HBA-CCH C.S.S.B. 126 77(R) BILL ANALYSIS Office of House Bill AnalysisC.S.S.B. 126 By: Madla Public Health 3/19/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, there are several programs which provide financial incentives for certain health professionals agreeing to work in rural and other medically underserved communities. The Senate Health Services Committee, the House Select Committee on Rural Development, and the Statewide Healthcare Coordinating Council each report a continued shortage of a variety of healthcare providers in rural areas and recommend programs be expanded to encourage other health professionals to work in such communities. C.S.S.B. 126 establishes the Rural Communities Health Care Investment Program to recruit health professionals other than physicians to practice in medically underserved communities by providing such individuals with loan reimbursement or a stipend. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the executive committee of the Center for Rural Health Initiatives in SECTION 2 (Sections 106.305 and 106.306, Health and Safety Code) of this bill. ANALYSIS C.S.S.B. 126 amends the Health and Safety Code to require the executive committee of the Center for Rural Health Initiatives (executive committee) to establish a Rural Communities Health Care Investment Program (program) in the Center for Rural Health Initiatives (center) to provide loan reimbursement for, or a stipend to, health professionals, other than physicians, who agree to serve in communities designated as medically underserved by the center. The bill requires the stipend to be paid in periodic installments. The bill provides that a health professional who participates in the program must establish an office and residency in the medically underserved area before receiving any portion of the stipend (Secs. 106.303 and 106.304). The bill requires the center to seek state and federal money available for economic development in rural areas for programs through the center (Sec.106.025). The bill authorizes a health professional to receive assistance through the program only if the health professional signs a contract agreeing to provide health care services in a medically underserved community. The bill authorizes a student in a degree program preparing to become a health professional to contract with the center for the loan reimbursement program before obtaining the license required to become a health professional. The bill also authorizes the center to contract with a health professional for part-time services under the stipend program. The bill provides that a health professional who participates in any loan reimbursement program is not eligible for a stipend. The bill specifies that such a contract provide that a health professional who does not provide the required services to the community or provides those services for less than the required time, is personally liable to the state for the total amount of assistance received from the center and the medically underserved community, interest on the amount of assistance received at a rate set by the executive committee, the state's reasonable expenses incurred in obtaining payment, including reasonable attorney's fees, and a penalty established by the executive committee by rule to help ensure compliance with the contract. The bill requires recovered amounts to be deposited in the permanent endowment fund for the rural communities health care investment program (Sec.106.305). The bill requires the center to appoint an advisory panel to assist in the center's duties under the program and sets forth advisory panel composition requirements (Sec.106.302). The bill requires the executive committee to adopt rules necessary for the administration of the program and sets forth certain guidelines. The bill authorizes the executive committee, by rule, to designate areas of the state as medically underserved communities. The bill requires the executive committee to make reasonable efforts to contract with health professionals from health professions (Sec. 106.306). The bill authorizes a health care professional who participates in the program to use telecommunication technology to supplement or enhance health care services, but prohibits telecommunication technology from being the sole or primary method of providing services or a substitute for heath care services provided in person (Sec. 106.307). The bill authorizes the center to administer the permanent endowment fund, and if the center elects not to administer the fund, the comptroller is required to administer the fund. The bill requires the administrator of the fund to invest the fund in a manner intended to preserve the purchasing power of the fund's assets and the fund's annual distributions. The bill authorizes the comptroller or the center to solicit and accept gifts and grants to the fund. Annual distributions for the fund shall be determined by the investment and distribution policy adopted by the administrator. The amount available for distribution from the fund, including any gift or grant, may be appropriated only for providing stipends and loan reimbursement and to pay the expenses of managing the fund. The expenditure of a gift or grant is subject to any limitation or requirement placed on the gift or grant by the donor or granting entity (Sec. 106.309). The bill requires the center to provide a report on the permanent endowment fund for the rural communities health care investment program to the Legislative Budget Board (LBB) no later than November 1 of each year. The report must include the total amount of money the center received from the fund, the purpose for which the money was used, and any additional information that may be requested by the LBB (Sec. 106.310). The bill also amends the Education Code to require the Texas Higher Education Coordinating Board, in cooperation with the center and the center's advisory panel, to develop a program to ensure that the board seeks to obtain the maximum amount of funds from any source to support programs to provide student loan reimbursement or stipends for graduates of degree programs in this state who practice, or agree to practice, in a medically underserved community (Sec. 61.0899). EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.S.B. 126 modifies the original by limiting the program to health professionals other than physicians. The substitute adds the requirement that the center seek state and federal money available for economic development in rural areas for its programs (Sec. 106.025). The substitute requires a stipend awarded to be paid in periodic installments. The substitute provides that a health professional who participates in the program must establish an office and residency in the medically underserved area before receiving any portion of the stipend (Sec. 106.304). The substitute modifies the original to provide that the executive committee, by rule, establish a penalty to help ensure compliance with the contract by health care professionals in the program. The substitute also requires any amounts collected for a violation of the contract to be deposited in the permanent endowment fund for the program (Sec. 106.305). The substitute differs from the original by establishing a permanent endowment fund, rather than a trust fund. The substitute sets forth provisions for the management of the fund, and requires the center to provide a report on the fund to the Legislative Budget Board (Secs. 106.309 and 106.310). The substitute adds language authorizing the use of telecommunications technology in the program (Sec. 106.307).