Substituted for: House Bill No. 1492

By Armstrong, Lois DeBerry, Brown, Ulysses Jones, John DeBerry, Cooper, Langster, Pruitt,

Larry Turner, Bowers, Miller, Brooks, Towns, Stulce, Whitson

AN ACT To amend Tennessee Code Annotated, Title 68, relative to establishing the Area Health Education Center (AHEC) Program of Tennessee. This act appropriates a sum sufficient to fund the administration and operation of the program herein established for fiscal year 1997-1998.

WHEREAS, Health care reform is occurring at the state and national levels that promotes an emphasis on primary care; and

WHEREAS, Many rural and urban underserved communities within Tennessee lack access to adequate health care; and

WHEREAS, Difficulties in the recruitment and retention of health care professionals to rural and urban underserved communities affects the viability, accessibility and quality of health care in these communities; and

WHEREAS, Decentralized, community-academic partnerships have been proven effective in generating solutions to improve the availability, accessibility and quality of health care in these communities; and

WHEREAS, Underserved, minority and underprivileged individuals are poorly represented in the health professions workforce, and experience has proven that minority and underprivileged individuals trained as health care professionals are more likely to choose to practice in rural and urban underserved communities; and

WHEREAS, Appropriation of state resources is required to generate matching support from the federal government to address issues of availability, accessibility and quality of health care to rural and urban underserved communities; now, therefore,

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

SECTION 1. Tennessee Code Annotated, Title 68, Chapter 1, is amended by adding Sections 2-15 inclusive of this act as a new, appropriately designated part.

SECTION 2. The General Assembly declares that the activities and program specified in this act have been proven effective in Tennessee and the nation as means to recruit individuals from rural and urban underserved communities to enter primary health care professionals who choose to practice and continue practicing in rural and urban underserved communities to enter primary health care professions. By increasing the number of primary health care professionals and retaining existing practitioners in rural and urban underserved communities, the Area Health Education Centers (AHEC) programs of Tennessee will improve the ability, accessibility and quality of health care in these communities. The General Assembly also declares that improved health among Tennessee's rural and urban underserved community residents will contribute to more viable and economically productive communities.

SECTION 3. The General Assembly further finds and declares the state financial support for AHEC activities within Tennessee is an essential criterion of the federal government in determining the eligibility for continued federal financial support. The intent of the federal government is that the state assume financial responsibility for AHEC programs after receiving federal funds for initial planning, development and start-up. State financial support is also necessary to generate matching federal contributions that may be as much as a one-to-one match of state dollars.

SECTION 4. There is hereby established the Area Health Education Center (AHEC) programs of Tennessee. For administration purposes only, the AHEC programs shall be attached to the Tennessee Department of Health. The mission of the AHEC programs shall be to use educational interventions through community academic partnerships. The AHEC programs shall accomplish this mission by promoting wellness, disease prevention, primary care and the recruitment of minority and underprivileged individuals into health care professions.

SECTION 5. The mission of the AHEC programs of Tennessee shall be accomplished by:

(1) Enhancement of programs to recruit primary, secondary and post-secondary students into primary health care professions; and

(2) Enhancement of programs designed to recruit health professions students and primary care medical residents to practice primary care in rural and urban underserved communities in Tennessee; and

(3) Development of educational programs designed to support practicing health care professionals in rural and urban underserved communities.

SECTION 6. (a) In order to effectuate the provisions of Sections 4 and 5, Meharry Medical College, East Tennessee State University, and University of Tennessee, Memphis, shall be charged to initiate or further develop programs designed below through individual AHEC programs inclusive of existing centers.

(b) For the purposes of subsection (a), responsibility for the AHEC programs shall be as follows:

(1) Meharry Medical College - the middle grand division and the AHEC Program of the East Tennessee Area Health Education Center, Inc. which shall serve the counties of Anderson, Bledsoe, Blount, Bradley, Grundy, Hamilton, Knox, Loudon, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Roane, Sequatchie and Sevier.

(2) East Tennessee State University - the AHEC Program of the Northeast Tennessee Area Health Education Center shall serve the counties of Campbell, Carter, Claiborne, Cocke, Grainger, Greene, Hamblen, Hancock, Hawkins, Jefferson, Johnson, Morgan, Scott, Sullivan, Unicoi, Union and Washington; and

(3) The University of Tennessee, Memphis - the western grand division.

SECTION 7. (a) In order to effectuate the provisions of Section 5(1), the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, with funding from this act, shall collaboratively develop a health careers manual targeted at the youth of Tennessee. The health careers manual shall be produced commencing in the fiscal year 1997-1998 and updated biennially thereafter.

(b) The AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall also develop and implement programs designed to interest the youth of Tennessee in entering primary health care professions; such programs may include, but shall not be limited to, health fairs, mentoring programs, field experiences, and enrichment activities.

SECTION 8. (a) In order to effectuate the provisions of Section 5(2), the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, may maintain and enhance existing programs and develop new community-based education and training programs for health professions students and primary care medical residents in rural and urban underserved communities through Tennessee. Such programs shall be made available in health professions students and primary care medical residents from all health professions training institutions within Tennessee. Students from non-Tennessee institutions may also participate in such training programs on an at-cost basis based upon the availability of spaces; provided, however, no student from a Tennessee institution shall be displaced from participation in such programs by the participation of an out-of-state student.

