2001 Legislative Compendium: Medical Education

Joint Admission Medical Program | Medical School Expansions | Medical School Class Size Expansion | Admission and Scholarship Criteria for Disadvantage Students | GME Funding for Primary Care: Budget Rider | GME Formula Funding Initiative | Nonprofit Libraries providing Clinical Medical Education | Medicaid Managed Care GME Carve-Out | Health-Related Institutions Formula Funding: Budget Rider | Indigent Care Relief for UTMB Galveston: Budget Rider | UTMB Galveston Student and Resident Training: Budget Rider | Health Insurance Requirements for Medical Students | Texas A&M University: New Center for Rural Public Health | Higher Education Assistance Pilot Program | School of Pharmacy at Texas A&M University-Kingsville | Medical School Rural Pilot Project | Limited State J-1 Visa Waiver Program | Geriatrics | Nursing Shortage Relief | Annual Reports of Health-Related Institutions' Practice Plans: Budget Rider | Medical School Campus at Texas Tech UHSC El Paso | Additional Funding for Physician Education Loan Repayment Program

JOINT ADMISSION MEDICAL PROGRAM

SB 940 by Sen. Teel Bivins (R-Amarillo) establishes the Joint Admission Medical Program (JAMP) to increase minority medical school enrollments. In the post-Hopwood era, the bill attempts to achieve this by reserving 10 percent of student slots at each Texas medical school for economically disadvantaged students. The program received $4 million for the biennium to be distributed through the Texas Higher Education Coordinating Board and when fully established is estimated to need less than $20 million per biennium.

TMA supported SB 940, which had broad bipartisan support.

MEDICAL SCHOOL EXPANSIONS

HB 42 by Rep. Ruth Jones McClendon (D-San Antonio) directs the Texas Higher Education Coordinating Board to conduct a feasibility study regarding establishment of a doctor of medicine degree program at Prairie View A&M University. The study is to be completed by Dec. 31, 2002. TMA supported the feasibility study. 

HB 42 won legislative approval in lieu of HB 3469, also by Representative McClendon, and HB 2521, by Rep. Ron Wilson (D-Houston). The two bills sought establishment of a new medical school at Prairie View A&M University.

MEDICAL SCHOOL CLASS SIZE EXPANSION

The 77th legislature authorized Texas Tech University Health Sciences Center School of Medicine in Lubbock to seek national accreditation and approval by the Texas Higher Education Coordinating Board to admit an additional 20 medical students per year until first-year enrollment reaches 200. Texas Tech officials indicated that an enrollment increase at the Lubbock campus is a first step in planning for a four-year medical school in El Paso. The medical student body is expected to be split between the Lubbock and El Paso campuses should the El Paso expansion take place in future years.

ADMISSION AND SCHOLARSHIP CRITERIA FOR DISADVANTAGED STUDENTS

HB 1641 by Rep. Irma Rangel (D-Kingsville) establishes in law the student admission and scholarship eligibility criteria, other than race, that may be used by higher education programs, including public medical schools, to increase the number of minority students. Texas medical schools already use much of the eligibility criteria listed in the bill. Further, the bill's specification that standardized test scores not be used as the sole admissions/scholarship criterion does not impact Texas medical schools that already base these decisions on a variety of factors. The bill had widespread legislative support as lawmakers sought ways to further diversify the state's future workforce.

Early in the legislative session, the TMA Council on Medical Education relayed concerns to the TMA Council on Legislation about the initial version of this bill, which sought to mandate medical school admissions criteria. This language could have interfered with medical school accreditation standards of the Liaison Committee on Medical Education that bar external influence on admissions criteria. The bill was amended during the session to make the admissions criteria specified in the bill an option for Texas medical schools rather than a mandate. This change took care of the council's initial concerns about the bill.

GME FUNDING FOR PRIMARY CARE:BUDGET RIDER

The coordinating board received continued funding of $27 million for primary care residency training programs for each year of the next biennium. Of this, $1 million is allocated for the three primary care preceptorship programs:  family practice ($400,000), pediatrics ($300,000), and internal medicine ($300,000).

GME FORMULA FUNDING INITIATIVE

During the last legislative interim session, Sen. Bill Ratliff (R-Mount Pleasant) asked the health-related institutions to evaluate the potential for establishing a state formula funding process for graduate medical education (GME) programs. Currently, state support for GME is mostly limited to primary care residency programs.  This proposal could expand state support to include non-primary care residency training programs.

