State

Description 

Alabama

AL HJR 341 (2000) expresses legislative support for the Southern Rural Access Program to address rural health care needs.

AL S 37 (1999) allows the commissioner of the Alabama Medicaid program to pay an enhancement, not to exceed the upper limits for Medicare nursing facility payments, to rural hospital connected nursing facilities under governmental authority or control.  

Alaska

American
Samoa

Arizona

AZ H 2050 (2000) establishes a Task Force to analyze health care insurance factors that vary among urban and rural areas and recommend ways in which these factors could be streamlined in order to establish a statewide health care insurance plan. The task force will also study and recommend ways to treat rural and urban areas in an equitable manner.

AZ S 1409 (2000) transfers $95,000 from the medically needy account to the department of health services for the provision of primary care services provided through an existing qualifying community health center that is located in a rural, medically underserved area of a county.

AZ H 2039 (1999) The department of health services shall establish a rural private primary care provider loan repayment program for physicians and mid-level providers with current or prospective rural primary care practices located in medically underserved areas in this state.

AZ H 2509 (1999)appropriates $1,250,000 from the emergency medical services operating fund to the department of health services for distribution to rural areas to improve emergency medical services, as determined by the director of the department after consultation with the emergency medical services council.

Ariz. Sess. Laws, Chap. 238E (HB 2270) (1998) allocates $2.5 million of tobacco tax money from the medically needy account for FY 1998-1999 for primary care capital project grants to public and private nonprofit entities that provide health services for rural and underserved areas.

Ariz. Sess. Laws, Chap. 157 (HB 2087) (1997) establishes a rural private primary care provider loan repayment program for physicians and mid-level providers with current or prospective rural primary care practices located in federally designated health personnel shortage areas in the state. To be eligible to participate in the program, the primary care provider agrees to provide organized, discounted, sliding fee scale services for medically uninsured individuals from families with annual income below 200 percent of the federal poverty guidelines. The Department of Health Services will approve the sliding fee scale.

Ariz. Sess. Laws, Chap. 257 (SB 1388) (1997) allows the Department of Health Services to contract with public and nonprofit entities to provide primary health care services through mobile clinics to indigent or uninsured Arizonans in rural areas or in medically underserved areas. The act specifies a number of services that medical mobile clinics are to provide, including medical care provided through licensed primary care physicians and licensed mid-level providers; comprehensive primary care services including well woman care, well child care, immunizations, treatment of minor illness and health education and referral; prenatal care services; community development activities to assist in organizing work with school health systems, the public health department and other health partners; and community development activities to assist communities in establishing means to provide permanent health care services, including community clinics.

Ariz. Sess. Laws, Chap. 257 (SB 1388) (1997) allows the Department of Health Services to contract with public and nonprofit entities to provide primary health care services through mobile clinics to indigent or uninsured Arizonans in rural areas or in medically underserved areas.

Ariz. Sess. Laws, Chap. 154 (SB 1016) (1996) extends the board of medical student loans until July 1, 2001, and adds to its duties the responsibility to collect and maintain data on the retention of doctors who practice in rural and other medically underserved areas.

Ariz. Sess. Laws, Chap. 237 (HB 2301) (1996) amends the definition of primary care disciplines to include family medicine, general internal medicine, general pediatrics and obstetrics and gynecology. This definition is amended for purposes of the mandate on the University of Arizona School of Medicine to reserve at least 60 percent of its available residency positions for medical school graduates entering programs defined as primary care disciplines of which at least 12 percent must be reserved for medical school graduates entering the family medicine program.

The act also amends the rural health professions program and requires the three universities under the jurisdiction of the Arizona Board of Regents to select 10 nurse practitioner students, 15 medical students and four pharmacy students each year to participate in the rural health professions program. The university must attempt to ensure that each individual participating student be able to fulfill the program requirements in a single rural practice setting. Pharmacy and medical students in the program will be placed in rural settings for a duration of at least one month during the summer months between academic years as part of the required curriculum during a clinical clerkship and in the final year of training. Nurse practitioner students in the program will be placed in rural settings in the state during the summer months between their first and second academic year.

