HB 133 — Relating to state income tax; to establish the Preceptor Tax Incentive Program to provide income tax credit incentives for certain medical students who train in rural and underserved counties in the state.
Last action — Enacted as 2023-519
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✓Introduced
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✓In Committee
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✓Passed House
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✓Passed Senate
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✓To Executive
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6Enacted
This bill has been enacted into law. Introduced March 21, 2023. Enacted.
Odds of enactment
High chanceBased on the sponsor, cosponsors, and committee posture, this bill has a high chance of becoming law.
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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.
Prognosis
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Enacted
Current position in the legislative process.
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1 sponsor
1 primary, 0 co-sponsors signed on.
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Single-party support
Sponsorship is currently within one party (1 D).
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Cleared a recorded vote
Passed 5 recorded votes so far.
Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.
Summary
Preceptor Tax Incentive Program created; students enrolled in certain health professions training programs to train in rural and underserved counties in the state and to address primary care shortages in the state
Bill Text
What changed in the latest version
231 added · 235 removedPlain-language change summary
The updated version of Bill HB 133 adds clarity to the definition of "clinical preceptorship" by specifying that the community-based faculty preceptor must not be compensated for their role. Additionally, it explicitly lists the health programs eligible for the incentive, including medical, dental, optometric, and physician assistant programs. These changes matter because they ensure that the tax incentives are targeted more effectively to support medical students training in underserved areas, which can ultimately improve healthcare access in those communities.
HB133 ENGROSSEDENROLLED W12A9E-2W12A9E-3 By Representatives Rafferty, Daniels RFD:
21-Mar-23 2023 Regular Session Page 0 HB133 EngrossedEnrolled 2Enrolled, 4An AAct, BILL3 TO BE ENTITLED AN ACT 9 Relating to state income tax;
(a)This Theact shall be known and may be cited as the Preceptor Tax Incentive Program isAct. created.
(b)Section For2. the purposes of this section, the following terms shall have the following meanings:
For the purposes of this act, the following terms have the following meanings:
A clinical educational or training rotation for a student in any of the following programs,programs that are physically located in this state and approved by and provided through a qualified health professions training program, for which the clinicalcommunity-based faculty preceptor, also physically located in this state, is otherwise not compensated for the preceptorship:
Page 1 HB133 Engrossed e.
An anesthesia assistant programprogram. f.
f.
(2) COMMUNITY-BASED FACULTYADVANCE PRACTICE NURSE PRECEPTOR.
A physician,Page advanced1 HB133 Enrolled certified registered advance practice nurse,nurse orlicensed assistantunder toChapter physician21 of Title 34, Code of Alabama 1975, who provides medical services in a health care facility that is licensedphysically located in this state and receivesnot noowned financialor compensationoperated fromby anya sourcequalified fornursing, themedical, teachingor ofosteopathic studentsschool inand awho, medicalthrough program,an dentalagreement program,with optometrica program,qualified physiciannursing assistantschool program,physically anesthesialocated assistantin program,this state, provides one or more clinical preceptorships for training to students in a certified registered nurse practitioner, certified nurse midwife, or certified registered nurse anesthetist program.program for which he or she receives no monetary compensation.
(3) COMMUNITY-BASED NURSEASSISTANT PRACTITIONERTO PHYSICIAN PRECEPTOR.
AAn certifiedassistant registeredto nursephysician practitioner licensed under Chapter 2124 of Title 34, Code of Alabama 1975, and practicing pursuant to a collaborationregistration agreement with a licensed physician, who provides medical services in a health care facility that is physically located in this state and not owned or operated by a qualified nursing, medical, nursing, or osteopathic school and who, through an agreement with a qualified nursinghealth schoolprofessions program physically located in this state, provides one or more clinical preceptorships for training to students in a certifiedphysician registeredassistant nurse practitioner, certified nurse midwife, or certifiedanesthesia registeredassistant nurse anesthetist program for which he or she receives no monetary compensation.
(4) COMMUNITY-BASED ASSISTANTFACULTY TO PHYSICIAN PRECEPTOR.
AnA assistantcommunity-based toadvance physicianpractice licensednurse underpreceptor; Chapter 24 of Title 34, Code of Alabama 1975, and practicing pursuant to a Page 2 HB133 Engrossed registration agreement with a licensed physician, who provides medical services in a health care facility that is physically located in this state and not owned or operated by a qualified medical, nursing, or osteopathic school and who, through an agreement with a qualified health professions program physically located in this state, provides one or more clinical preceptorships for students in a physician assistant or anesthesia assistant program for which he or she receives no monetary compensation.
(5)community-based COMMUNITY-BASEDassistant PHYSICIAN,to DENTIST,physician ORpreceptor; OPTOMETRY PRECEPTOR.
or community-based physician, dentist, or optometrist preceptor.
(5) COMMUNITY-BASED PHYSICIAN, DENTIST, OR OPTOMETRIST Page 2 HB133 Enrolled PRECEPTOR.
