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).