Arkansas

AR H 1606 (1999) establishes a program of financial assistance to enhance the retention as well as the recruitment of physicians to rural communities.

AR H 1744 (1999) appropriates funds to the Rural Medical Clinic Revolving Loan Fund for grants and loans to communities to establish a medical clinic and for loans to physicians for establishment of medical clinics in rural communities.

AR H 1975 (1999) establishes the rural advanced nursing practice and nurse educator student loan and scholarship program.

Ark. Acts, Act 509 (HB 1592) (1997) appropriates funds for incentive payments to physicians practicing in rural areas of the state.

California

CA AB 761 (1999) creates the Small and Rural Hospital Supplemental Payments Fund and states that each hospital contracting to provide services under this article that meets the criteria contained in the state Medicaid plan for disproportionate share hospital status will be eligible to negotiate with the commission for distributions from the Small and Rural Hospital Supplemental Payments Fund.

CA SB 514 (1999) establishes the Rural Health Care Equity Trust Fund to provide subsidies and reimbursements, as specified, for certain health care premiums and health care costs incurred by state employees and annuitants in rural areas.

Cal. Stats. Chap. 894 (SB 1194) (1998) requires that reimbursement to federally qualified health centers and rural health clinics for defined services be paid in a manner that is not less than the level and amount of payment that the plan would make for the same scope of services if the services were furnished by a provider that is not a federally qualified health center or rural health clinic and applies that requirement to reimbursement for services provided pursuant to a subcontract with a local initiative, a commercial plan, a geographic managed care program health plan or a county organized health system.

Colorado

(CO H 1063) (2000) defines "health care professional shortage area" and establishes a tax credit for certain health care providers in designated health care professional shortage areas.

Connecticut

Delaware

Vol. 70 Del. Laws, Chap. 516 (SB 418) (1996) reauthorizes the Delaware Institute of Medical Education and Research (DIMER) by reconstituting it as an advisory board to the Delaware Health Care Commission. The act expands representation on the DIMER board, emphasizes DIMER's statewide responsibilities and expands its purpose to help the state meet its health care needs. The act requests that the board look at expanding opportunities to training at a reasonable cost in the health and health-related professions when state residents commit to practice their professions in Delaware, offering incentives for qualified personnel in the health and health-related professions to practice in Delaware and continuing to develop a coordinated program of premedical, medical and graduate education among state public institutions of higher learning, Delaware hospitals and Jefferson Medical College. The board is encouraged to support graduate and post-graduate medical and health care training programs, including emphasis on those programs targeted to meet the state's health care needs and programs of education, training and research in the health fields, including the vital areas of public health education, community health planning and health care costs. The act gives the board the responsibility for developing a recruitment program for medical education in conjunction with local colleges and universities to encourage medical school applications from minorities and residents of rural counties and underserved areas of Delaware, in addition to other students interested in pursuing a medical education. 

District of Columbia

Florida

FL H 1121 (2000) establishes the Florida State University College of Medicine, a 4-year allopathic medical school that focuses on recruiting and training medical professionals to meet the primary health care needs of the state, especially the needs of the state's elderly, rural, minority, and other underserved citizens.

FL H 1853 (2000) establishes the Palm Beach County Health Care District.

FL H 2319 (2000) defines the term rural hospitals (definition includes hospitals designated as a Critical Access Hospital) and revises eligibility for funding under the disproportionate share/financial assistance program for rural hospitals.

FL SB 890 (1999) creates a rural hospital capital improvement grant program. It states that a rural hospital may apply to the Department of Health for a grant.

Fla. Laws, Chap. 98-14 (S 288) (1998) amends current law by revising the definition of "rural hospitals" to increase the allowable number of licensed beds from 80 to 100. Additionally, it seeks to exempt home health services provided by a rural hospital from certificate of need review by the Agency for Health Care Administration.

