2003 LEGISLATIVE COMPENDIUM Workforce/Medical Education

[ Medical School Expansions | Primary Care and Rural Practice Incentive Programs | Town/Gown (Budget Rider) | Faculty Practice Plans (Budget Rider) | Efforts to Increase Medical School Diversity (Budget Rider) | Texas Higher Education Coordinating Board Sunset Bill | Nursing Shortage Relief | Workforce/Medical Education Near Misses | Medicaid Graduate Medical Education Funding | Indigent Care Funding ]

MEDICAL SCHOOL EXPANSIONS

El Paso Medical School

Texas Tech University System gained legislative approval to convert the two-year El Paso Regional Academic Health Center (for third- and fourth-year medical students) to a four-year medical school. This will increase the number of medical schools in the state to nine.

State Funding:	FY 2003-04 $1.3 million
	FY 2004-05 $1.3 million

Lower Rio Grande Valley Regional Academic Health Center, Harlingen and McAllen

Although Senate Bill 1586 by Sen. Eddie Lucio (D-Brownsville) to expand the two-year medical education program at the Lower Rio Grande Valley Regional Academic Health Center (RAHC) to a four-year medical school was unsuccessful, South Texas legislators made a strong effort to obtain increased state funding for RAHC. Until the final weekend of the regular session, $19.1 million in state funding was earmarked for RAHC. After final negotiations, the biennial appropriation was approximately $9.2 million.

During the first two weeks of the first-called special session, three bills were filed that requested between $9 million and $19.2 million in additional state funds to support RAHC during the 2004-05 biennium. Governor Perry has said he may add RAHC funding to the agenda for one of the special legislative sessions.

Texas Tech University Health Sciences Center, Lubbock

Texas Tech University Health Sciences Center (TTUHSC) received continued authority to increase first-year medical school enrollment by an additional 20 students until first-year enrollment reaches 200. This is the second biennium that TTUHSC has received legislative approval to increase its medical school class to 200 students.

Ten-Percent Cap in Nonresident Medical School Enrollments

Public medical schools are barred from using state appropriations for employee salaries if they limit admissions and accept nonresident students beyond a 10-percent cap if doing so denies admission to a qualified Texas applicant.

Minimum Medical School Enrollment Levels

The usual medical school enrollment minimums are continued: no less than 200 students in the entering class for the four University of Texas System medical schools and no less than 100 students at Texas Tech University and University of North Texas medical schools.

Decrease in Formula Funding for Medical Students

State funding for medical education has been allocated on a per-capita formula basis since 1999. The formula's base unit was reduced by the legislature for the next biennium from $11,776 per student to $9,934, a 16-percent reduction. An additional weight of 4.753 per medical student was unchanged from the previous state budget. This reduced the state appropriation per medical student from $56,000 to $47,000. Study committees appointed by the Texas Higher Education Coordinating Board are to review and update the formulas by June 2004.

East Texas Center for Rural Geriatric Studies, UT Health Center at Tyler

SB 1642 by Sen. Todd Staples (R-Palestine) creates the East Texas Center for Rural Geriatric Studies at The University of Texas Health Center at Tyler to advance medical knowledge about care for the elderly, with an emphasis on elderly persons in nonmetropolitan areas. The center is to serve as a resource for training and research for physicians in east Texas.

Recovery from Tropic Storm Allison

The University of Texas Health Science Center at Houston (UT-Houston) received legislative approval to issue $64.9 million in tuition revenue bonds to repair storm damage and rebuild or relocate research laboratories and equipment lost from Tropic Storm Allison in 2001. House Bill 1941 by Rep. Beverly Woolley (R-Houston) authorizes the issuance of $34 million in tuition revenue bonds to help pay for infrastructure repairs and to qualify for federal disaster relief funds. An additional $30 million was authorized for rebuilding about 75,000 square feet for research laboratories and academic space.

Indigent Care by Institutions of Higher Education

Institutions of higher education providing indigent health care are instructed to contract with relevant counties in their service area to recover costs associated with treating those counties' indigent patients.

Endowed Chair or Professorship for Spinal Cord Injury Research

Baylor College of Medicine, UT-Houston, and The University of Texas Medical Branch (UTMB) in Galveston are authorized to spend up to $1 million to fund one endowed chair or professorship for spinal cord injury research and are encouraged to pursue matching grant funds.