During this session, the Texas Higher Education Coordinating Board created the Graduate Medical Education Study Committee, made up of representatives from health-related institutions, to study the faculty instructional costs of GME.  The workgroup presented its findings to the House Appropriations Committee late in the session, including the proposal that state GME formula funding be based on 25 percent of the cost to the state for educating a medical student.  No GME formula funding proposals were adopted by the legislature this session; however, the coordinating board commissioner was directed to appoint a task force to analyze all sources of graduate medical education funding.  Although no funds were appropriated, the board is further authorized to hire an independent consultant to assist the task force, estimated to cost $300,000.  The task force has until Sept. 1, 2002, to recommend to the 78th legislature funding priorities to preserve the long-term viability of GME in Texas by improving graduate and post-graduate medical education's service to Texas residents.

NONPROFIT LIBRARIES PROVIDING CLINICAL MEDICAL EDUCATION

HB 3591 by Rep. Bob Hunter (R-Abilene) is a TMA-initiated bill that amends existing laws to enable certain nonprofit libraries, including the TMA Library, to participate in the Texas State Library and Archives Commission's TexShare program. This change allows the TMA Library to provide remote access to electronic resources to TMA physician members statewide. Rural and urban practitioners in Texas could benefit from the proposed library partnership and sharing of online databases, including full-text books, reference materials, and journals.  The legislation also could enable the TMA Library to apply for grant opportunities for telecommunications-related projects managed by the Telecommunications Infrastructure Fund Board.

MEDICAID MANAGED CARE GME CARVE-OUT

The Texas Department of Health (TDH) was directed in Rider 44 in Article II of the Appropriations Act to enter into a memorandum of understanding with the Health and Human Services Commission to carve out Medicaid GME payments from payments to managed care organizations. Payments for GME support are to be made directly to teaching programs based on Medicaid volume and number of filled positions in accredited medical residency programs. 

HEALTH-RELATED INSTITUTIONS FORMULA FUNDING: BUDGET RIDER

In 1999, legislation was passed to convert state support for undergraduate medical education (instruction and operations support) to a formula funding process. An increased funding level has been approved for students at health-related institutions during the next biennium from a base unit of $11,383 to $11,776 per student.  For medical students, an additional weight of 4.753 per student is applied, resulting in a total appropriation of $56,000 per medical student, up from $54,000 last biennium. 

INDIGENT CARE RELIEF FOR UTMB GALVESTON: BUDGET RIDER

Early in the legislative session, The University of Texas Medical Branch at Galveston (UTMB) indicated its No. 1 legislative priority would be indigent health care costs.  Rider 56 in Article II of the Appropriations Act re-authorizes the funding of up to $40 million to UTMB for indigent care costs.  This provision, initially authorized last session, directs these funds from unclaimed state lottery winnings to TDH to be drawn down by UTMB.  

UTMB GALVESTON STUDENT AND RESIDENT TRAINING: BUDGET RIDER

The legislature authorized UTMB to expend funds to develop student and resident training programs in Austin.

HEALTH INSURANCE REQUIREMENTS FOR MEDICAL STUDENTS

Currently, Texas medical students are not required to carry health insurance while enrolled in medical school.  Because of health risks related to direct patient contact in medical care facilities, legislation was passed to authorize institutions to require medical students to have health insurance in effect during the calendar year of enrollment. The University of Texas System strongly supported SB 505 by Sen. J.E. "Buster" Brown (R-Lake Jackson), and the recommendation to require health insurance was endorsed by the student governance at the five UT health components with enrolled students. The UT System has estimated that they will be able to provide health insurance for the cost of about $600 per year, which would provide affordable health care in the event of unexpected illness or accident. Students will be able to roll the health insurance costs into their financial aid packages. The Texas A&M University System and Texas Tech University System already require health insurance for medical students, but indicated the implementation of this legislation would clarify that this requirement is indeed lawful. According to the Liaison Committee on Graduate Medical Education, 88 percent of the nation's medical schools currently have this requirement.

TEXAS A&M UNIVERSITY: NEW CENTER FOR RURAL PUBLIC HEALTH

HB 910 by Rep. Roberto Gutierrez (D-McAllen) establishes the Texas A&M University System Health Science Center South Texas Center for Rural Public Health to deliver health education outreach programs, provide community based instructional sites for the education of public health professionals, and address the need to overcome the limited access of rural residents to public health professionals. The center was appropriated $2 million for the biennium. The legislation further requires the Texas Higher Education Coordinating Board to prepare an impact statement examining the initial implementation of the bill by Aug. 31, 2002.