Fla. Laws, Chap. 98-21 (H 3231) (1998) clarifies the definition of "rural hospital" to include facilities with 85 or fewer beds which serve a community of no greater than 100 people per square mile and requires the Agency for Health Care Administration to analyze the definition of "rural hospital" with regards to economic and demographic factors, federal rules and regulations, health planning principles and the potential impact of alternative definitions on the communities that contain rural hospitals as currently defined. The agency will submit its findings and recommendations to the governor and the Legislature.

Fla. Laws, Chap. 237 (HB 1357) (1997) revises, reorganizes, updates, and conforms various provisions relating to public health and vital records, and duties of the Department of Health. In addition, the law eliminates the role of the State Health Office in relation to the role of the Office of Rural Health and makes the Department of Health the immediate oversight to the Office of Rural Health.

Fla. Laws, Chap. 509 (HB 2005) (1996) clarifies that the Palm Beach County Health Care District's authority includes the ability to plan, set policy and fund from its revenue sources the establishment and implementation of cooperative agreements with other government authorities and public and private entities within and outside of Palm Beach County which promote the efficiencies of local and regional trauma agencies, rural health networks and cooperative health care delivery systems, provided that any agreements with entities outside of Palm Beach County ensure that the costs associated with trauma services are the responsibility of that entity. The district also has the authority to reorganize any of the hospitals it owns in accordance with state law.

Georgia

GA H 260 (2000) ends Part 6 of Article 7 of Chapter 3 of Title 20 to state that students may repay the full amount of their loans or scholarships in services rendered in a rural community.

GA S.B. 334 (2000) amends the Essential Rural Health Care Provider Access Act; HMOs must show willingness to grant reasonable consideration to rural health care providers in the negotiating and contracting process.

GA SB 195 (1999) This measure is termed the "Rural Hospital Authorities Assistance Act." It recognized that hospital authorities are created under Code Section 31-7-72 in and for each county and municipal corporation of the state in order to promote public health goals of the state, and states the General Assembly's findings that "many hospitals owned or operated by hospital authorities in rural counties are in desperate financial straits." In order to preserve the availability of primary health care services provided by such hospitals to residents of rural counties, this bill recognizes that a program of state grants must be made available to such hospitals.

Ga. Laws, p. 870 (SB 594) (1998) enacts the Essential Rural Health Care Provider Access Act. The act provides that any essential rural health care provider is to have the opportunity to become a participating provider of health care services in a health care benefit plan if the provider meets certain designated conditions. The act also provides for conditions for denial, rejection or termination of an essential rural health care provider and an opportunity to cure any deficiency.

Guam

Hawaii

HI H 2534 (2000) amends Hawaii statutes to define "critical access hospital" and enhance the federal Medicare rural hospital flexibility program by reimbursing critical access hospitals on a cost basis under the Medicaid program using matching federal funds.

Hawaii Sess. Laws, H. Concur. Res. 35 and S. Concur. Res. 31 (1998) recognize that the districts of Puna and Ka'u are rural areas lacking the necessary primary care infrastructure to meet the needs of residents. It requests the Department of Health to develop a rural health plan for the island of Hawaii, emphasizing Puna and Ka'u, to plan the improvement of health facilities and to make available sufficient medical services to all residents of the island. The resolution also directs the department to "aggressively explore ways to obtain or maximize federal funding" for the purpose of implementing the rural health plan. The plan is due to the Legislature by no later than 20 days prior to the commencement of Hawaii's 1999 regular session.

Idaho

ID S 1444 (2000) replaces the Health Professional Loan Repayment Program with the Idaho Rural Health Care Access Program. Allows for grants of up to $35,000 per year for three years to be awarded to medically underserved communities for the purpose of recruitment and retention of primary care providers (e.g., loan repayment, telehealth and community development projects).