PRIMARY CARE AND RURAL PRACTICE INCENTIVE PROGRAMS

Primary Care Graduate Medical Education Funding

State graduate medical education (GME) funding allocated by the Texas Higher Education Coordinating Board (THECB) was slashed 46 percent. Funding to Baylor College of Medicine in Houston for undergraduate medical education is down 7 percent, and similar cuts were made to undergraduate funding for the state's seven public medical schools.

To summarize THECB funding levels:

1. The Resident Physician Compensation Program, a $4 million-per-year compensation to teaching hospitals for their large share of graduate medical education costs, received no  funding. Because the financial burden of training residents falls disproportionately on teaching hospitals while the whole state benefits, this program was designed to partially offset teaching expenses not covered by Medicare GME or other funds.
2. The Graduate Medical Education Program was cut 76 percent from $16 million per biennium to less than $4 million. This is one of the newest state funding mechanisms to support teaching costs at primary care GME programs, and TMA vigorously supported its establishment in 1996.
3. The Family Practice Pilot Projects received no funding. For a number of years, this program has distributed $2 million per biennium primarily to support indigent care services at family practice residency programs. It has enabled many of the state's family practice programs to expand patient care services.
4. Funding for the three primary care preceptorship programs - family practice, general internal medicine, and general pediatrics - was cut in half from $2 million to $1 million per biennium. These programs are designed to cultivate interest in primary care careers among medical students.
5. Almost $1 million per biennium in loan repayment funds for family practice residents and faculty was wiped out. Through efforts of the Texas Academy of Family Physicians (TAFP), TMA, and other state organizations, the base funding for the remainder of the physician education loan repayment program was retained and expanded to include an estimated $180,000 in additional funds per year, for a total of more than $2 million per biennium. The loan repayment program has been one of the state's most successful initiatives for recruiting and retaining primary care physicians in underserved areas. It has experienced a shortage of funds in recent years, resulting in a waiting list exceeding 80 physicians.
6. Approximately $3 million per year was cut from state support for residency programs in general psychiatry and child/adolescent psychiatry at the Austin State Hospital. It was reported, however, that these programs will be picked up by the Austin Medical Education Programs of Seton Healthcare Network. These residency programs are especially needed because of the state's longstanding shortage of psychiatrists.

Creation of Texas Conrad-30 Program for Processing J-1 Visa Waivers

HB 1130 amends state law to expand eligible areas for J-1 Visa-waivered physicians to practice under the federal Conrad-30 program to include federally designated Health Professional Shortage Areas. Current law limits eligibility to academic physicians on staff at the South Texas Regional Academic Health Center.

Increased Funding for Physician Education Loan Repayment Program

HB 1420 by Rep. Rick Hardcastle (R-Vernon) expands funding base for the Physician Education Loan Repayment Program, one of the most successful rural practice incentive programs, by extending the current 2-percent tuition set-aside for medical students to include those paying out-of-state tuition. This bill also puts in place a more rigid auditing process to ensure a more accurate and timely transfer of the set-aside funds from the medical schools to THECB, the agency that administers the program. This bill was initiated by TAFP and supported by TMA.

TOWN/GOWN (BUDGET RIDER)

Health-related institutions cannot use state appropriations to replace or duplicate services provided by Driscoll Children's Hospital, including pediatric cardiovascular diseases.

FACULTY PRACTICE PLANS (BUDGET RIDER)

As in the past, medical schools are required to file an annual report on the use of practice plan funds within 120 days following the end of the state fiscal year; otherwise state appropriations become frozen and cannot be used by the institution.

EFFORTS TO INCREASE MEDICAL SCHOOL DIVERSITY (BUDGET RIDER)

HB 85 Rep. Ruth Jones McClendon (D-San Antonio) was passed to establish an undergraduate premedical academy at Prairie View A&M University in Prairie View. TMA supported creation of the academy as a means of potentially expanding the medical school applicant pool.

TEXAS HIGHER EDUCATION COORDINATING BOARD SUNSET BILL

THECB was up for sunset review this legislative session, and SB 286 by Sen. Eliot Shapleigh (D-El Paso) was passed by the legislature to continue the agency and make various administrative changes, including reducing the number of board members.

NURSING SHORTAGE RELIEF

HB 3126 by Rep. Vicki Truitt (R-Keller) makes changes to the law passed last session to help expand training opportunities in nursing. Lawmakers earmarked $528,000 for the biennium to allow nursing programs to prepare more students for initial licensure as registered nurses (RN) or faculty members with graduate degrees, and $111,000 to prepare licensed vocational nurses (LVNs).

