2001 Legislative Compendium: Rural Health

Creation of the Office of Rural and Community Affairs | Rural Community Health System | Expedited BME Applications for Rural Physicians | Limited State J-1 Visa Waiver Program | Medical School Rural Pilot Project | Rural Communities Health Care Investment Program | Rural Foundation | EMS Providers in Rural Areas | Texas A&M University: New Center for Rural Public Health | State Rural Locum Tenens Program | Expansions of Community Matching Program


Recognizing the interconnection between health care and economic development, Rep. Warren Chisum (R-Pampa) and Sen. David Sibley (R-Waco) sponsored HB 7, establishing a new state agency for rural issues - the Office of Rural and Community Affairs (ORCA).

The bill, endorsed by House Speaker Pete Laney (D-Hale Center) and the House Rural Caucus, combines two existing state agencies, the Center for Rural Health Initiatives and Office of Community Affairs.

Overseeing ORCA is a new executive committee consisting of nine members; three members will be selected by the governor, three by the lieutenant governor, and three by the speaker of the House.  Outlined within HB 7 are specific functions for ORCA, including:

  • Work with other state agencies to improve results and cost-effectiveness of state programs;,
  • Develop programs to improve leadership capacity of rural leaders,
  • Monitor developments that affect rural areas and compile a report of the progress of the condition of rural communities,
  • Administer the Federal Community Block Grant nonentitlement program,
  • Research and report the most cost-effective ways to improve the welfare of rural communities,
  • Ensure that the state qualifies for federal grants from the U.S. Office of Rural Health Policy, and
  • Manage the state's Medicare rural hospital flexibility program.

The bill allows ORCA to accept grants to fund programs.

ORCA must hold an annual meeting of agency heads to discuss rural issues and also develop, implement, and update a Rural Health Work Plan.

For physicians and other health care providers, the bill specifically authorizes ORCA to transfer existing Center for Rural Health Initiatives programs to the agency, including:

  • Outstanding Rural Scholar Loan Program,
  • Health Careers Promotion and Education Program,
  • Medically Underserved Community-State Matching Incentive Program,
  • Texas Health Services Corps,
  • Rural Health Facility Capital Improvement Fund,
  • Designating rural hospitals to qualify for federal funds, and
  • Breast Cancer Screening Program.
  • Additionally, HB 7 creates a process by which all powers, duties, obligations, rights, contracts, leases, records, property, and unspent and unobligated appropriations and other funds of the Center for Rural Health Initiatives are transferred to ORCA.

TMA supported HB 7.


Senate Bill 1394 by Sen. Troy Fraser (R-Horseshoe Bay) and Rep. Judy Hawley (D-Portland) authorizes the Rural Community Health System (RCHS) to create a pilot project to determine the effectiveness of exclusive provider networks in the delivery of rural Medicaid and indigent care. The RCHS was established in 1997 by the legislature to develop community-based, physician-directed health care networks that could respond to the growing presence of managed care in rural Texas. However, a lack of funding for the RCHS precluded it achieving its full potential.  SB 1394 allows RCHS to test new rural health care delivery models in partnership with existing insurers and networks, thus relieving many of the system's start up-costs. TMA supported the RCHS-enabling legislation as well as SB 1394.


HB 1018 by Rep. Rick Hardcastle (R-Vernon) and Sen. Tom Haywood (R-Wichita Falls) requires the Texas State Board of Medical Examiners (TSBME) to expedite medical licensure applications for physicians already licensed in another state or country who are relocating to Texas to practice in a rural area. Applications also will be expedited for physicians with an affidavit showing that he or she intends to work at an entity affiliated with a public graduate medical education (GME) program located in an underserved community, serve on the faculty of a public GME program, and engage in the practice of medicine and teaching in a specialty that is necessary for the GME program to obtain or maintain its accreditation.


Also within HB 1018 is a provision allowing the South Texas Regional Academic Health Center (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 the Texas Department of Health 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. 

TMA assisted community representatives and administrators of the RAHC in gaining legislative approval for the RAHC to participate in a limited J-1 visa waiver program. 


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


A new loan repayment and stipend program is created by SB 126 by Sen. Frank Madla (D-San Antonio) for health care professionals other than physicians who agree to practice in underserved rural areas. The program, to be administered by the Center for Rural Health Initiatives, was developed in response to shortages of some health professionals in rural areas of the state. Graduates of Texas programs receive priority status for loan repayment and stipends under the program. The legislature allocated $5 million for this new initiative.


SB 115 by Senator Madla and Representative Hawley creates a Rural 5.01(c)(3) Foundation within the Center for Rural Health Initiatives to assist rural communities and health professionals with raising money for local projects. The new foundation will provide grant-writing assistance for funds available through government entities, foundations, and other sources that fund local rural health projects.


In its interim report to the 77th Texas Legislature, the House Committee on Public Health examined the requirements imposed on emergency medical service (EMS) providers in rural areas to determine whether individual requirements encourage or hinder the provision of services. HB 2446 by Rep. Bob Glaze (D-Gilmer) and Senator Madla addresses the recommendations outlined in the interim report including:

  • Allowing an advisory council to advise the Texas Board of Health on emergency medical services,
  • Allowing counties to reimburse EMS providers under the Indigent Health Care and Treatment Act at Medicaid rates, and
  • Considering the standardization and simplification of EMS terminology and classification of providers.
  • The bill also addresses recommendations offered by TDH:
  • Establishing a peer assistance program, and
  • Providing confidentiality for the regional advisory council's quality improvement and data process.


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.

Rural Health Near Misses

STATE RURAL LOCUM TENENS PROGRAM                                                

Gov. Rick Perry vetoed a bill that would have offered discounted, temporary coverage of a physician's rural medical practice.  The Center for Rural Health Initiatives would have administered the program to make it easier for rural physicians to obtain continuing medical education and take a break from their practices. It was intended to promote rural medical practice and prevent career burnout among rural physicians.

During the final days of the session, an amendment was added to the bill that would have enabled certain physicians to become licensed in the state even though they failed one part of the United States Medical Licensing Exam more than six times.  

TMA strongly supported the program, which was developed by an interim committee comprising rural physicians, rural hospitals, medical schools, private locum tenens organizations, and state agency officials.


A bill did not advance to final stages that would have opened up two rural physician incentive programs initiated by TMA during the 1990s to any health professional identified by the Center for Rural Health Initiatives. SB 514 by Sen. Carlos Truan (D-Corpus Christi) would have allowed $25,000 in state money matched by $25,000 in community funds to be given to pharmacists, registered nurses, and other health professionals as "start-up" money.

Rural Health TMA Staff Contacts

  • Helen Kent Davis, Director, Office of Governmental Affairs, (512) 370-1401
  • Marcia Collins, Director, Medical Education Studies Department, (512) 370-1375

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