Illinois

IL H 4435 (2000) appropriates $750,000 to Southern Illinois University to extend telemedicine projects in rural Illinois.

Indiana

Ind. Acts, P.L. 260-1997(ss)(SEA 6(ss)) (1997) appropriates funds for state programs, including educational technology. The act requires the Intelenet Commission, with the Department of Education and the state library, to coordinate available federal and state funds and funding mechanisms to accomplish full access to telecommunications services and equipment by all schools, libraries, and rural health care providers.

Iowa

IA S 2302 (1999) establishes PRIMECARE, a primary care provider recruitment and retention program under the center for rural health and primary. PRIMECARE will feature a community scholarship program and loan repayment for primary care providers.

Iowa Acts, Chap. 1069 (HF 2523) (1998) requires that rural health clinics and federally qualified health clinics are to receive cost-based reimbursement for services provided under the Medicaid Program.

Iowa Acts, Chap. 1212 (HF 2499) (1998) appropriates money to the College Student Aid Commission and forgivable loans to Iowa students attending the University of Osteopathic Medicine and Health Sciences in an effort to direct primary care physicians to areas of the state experiencing physician shortages, and to support student aid programs, the National Guard Tuition Aid Program and the Chiropractic Graduate Student Forgivable Loan program.

Kansas

(KS SCR 1636) (2000) supports funding of the Kansas Memory Assessment Program which has, as its goals, the support of access to dementia diagnosis and treatment services for rural families, and support for the education of rural health care providers in the diagnosis and management of persons with dementia.

Kan. Sess. Laws, Chap. 53 (SB 425) (1998) amends existing statutes to replace the term "rural primary care hospital" with the term "critical access hospital" in the statutes and deletes all references to essential access community hospitals. A critical access hospital is defined as a part of a rural health network having available 24-hour emergency care services, with no more than 15 acute inpatient beds for the provision of inpatient care for not more than 96 hours, and, in certain circumstances, inpatient extended care services as long as the total number of beds does not exceed 25. Additionally, to meet the definition of critical access hospital, the facility must provide nursing services under the direction of a professional nurse, may provide certain services on a part-time, off-site basis under written agreements and may provide inpatient services by a physician's assistant, nurse practitioner or clinical nurse specialist, subject to oversight of a physician who need not be present in the facility.

Kentucky

KY S 305 (2000) establishes criteria for critical access hospitals and requires reimbursement. Requires insurer or managed care programs that contract with the Department for Medicaid Services (for receipt of Federal Social Security Act Title XIX funds) to reimburse at rates at least equal to those established by the Federal Health Care Financing Administration for Medicare reimbursement to a critical access hospital.

Ky. Acts, Chap. 559 (SB 328) (1998) directs the Cabinet for Human Resources to develop a Rural Health Plan. The act also deletes references to "rural primary care hospital" and replaces them with "critical access hospital" and adds criteria for the relicensure of a general acute-care hospital as a critical access hospital. It also sets forth services required to be provided by a critical access hospital instead of by a rural primary care hospital and requires that a certificate of need be obtained prior to critical access hospital provision of home health services. The law deletes a mandate for the Cabinet for Human Resources to seek a federal Medicaid waiver to permit cost-based reimbursement of services provided to Medicaid recipients in a critical access hospital and instead requires the cabinet to provide for reimbursement for the services. It also sets forth staffing plan requirements for a critical access hospital; provides for specified agreements for patient referral and transfer and credentialing and quality assurance when a critical access hospital is part of a rural health network.

Louisiana

LA HB 1184 (1999) This bill sets forth that the hospital-based rural health clinic does not have to receive a separate license from a rural hospital.

La. Acts, P.A. 281 (HB 1428) (1997) provides for a tuition payment program for two years for state residents enrolled at the Louisiana State University medical schools who agree to practice in rural or poor communities for at least two years after becoming licensed. The number of recipients will be limited to four per year.