(b) To promote an increasing number of medical school graduates to enter the primary care specializations of family medicine, general internal medicine, and general pediatrics and to practice in rural and urban underserved communities of Tennessee, the three (3) institutions receiving funding from this act shall be required to place their medical students in AHEC-sponsored one (1) week preceptorship with a primary care physician during each student's freshman and sophomore years. Such preceptorship may commence no later than the 1998-1999 academic year for the sophomore class. Development of the above described AHEC preceptorship is contingent upon the appropriation of adequate resources to fund the preceptorship experiences.

(c) To ensure the health profession students and primary care medical residents receive quality training experiences in rural and urban underserved communities, the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall recruit, train, and provide professional support for community-based faculty.

(d) To promote health professions students' and primary care medical residents' participation in community-based training experiences, the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, may collaboratively develop and maintain a computerized database of clinical sites available within Tennessee for health professions students' and primary care medical residents' field experiences. All health professions training institutions within Tennessee shall be permitted access to the computerized listing of community-based field training sites.

(e) To promote health profession students' and primary care medical residents' interest in practicing in rural and urban underserved communities, individuals participating in such field experiences shall be eligible for reimbursement for travel expenses and living expenses actually incurred as a result of their participation in such field experiences. All such reimbursements for travel expenses and living expenses shall be in accordance with the Comprehensive State Travel Regulations promulgated by the Commissioner of Finance and Administration. The AHEC programs at Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall be responsible for administering all eligible health professions students' and primary care medical residents' field experiences funded by this act.

(f) In response to the changing health care systems in Tennessee and the nation that increasingly utilize multi-disciplinary team approaches to health care delivery, the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall promote multi-disciplinary training of health professions students and medical residents in AHEC-supported activities.

SECTION 9. (a) In order to effectuate the provisions of Section 5(3), the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall develop and present professional development programs that address the local needs of primary health care professionals in rural and urban underserved communities in Tennessee. The purpose of professional development programs is to improve the health status of Tennesseans in rural and urban underserved communities by promoting wellness, primary care, disease prevention, and quality of health care delivery.

(b) Because quality health care delivery is dependent upon health care professionals' timely access to information about the latest medical and health care discoveries, and because the isolation and difficulties associated with practicing in rural and urban underserved communities limit health care professionals' access to information about the latest discoveries in their fields, the AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, may develop and enhance existing information dissemination systems. These information dissemination systems shall use appropriate technologies, including telecommunications technologies, to ensure that health care professionals in rural and urban underserved communities have timely access to the latest medical and health care discoveries. The three (3) institutions receiving funding as part of this act are encouraged to link their respective health science centers via telecommunication technologies with health care providers and institutions in rural and urban underserved communities to provide clinical and educational opportunities.

SECTION 10. To promote wellness and reduce health care cost in Tennessee's rural and urban underserved communities, the AHEC programs at Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall develop consumer health promotion programs. The consumer education programs shall be thoroughly integrated with the AHEC's educational programs and targeted health professions students, primary care medical residents, and practicing health care professionals.

SECTION 11. The AHEC programs of Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, shall individually report to the Department of Health on an annual basis.

SECTION 12. The activities and programs authorized by this act shall not duplicate other services, programs, or activities provided by any department, board, commission, or other governmental authority or entity of government.

SECTION 13. Any income generated as a result of programs or activities authorized by the provisions of this act shall not revert to the general fund at the end of the fiscal year, but shall be maintained by the individual AHEC programs at Meharry Medical College, East Tennessee State University, and the University of Tennessee, Memphis, and shall be reinvested to further the mission of the programs as stated in this act.

SECTION 14. (a) The appropriation provided for the AHEC program in any fiscal year shall be as set in the General Appropriations Bill.

(b) For fiscal years beginning on and after July 1, 1998, funds appropriated for the individual Area Health Education Center Programs shall be allocated as follows:

(1) Sixteen and two-thirds percent (16.67%) to East Tennessee State University for the Northeast Tennessee Area Health Education Center Program;

(2) Sixteen and two-thirds percent (16.67%) to Meharry Medical College for the East Tennessee Area Health Education Center Program; and

(3) Thirty-three and one-third percent (33.33%) to Meharry Medical College for the Middle Tennessee Area Health Education Center Program; and

(4) Thirty-three and one-third percent (33.33%) to the University of Tennessee, Memphis, for the West Tennessee Area Health Education Center Program.

From the funds appropriated, the institutions shall distribute not less than seventy-five percent (75%) of the funds to the local AHEC programs. The institutions shall not require any organizational changes in the local AHEC programs unless federal law so requires such changes.

SECTION 15. The Commissioner of Health is authorized to promulgate rules and regulations to effectuate the purpose of this act. All such rules and regulations shall be promulgated in accordance with the provisions of Tennessee Code Annotated, Title 4, Chapter 5.

SECTION 16. For the purposes of promulgating rules and regulations, this act shall take effect upon becoming a law, the public welfare requiring it. For all other purposes, this act shall take effect July 1, 1998, the public welfare requiring it.