HIGHER EDUCATION ASSISTANCE PILOT PROGRAM

HB 400 by Rep. Helen Giddings (D-Dallas) establishes a two-year pilot program at the coordinating board to assist prospective students in three regions of the state with low post-secondary enrollment rates as determined by the board. The board is to provide admissions and financial aid applications and assist students in completing the forms. A report is to be prepared by the board on the effectiveness of the pilot program, including recommendations on whether to implement the program on a statewide basis by Sept. 1, 2002.

SCHOOL OF PHARMACY AT TEXAS A&M UNIVERSITY-KINGSVILLE

HB 1640 by Representative Rangel authorizes a school of pharmacy at Texas A&M University-Kingsville and requires the coordinating board to prepare an impact statement on initial implementation of the bill by Aug. 31, 2002.

MEDICAL SCHOOL RURAL PILOT PROJECT

The legislature approved a pilot program to offer incentives to a Texas medical school to prepare more students for rural practice. This TMA-initiated bill, HB 2421 by Rep. Judy Hawley (D-Portland), did not receive the $200,000 in annual funding needed to establish the pilot project; thus, implementation of the fill will require a medical school to pursue federal grants or non-government funding.

LIMITED STATE J-1 VISA WAIVER PROGRAM

TMA assisted community representatives and administrators of the South Texas Regional Academic Health Center (RAHC) in gaining legislative approval for the RAHC to participate in a limited J-1 visa waiver program. HB 1018 by Rep. Rick Hardcastle (R-Vernon) allows the RAHC to recruit physicians with J-1 visas in specialties that are needed to obtain accreditation approval from the Accreditation Committee on Graduate Medical Education. The bill grants authority for TDH to recommend federal approval of J-1 visa waivers for applicants meeting the above criterion and is limited to the four counties served by the South Texas RAHC and up to 20 physicians per year. 

GERIATRICS

Lawmakers approved HB 2584 by Rep. Norma Chavez (D-El Paso) directing the coordinating board to establish a commission to evaluate and report back by October 2002 whether geriatrics should become a mandated part of the Texas medical school curriculum.

NURSING SHORTAGE RELIEF

To address the nursing shortage, the legislature passed SB 572 by Sen. Mike Moncrief (D-Fort Worth), which provides additional funding for registered nurse educational programs.  Lawmakers allocated $724,000 a year to allow nursing programs to hire more faculty and secure more classroom and training space to accommodate more nursing students.

ANNUAL REPORTS OF HEALTH-RELATED INSTITUTIONS' PRACTICE PLANS: BUDGET RIDER

Health-related institutions are required to file an annual report on practice plan funds at the end of each fiscal year. If the report is not received, the institutions are unable to expend funds after a period of 120 days following the close of the fiscal year.

Medical Education Near Misses

MEDICAL SCHOOL CAMPUS AT TEXAS TECH UHSC EL PASO

SB 1303 by Sen. Eliot Shapleigh (D-El Paso), calling for the establishment of a four-year medical school at Texas Tech University Health Sciences Center in El Paso, failed to progress during the session. Texas Tech officials have expressed their ongoing commitment to the proposal and will continue to gather data and conduct analyses pertaining to the proposed medical school during the legislative interim. The El Paso County Medical Society supported the bill.

ADDITIONAL FUNDING FOR PHYSICIAN EDUCATION LOAN REPAYMENT PROGRAM

HB 2417 by Representative Hardcastle failed to win passage during the session.  It would have slightly expanded funding for the Physician Education Loan Repayment Program by directing Texas medical schools to expand their contribution to the program. The need for the bill was prompted by the current funding shortfall for the program, with 71 physicians on a waiting list to receive loan repayment funds.  The bill was initiated by the Texas Academy of Family Physicians and supported by TMA, the Texas Pediatric Society, and the Texas Academy of Internal Medicine. 

Current funding for the program is primarily derived from a 2 percent set-aside of medical school in-state tuition.  The bill would have directed medical schools to also allocate 2 percent from out-of-state medical school tuition.  Because a few payments have been missed by Texas medical schools in the past, the bill would have directed the state comptroller's office to give annual reports to legislative leaders on medical school payments for this program.

Medical Education TMA Staff Contacts

• Marcia Collins, Director, Medical Education Studies Department, (512) 370-1375
• Bridget McPhillips, Director, Division of Medical Education, (512) 370-1404

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