La. Acts, P.A. 1333 (HB 1806) (1997) provides for the licensure of rural health clinics and authorizes the Department of Health and Hospitals to adopt rules and regulations in regard to the licensure of such facilities.

La. Acts, P.A. 1485 (SB 500) (1997) enacts the rural Hospital Preservation Act which allows rural hospitals to use local funds as Medicaid match to maximize disproportionate share payments.

La. Acts, H. Concur. Res. 157 (1997) requests committees of the Legislature to investigate problems facing rural hospitals and to propose recommendations for solutions including legislation to assure the continued survival of those hospitals. It also requests an investigation of potential alternative accrediting organizations for their licensure.

La. Acts, H. Concur. Res. 170 (1997) urges the U.S. Congress to enact legislation which would provide for consideration of geographical location and the availability of patient options in the reimbursement of claims for emergencies treated in rural hospital emergency rooms which are not life-threatening and to enact legislation which would correct the current inequity in reimbursing rural hospitals for costs of stabilizing patients who are to be referred to larger, more suitably equipped facilities.

La. Acts, H. Concur. Res. 169 (1997) requests the House and Senate Committees on Health and Welfare, the House Committee on Appropriations, the Senate Committee on Finance, and the secretary of the Department of Health and Hospitals to review Medicaid reimbursement of emergency room care in rural hospitals to determine if consideration of geographic location and the limitation of certain options may be considered in determining for certain services.

Maine

Maryland

MD H 433 (2000) creates a Governor's Wellmobile Program in the University of Maryland School of Nursing with the goal of delivering primary and preventive health care services to geographically underserved communities and uninsured individuals around Maryland. The program also expands training for students who may work with underserved populations.

MD H 1425 (2000) encourages coordination among counties through regional community health coalitions; coalitions should reflect the demographics of a county.

Massachusetts

Michigan

Minnesota

MN HB 1426 (1999) allows hospitals to cover expenses associated with being designated as a critical access hospital for the Medicare rural hospital flexibility program.

Minn. Laws, Chap. 257 (HF 2550) (1998) requires the commissioner of health to establish a Medicare rural-hospital flexibility program, and to designate certain rural nonprofit or public hospitals and facilities as critical access hospitals. Such facilities can be certified by the state as necessary providers of health care services to residents in the area.

Minn. Laws, Chap. 395 (SF 2849) (1996) provides $14.4 million for higher education spending including $6.6 million to restructure the University of Minnesota academic health center, improve technology and update the curriculum. Ninety percent of the academic health center appropriation--about $5.9 million--is contingent upon making changes to the personnel policies in the center. The act requests that the school pursue changes in the tenure code for the academic health center without infringing on academic freedom. The remaining 10 percent of the $6.6 million for the academic health center is earmarked for the University of Minnesota-Duluth (UMD) medical school. The money hinges on the continued development of the medical school as a rural health center, which aims to produce more medical professionals to serve rural areas. Another $2 million in the act will be used for interactive communications technology to link academic health center facilities in Minneapolis, St. Paul and Duluth and other community-based sites. Most of the remaining money will be used to bolster technology at the state's higher education institutions.

Mississippi

Miss. Laws, Chap. 476 (HB 1025) (1998) authorizes the state Department of Health to develop a state rural health care plan in accordance with federal law.

Missouri

Mo. Laws, p. 43 (HB 1302) (1998) states that individual physicians can be called "essential community providers" when they practice in areas designated by the U.S. Department of Health and Human Services as medically underserved. The essential community provider is required to spend a minimum of 20 hours per week in the health professional shortage area and be available to patients during evenings and weekends. Essential community providers must have hospital staff privileges or be affiliated with doctors who have such privileges and cannot be direct employees of a health care insurer. Health care insurers that market a group policy or contract for health care coverage are not required to offer it to all essential community providers in the service areas of the plan.

Montana

Mont. Laws, Chap. 89 (SB 126) (1997) amends existing law to change the maximum amount of educational debt payment that a rural physician may receive from $30,000 to $45,000 over five years instead of over a four-year period or a proportionally reduced amount for a shorter period.