This bill specifically names an RN to the Statewide Health Coordinating Council (SHCC) and increases the council to 18 members. SHCC is authorized to establish a nursing resource section within the health professions resource center at the Texas Department of Health to collect data on nursing training and employment trends. A nursing advisory committee also is created to advise the SHCC on activities of the nursing resource section. The section is to be funded through a $3 surcharge on RN license fees and $2 surcharge on LVN license fees.

Workforce/Medical Education Near Misses

MEDICAID GRADUATE MEDICAL EDUCATION FUNDING

The legislature zeroed $40 million per year in Medicaid GME funding out of the state budget. These funds were distributed to teaching hospitals to help offset increased costs related to medical teaching. Medicaid GME funding has been added to the "wish list" for the Legislative Budget Board's impending distribution of the additional dollars allocated to Texas as a result of the recent federal tax cut.

INDIGENT CARE FUNDING

UTMB lost exclusive access to proceeds from unclaimed lottery winnings to help fund indigent care expenses. For the last four years, UTMB received authorization to drawdown dollars from the fund, which historically have totaled about $40 million per year. HB 2292 and a rider within the budget stipulate that UTMB cannot receive more than $20 million of the funds per year. Any remaining funds will be used to fund charity care along the border and other general purposes specified by the legislature, including indigent care.

HB 3521 by Rep. Ken Paxton (R-McKinney) relates to human embryo research. (See Medical Science section.)

HB 1383 by Rep. Jim Solis (D-Harlingen) would have reduced postgraduate training requirements for international medical graduates from the current three years to one year.

SB 788 by Sen. John Carona (R-Dallas) would have allowed international medical graduates meeting certain criteria to qualify for licensure without taking the current national medical licensing examination or completing three years of post-graduate training.

HB 484 Rep. Ron Wilson (R-Houston) would have required graduate and medical schools to tag 30 percent of their student slots for preferred admission to baccalaureate graduates in the top 10 percent of their graduating class. This bill was opposed by many physicians because it assumed all undergraduate programs are equal and puts inappropriate emphasis on grades in the medical school admissions process. Further, it would have limited a medical school's ability to select the most qualified applicants.

SB 309 by Sen. Mario Gallegos (D-Houston) would have established in law the authority for public hospitals to provide ambulatory care to undocumented aliens. Previous Texas attorney general opinions had disallowed this care but the latest opinion supports it. The bill would have removed this issue from future possible fluctuations in attorney general interpretations.

HB 1212 by Representative Wilson would have limited the number of foreign students in graduate and professional degree programs, including medical schools, to 10 percent of enrollments. Texas medical schools already have a 10 percent cap for non-Texas resident students.

HB 273 by Rep. Elliott Naishtat (D-Austin) and SB 55 by Sen. Judith Zaffirini (D-Laredo) sought to add forensics to medical school curriculums. The bill died in committee as result of the medical schools' opposition to mandatory training requirements. The bill authors did attempt to salvage the bill with an alternate amendment proposing an interim study, thus the issue could reemerge during the interim.

SB 170 by Sen. Gonzalo Barrientos (D-Austin) would have required higher education programs, including medical schools, to implement a uniform strategy to identify, attract, hire, and retain faculty and staff that are reflective of the state's demographics.

SB 462 by Senator Shapleigh would have increased clinical research capacity in El Paso by creating an asthma research center at the TTUHSC Regional Academic Health Center in El Paso in conjunction with The University of Texas at El Paso and the Texas Commission on Environmental Quality. Similarly, and HB 150 by Rep. Norma Chavez (D-El Paso) would have established a geriatrics research academy at the same campus to conduct research on long-term care, geriatrics, and gerontology, and provide resources for training and research for professionals in medicine, nursing, pharmacy, and allied health schools.

Among their many provisions, the initial version of SB 342 by Senator Shapleigh and HB 1016 by Representative Gallego would have transferred $200,000 in state funding per biennium from the Texas Health Service Corps to a newly created Border Health Corps. The Office of Rural and Community Affairs oversees the Texas Health Service Corps, which provides $15,000 a year to residents in primary care training programs as an incentive for practicing in underserved areas of the state upon completion of training. The Border Health Corps would have provided $10,000 per year in education loan repayment to students in medical, dental, and nursing school who agreed to practice/work for a minimum of two years in a border community following completion of training.

HB 757 by Rep. Helen Giddings (D-Dallas) would have continued the Higher Education Assistance Pilot Program at THECB. The pilot program was created in 2001 to assist disadvantaged students in applying for admission to a higher education institution.

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