, but authorizes that member to receive reimbursement for travel to official meetings according to policies established by the board. Sec. 61.861. DUTIES OF ADVISORY COMMITTEE. Requires the committee to perform certain duties. Sec. 61.862. APPLICATION BY SCHOOL OF PHARMACY FOR FUNDING. Provides that a college of pharmacy must include in an application for funds under this subchapter certain information. Sec. 61.863. FUNDING OF FACULTY PRECEPTOR POSITIONS (a) Authorizes a college of pharmacy to apply and receive a grant under this section to support full-time faculty members who are residency preceptors who supervise accredited pharmacy residencies. (b) Requires the committee to recommend to the board an allocation of residency preceptor positions that are to receive funds under this section. (c) Provides that an allocation of funds under this section must take into consideration certain factors. (d) Requires the board to continue to grant funds to support that position for a period not to exceed one additional calendar year once funds are granted to support a residency preceptor position affiliated with a college of pharmacy. Requires the college, after that time, to provide an amount equal to the annualized amount of the grant in its operating budget to maintain the level of compensation for the position for two years after the grant period has ended. (e) Prohibits the board from using more than 10 percent of the total amount appropriated to the pharmacy residency program under this subchapter to fund residency preceptor positions. (f) Authorizes the board to solicit, receive, and spend grants, gifts, and donations from public and private sources for purposes of this section. SECTION 2. Amends Section 17(a), Article 4542a-1, V.T.C.S. (Texas Pharmacy Act), to provide that the board is responsible for the regulation of the practice of pharmacy in this state, including the determination and issuance of standards for recognizing and approving a pharmacy residency program for purposes of Subchapter T, Chapter 61, Education Code, among other responsibilities. SECTION 3. Requires the comptroller to transfer $850,000 from the State Board of Pharmacy fund account to the undedicated portion of the general revenue fund on the effective date of this Act. Authorizes the legislature to appropriate these funds only for the pharmacy residency program established by this Act. SECTION 4. Effective date: September 1, 1999. SECTION 4. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2528 differs from the original by modifying SECTION 1, which amends Chapter 61, Education Code by adding Subchapter T, as follows: Sec. 61.851. The substitute defines "college of pharmacy," rather than "school of pharmacy," and "residency preceptor," rather than "faculty preceptor." The substitute modifies the definitions of "community pharmacy," "institutional pharmacy," "nuclear pharmacy," "pharmacy residency program," and "resident pharmacist," set forth in the original and makes conforming changes. The substitute reorders the subdivision numbers of the original. Please note that conforming changes are made throughout the substitute with respect to changing "school of pharmacy" to "college of pharmacy" and "faculty preceptor" to "residency preceptor." Sec. 61.852. The substitute makes a conforming change. Sec. 61.853. Prohibits the total number of compensated first-year resident pharmacists from exceeding the total number, rather than 50 percent of the total number, of persons in the preceding year's combined graduating classes of all colleges of pharmacy. Sec. 61.854. The substitute makes conforming changes. Sec. 61.855. The substitute makes conforming changes. Sec. 61.856. The substitute adds new Subsection (d), to prohibit general revenue funds from being used to fund pharmacy residencies other than in the manner prescribed by this subchapter after August 31, 2001. Sections 61.857-61.859. The substitute makes conforming changes. Sec. 61.860. Requires the Texas State Board of Pharmacy (board) to establish, rather than to appoint, an advisory committee to advise the board regarding the development and administration of the pharmacy residency program. The substitute modifies the composition of the advisory committee set forth in the original, requires the Texas State Board of Medical Examiners to appoint certain committee members, and modifies the manner in which the board appoints the remaining committee members for specific terms. Makes conforming changes. Sec. 61.861-61.862. Makes conforming changes. Sec. 61.863. The substitute authorizes a college of pharmacy to apply for and receive a grant under this section to support full-time faculty members who are residency preceptors, rather than to support full-time affiliated faculty preceptors, who supervise accredited pharmacy residencies. Makes conforming changes. The substitute adds new SECTION 2, which amends Section 17(a), Article 4542a-1, V.T.C.S. (Texas Pharmacy Act), to provide that the board is responsible for the regulation of the practice of pharmacy in this state, including the determination and issuance of standards for recognizing and approving a pharmacy residency program for purposes of Subchapter T, Chapter 61, Education Code, among other responsibilities. The substitute redesignates SECTIONS 2-4 of the original to SECTIONS 3-5.