Nebraska

Neb. Laws, L.B. 1070 (1998) creates the Excellence in Health Care Trust Fund which will be used for awarding grants for the conversion of hospitals in rural areas to limited-service rural hospitals and education, recruitment and retention of primary care professionals, behavioral health professionals and nurses for medically underserved areas.

Neb. Laws, L.B. 837 (1997) authorizes the Department of Health and Human Services Regulation and Licensure to adopt rules related to limited-service rural hospitals, including staffing requirements, standards for the governing board medical staff, nursing services and quality assurance program and standards for the scope of practice for services provided. The act states that the purpose of limited-service rural hospitals is to ensure access to health care services for rural communities by allowing hospitals to be designated as limited-service rural hospitals if such hospitals limit the scope of available inpatient acute care services.

Nevada

Nev. Stats., Chap. 280 (AB 12) (1997) authorizes the commissioners of the Western Interstate Commission for Higher Education to require students in the medical professions to practice in underserved areas within Nevada as a condition to receive state financial support. The professions include dentists, physical therapists, pharmacists, and physicians' assistants. If a person agrees to practice in a medically underserved area for at least two years, the commissioners may forgive the loan portion of a student's support fee as well as the stipend portion. The act also provides penalties for failure to meet the conditions of the agreement.

New Hampshire

NH S 323 (2000) lowers the threshold amount necessary for certificate of need review of the construction of ambulatory surgical centers within the service areas of certain hospitals.

New Jersey

New Mexico

NM HM 3 (2000) establishes that the New Mexico health policy commission will consider developing a managed care plan provided through federally qualified health care centers and rural health clinics.

NM HJM 9a (2000) requests that the Department of Health establish a task force to develop critical access community health care provider designation.

NM S 310 (2000) amends the "special county hospital gross receipts tax" to allow for the use of the tax for ambulance service and a rural health clinic.

NM S 253 (2000) amends existing appropriations to authorize imposition of the county hospital emergency gross receipts tax for an additional purpose of developing or adding onto a county health facility.

N.M. Laws, Sen. Jt. Res. 31 (1996) resolves that the Department of Health study the feasibility of expanded emergency medical services in rural, medically underserved communities throughout the state as one major asset to be included in any managed care plans for the area. The department is requested to report its findings to the interim legislative health and human services committee at its October 1996 meeting.

New York

North Carolina

North Dakota

Ohio

Oklahoma

OK H 2127 (2000) seeks to reduce inequities between Medicaid beneficiaries in rural and urban areas by increasing reimbursement rates and creating financial incentives for providers to practice in underserved areas.

OK HB 1767 (1999) authorizes the state Department of Health to award one or more competitive grants to public hospitals or health care facilities for programs which deliver medical and other health care services through a telemedicine system. The goal of the grant program will be to assist in the development of the telemedicine program which in turn have the effect of empowering rural health facilities, expanding range of services in rural areas, providing greater access to patients in rural areas, reducing the number of patients transfers to urban areas, and enhance rural economic development. 

Oregon

OR SB 530 (1999) extends for an indefinite period credits against personal income tax for rural health practice, and removes the 10-year limit for individuals claiming credit. It also defines rural critical access hospitals and adds them to the list of specified hospitals at which a practitioner may be eligible for a tax break.

OR SB 911 (1999) establishes a grant program to disburse funds for purchase of equipment and improvement of existing emergency systems in rural communities.

OR SB 965 (1999) exempts property of health districts leased to health care practitioners if located in frontier rural practice counties. Exemptions would apply to tax years beginning on or after January 1, 2000.

Or. Laws, Chap. 642 (SB 507) (1997) requires health care providers participating in the Oregon Health Plan (OHP) to reimburse Type A and B rural hospitals for the full cost of services provided to OHP members.

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

TN H 1537 (2000) states that hospitals designated as critical access hospitals do not need to obtain a certificate of need. 