(6) HEALTHMEDICALLY PROFESSIONALUNDERSERVED SHORTAGERURAL AREA.
AreasA ofprimary thecare stateservice thatarea arewith designateda bydeficit, theor Healthsurplus Resourcesof andless Servicesthan Administration2.0 ofprimary-care physicians, as shown by the Unitedmost-recent StatesStatus DepartmentReport of Healththe andAlabama PagePrimary 3Care HB133Physician EngrossedWorkforce Humanfrom Servicesthe asOffice havingfor shortagesFamily ofHealth primaryEducation medicaland care,Research dentalat care,the orUAB mentalHuntsville healthRegional careMedical providers.Campus.
A(7) shortagePROGRAM. area may be geographic-based, population-based, or facility-based.
Health professional shortage area scores are based on discipline-specific methodology, however, three scoring criteria are common across all health professional shortage area disciplines:
a.
Population to provider ratio.
b.
Percentage of the population below 100 percent of the federal poverty level.
95 c.
Travel time to the nearest source of care outside the designated shortage area.
(7) MEDICALLY UNDERSERVED AREA and MEDICALLY UNDERSERVED POPULATION.
a.
An area or population in this state identified by the Health Resources and Services Administration Agency of the United States Department of Health and Human Services as a geographic area and population with a lack of access to primary care services based on the following established indicators:
1.
Provider per 1,000 population ratio.
2.
Percentage of population at 100 percent of the federal poverty level.
3.
Percentage of population age 65 and older.
4.
Infant mortality rate.
b.
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A calculated index of medical underservice score of 62.0 or below qualifies for designation as a medically underserved area or medically underserved population.
Page 4 HB133 Engrossed (8) PROGRAM.
(9)(8) QUALIFIED HEALTH PROFESSIONS TRAINING PROGRAM.
An institution of higher education that is physically located in this state and has an accredited educational program for medicine, dentistry, optometry, physician assistants, anesthesia assistants, or certified registered nurse practitioners, certified nurse midwives, andor certified Page 3 HB133 Enrolled registered nurse anesthetists.
(10)Section RURAL3. AREA.
As(a)(1)The definedAlabama byStatewide theArea UnitedHealth StatesEducation CensusCenter Bureau,Program inOffice theshall contextadminister ofthe healthprogram care,and healthcertify data,clinical andpreceptorships theon locationbehalf of health care services, all population,eligible housing,qualified andhealth territoryprofessions nottraining includedprograms. within a state-urbanized area with a population of 50,000 or more.
(c)(1)(2) BeginningA withclinical thepreceptorship 2024may taxnot year,be acertified community-basedas physician,eligible dentist,under orthe optometryprogram preceptor,unless community-basedthe assistantclinical topreceptorship physicianis preceptor,performed or community-based nurse practitioner, nurse midwife, or nurse anesthetist preceptor physically located in this state shall be allowed a creditmedically againstunderserved therural taxarea. imposed by Section 40-18-2, Code of Alabama 1975, if he or she conducts an unpaid clinical preceptorship, in the following amounts:
(b)(1) Prior to the certification of any clinical preceptorship, the Alabama Statewide Area Health Education 95 Center Program Office shall conduct a needs assessment of the current number and current need for community-based faculty preceptors in the state and submit a final report of the assessment to the Governor, Speaker of the House of Representatives, President Pro-Tempore of the Senate, the Chairs of the Senate Healthcare and House Health Committees, and the Chairs of the Senate Committee on Finance and Taxation Education and the House Ways and Means Education Committees.
(2) The Alabama Statewide Area Health Education Center Program Office shall consult with the Alabama Commission on the Evaluation of Services to develop the appropriate measures and methodology for conducting the needs assessment.
Section 4.
(a)(1) Beginning with the 2024 tax year, a community-based faculty preceptor, if he or she conducts a clinical preceptorship, shall be allowed a credit against the tax imposed by Section 40-18-2, Code of Alabama 1975, in the following amounts:
A community-based physician, dentist, or optometrist Page 4 HB133 Enrolled preceptor shall be allowed a credit of five hundred dollars ($500) per rotation, up to an annual maximum of six thousand dollars ($6,000).
A community-based assistant to physician preceptor shall be allowed a credit of four hundred twenty-five dollars ($425) per rotation, up to an annual maximum of five thousand Page 5 HB133 Engrossed one hundred dollars ($5,100).
A community-based nurseadvance practitioner,practice certified nurse midwife, or certified registered nurse anesthetist preceptor shall be allowed a credit of four hundred twenty-five dollars ($425) per rotation, up to an annual maximum of five thousand one hundred dollars ($5,100).
(2) An individual shallmay not accrue more than 12 clinical preceptorships ofin any combination of the above categories in one calendar year.
(3)(b) A community-based faculty preceptor shallmay not be eligible to earn hours credited toward athe clinical preceptorship tax credit ifpursuant heto orsubsection she(a) unless the clinical preceptorship has notbeen registeredcertified withby the Alabama Statewide Area Health Education Center Program Office inas Birmingham,eligible Alabama.for the credit.