Tenn. Pub. Acts, Chap. 495 (HB 1443) (1997) ensures that the availability of a TennCare provider is accessible to an enrollee within 20 minutes or 20 miles from the enrollee's residence, whichever is less, regardless of whether the enrollee resides in an urban or rural area.

Tenn. Pub. Acts, H. Jt. Res. 431 (1996) continues the special joint committee to study women's health issues for two years to further study and make recommendations on numerous other women's health issues. The resolution also notes that the special joint committee has voted to support the proposed statewide Center of Excellence of Women's Health to be based at the University of Tennessee Memphis-Medical. This proposed Center of Excellence would serve as a national model for women's health in research, prevention and service by providing statewide education efforts in rural and underserved areas and developing health professional training and curriculum in women's health. The University of Tennessee network of providers and agencies across the state would be an integral part of this effort.

Texas

TX HB 2219 (1999) amends the state's insurance code by specifying what factors the commissioner is to consider when designating "rural areas;" deleting the reference that the statewide rural health care system is to arrange for or provide health care services on a prepaid basis to enrollees who reside in rural areas; stating that if the system arranges for or provides health care services to enrollees in exchange for a predetermined payment per enrollee on a prepaid basis, the system must obtain a certificate of authority under, and meet each requirement imposed by the Texas Health Maintenance Organization Act, as if the organization were a person under the Act.

Tex. Gen. Laws, Chap. 644 (HB 2192) (1997) requires the Center for Rural Health Initiatives to establish the Texas Health Service Corps Program to assist communities in recruiting and retaining physicians to practice in medically underserved areas. The center is authorized to award a yearly stipend of not more than $15,000 to physicians who provide services in medically underserved areas. The act also requires physicians who enter into contracts, but do not provide the required services, to be personally liable to the state for the amount of the stipend plus interest.

Tex. Gen. Laws, Chap. 689 (SB 913) (1997) transfers responsibility for the medically underserved community-state matching incentive program from the Texas Board of Health to the Center for Rural Health Initiatives. The act deletes the requirements that primary care physicians sponsored by a medically underserved area have completed a residency within seven years of applying for sponsorship and that the physicians practice in the community on a full-time basis.

Tex. Gen. Laws, Chap. 787 (HB 2626) (1997) establishes programs for medical students, pursuing careers as primary care physicians, similar to the statewide preceptorship programs in general internal medicine and in general pediatrics for Texas medical school students in public health settings. The act authorizes the Texas Higher Education Coordinating Board to contract with tax-exempt organizations operated by state accredited medical schools to operate the programs. The act also requires the coordinating board to require family practice residency programs to provide an opportunity for residents to have a one-month rotation through a rural setting and a public health setting.

Tex. Gen. Laws, Chap. 941 (SB 1246) (1997) establishes a statewide rural health care system to arrange for or provide health care services on a prepaid basis to enrollees who reside in rural areas. The commissioner of insurance is required to designate as the system one organization that meets the requirements imposed by the Texas Health Maintenance Organization Act and the system is required to be a nonprofit corporation composed of a combination of two or more rural hospital providers. The system is required to arrange for local health care provider networks that are composed of not more than 19 counties to deliver services to enrollees residing in the rural areas served by the system participants. If local providers are unable to provide service, the system is authorized to contract with health care practitioners who are not local providers. To the extent consistent with federal law, the state is required to award to the system at least one Medicaid managed care contract to provide services to beneficiaries in the rural areas served by the providers participating in the system. The system is required to meet established standards for providing care to Medicaid beneficiaries and the Medicaid contracting agency is required to reimburse the system at the state-defined capitation rate for each service area in which the system operates.

The act takes effect September 1, 1997, except that the insurance commissioner is required to adopt rules to implement the program by January 1, 1998, and the statewide rural health care system is required to begin offering services by March 1, 1998, unless the system determines that it is not prepared to fulfill its obligations by that date.

Tex. Gen. Laws, Chap. 1096 (HB 2099) (1997) provides for reimbursement of student loans for physician assistants trained in any state who practice in rural health professional shortage areas and medically underserved areas.

Tex. Gen. Laws, Chap. 1251 (HB 2386) (1997) provides for Medicaid reimbursement for a telemedical consultation between a physician who practices in a rural nonprofit health facility, an accredited medical school, or a teaching hospital and a physician who has a private rural health practice or who practices in a rural nonprofit health facility.

U.S. Virgin Islands

Utah

UT S 95 (2000) requires HMOs to pay for covered health care services rendered to an enrollee at a federally qualified health center if the enrollee lives or resides within 30 paved road miles of the federally qualified health center or lives or resides in closer proximity to the federally qualified health center than a contracting provider.

UT S 172 (2000) amends Section 59-12-804, regarding the imposition of rural city hospital tax; money generated by a tax imposed may only be used for the financing of financing ongoing operations, acquisition of land, or designing or furnishing a rural city hospital.

Vermont

Virginia

VA S 665 (2000) authorizes the development of a rural health care plan to establish a Medicare Rural Hospital Flexibility Program.

VT H 842 (2000) appropriates funds to be used for primary care loan repayment for providers who agree to practice in underserved areas or shortage areas.

VA H 1011 (2000) allows the Board of Health to establish annual medical scholarships to students in certain specialties who commit to practicing in underserved areas.

VA H 1075 (2000) authorizes the Dental Board to establish a dentist loan repayment program for graduates of accredited dental schools who practice in underserved areas or health professional shortage areas.

VA H 1076 (2000) creates the Health Workforce Recruitment and Retention Commission focusing on recruiting and retaining providers in underserved areas and health professional shortage areas.

Va. Acts, H. Jt. Res. 196 (1998) requests the Department of Medical Assistance Services to develop a plan of action and budgetary recommendations for Medicaid transportation for pregnant women to receive prenatal care, with emphasis on rural and underserved areas.

Washington

West Virginia

WV SB 550 (1999) allows any rural hospital that was formerly owned and operated by the county but now is owned by a non-profit multi-hospital chain owning two or more rural hospital, to apply for a certificate of need to convert up to 16 beds of existing licensed acute care beds to Medicare and Medicaid nursing beds under certain conditions. 

W. Va. Acts, Chap. 165 (H.B. 4471) (1998) allows a rural hospital with less than 80 licensed acute care beds as of January 1, 1998, to convert up to 44 percent of these beds to skilled nursing beds for certification by Medicare and Medicaid for reimbursement, despite any other rule, including certificate of need requirements. The conversion is allowed subject to certain conditions.

W. Va. Acts, Chap. 151 (HB 4511) (1996) provides that when a HMO enrollee receives covered emergency health care services from a noncontracting provider, the HMO is responsible for payment of the provider's normal charges for those health care services, exclusive of any applicable deductibles or copayments. In addition, the act expresses legislative intent that ambulance services in the state are performed by various volunteer emergency service squads, county operations and small businesses that may lack the sophistication and expertise required to negotiate a contract with an HMO for the provision of ambulance services and that the best interests of the state require the continued development and preservation of an emergency medical system to serve all the citizens of the state, including those who do not receive health care services through an HMO. The act directs the commissioner of insurance to promulgate legislative rules to regulate contracting for emergency medical services, including reimbursement for nonemergency transportation by non-participating providers and the appropriate use of 911 or community dispatching. The promulgated rules will be considered by the legislature in the 1997 regular session.

Wisconsin

Wis. Laws, Act 27 (HB 100) (1997) directs the Department of Health and Family Services (DHFS) to assist the state congressional delegation, if requested to prepare federal legislation to enable Wisconsin to operate a demonstration project for rural medical centers.

Wyoming

Wyo. Sess. Laws, Chap. 12 (HB 47) (1998) repeals the sunset date of the Office of Rural Health.