(4)(c)(1) TheTo Alabamareceive Statewidethe Areacredit Healthprovided Educationby Centerthis Programact, Officea shallcommunity-based administerfaculty thepreceptor programshall andclaim certifythe clinicalcredit preceptorship rotations on behalfhis ofor allher eligiblestate publicincome andtax privatereturn training programs for medicine,the optometry,tax andyear dentalin physicianwhich assistant,he anesthesia assistant, or certifiedshe registeredcompleted nursethe practitioner,clinical certifiedpreceptorship nurserotation; midwife, and certified registered nurse anesthetist programs physically located in this state.
(5)shall Tocertify receivethat he or she, and the credithealth providedcare bycenter thisor section,facility athrough community-basedwhich facultyhe preceptoror shallshe claimis theemployed, creditdid onnot hisreceive ormonetary herpayment stateduring incomethe tax returnyear from any source for the taxtraining yearof inmedical, whichoptometry, hedental, physician assistant, anesthesia assistant, or shecertified completedregistered thenurse clinicalpractitioner, preceptorshipPage rotation;5 HB133 Enrolled certified nurse midwife, and certified registered nurse anesthetist students;
shall certify that he or she, and theshall healthsubmit caresupporting centerdocumentation, orincluding facilitycertification throughobtained whichfrom hethe orAlabama sheStatewide isArea employed,Health didEducation notCenter receiveProgram monetaryOffice, Pageto 6 HB133 Engrossed payment during the taxDepartment year from any source for the training of medical,Revenue. optometry, dental, physician assistant, anesthesia assistant, or certified registered nurse practitioner, certified nurse midwife, and certified registered nurse anesthetist students;
and(2) shallFailure submitto supportingprovide documentationthe torequired documents shall result in the Departmentautomatic denial of Revenue.the credit.
(6)(d) In no event shall the total amount of the tax credit provided by this section for a taxable year exceed the income tax liability of the taxpayer.
(d)(e) Adjudication of possible filing errors or violations of thethis lawact shall be determined by the Department of Revenue.
(e)Section The5. Alabama Statewide Area Health Education Center Program Office shall do both of the following:
The Alabama Statewide Area Health Education Center Program Office shall do both of the following:
(f)Section The6. certification obtained from the Alabama Statewide Area Health Education Center Program Office, and any other documentation required, shall be submitted by the taxpayer with his or her annual tax return on which the credit Page 7 HB133 Engrossed is being claimed.
Failure(a) toAnnually, provideon or before the requiredfirst documentsday of December, the Alabama Statewide Area Health Education Center Program Office shall resultreport inon the automaticcondition, denialperformance, and Page 6 HB133 Enrolled accomplishments of the credit.program to the Governor, Speaker of the House of Representatives, President Pro-Tempore of the Senate, the Chairs of the Senate Healthcare and House Health Committees, and the Chairs of the Senate Committee on Finance and Taxation Education and the House Ways and Means Education Committees.
(g)(b) The DepartmentAlabama ofStatewide RevenueArea mayHealth adoptEducation rulesCenter forProgram Office shall consult with the implementationAlabama Commission on the Evaluation of Services to develop performance metrics and administrationother measures of thissuccess section.to include in the annual report required pursuant to subsection (a).
SectionDuring 2.the 2030 fiscal year, the program shall undergo an evaluation by the Alabama Commission on the Evaluation of Services to determine whether the program is impacting the determined measures of success.
Section 7.
The Department of Revenue may adopt rules for the implementation and administration of this act.
Section 8.
This act shall be repealed on September 29, 2031, unless extended by act of the Legislature Section 9.
Page 87 HB133 EngrossedEnrolled House________________________________________________ Speaker of Representativesthe ReadHouse forof theRepresentatives first________________________________________________ timePresident and referredPresiding ................21-Mar-23Officer toof the Senate House of Representatives committeeI onhereby Wayscertify andthat Meansthe Educationwithin ReadAct fororiginated thein second time and placedwas ................19-Apr-23passed onby the calendar:House 25-Apr-23, as amended.
amendmentsJohn ReadTreadwell forClerk theSenate third01-Jun-23 timePassed andHouse passed06-Jun-23 ................25-Apr-23Passed as amended Yeas 104 Nays 0 Abstains 0 John Treadwell Clerk Page 98
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Amendments
4 amendments- Amendment 97U4PB-1 Show changes
- Amendment Q8MD15-1 Show changes
- Amendment D1YITH-1 Show changes
- Ways and Means Education Amendment E134CC-1 Show changes
Click Show changes on an amendment above to see how it modifies the bill.
Action History
-
Enrolled
Sponsors
- Neil Rafferty · Primary
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 0 co-sponsors · 139 not signed on
Sponsors (1)
Co-sponsors (0)
None.
Not signed on (139)
139 members have not signed on to this bill.
Show all 139 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Unaffiliated | 5 | 0 | 0 | 0 |
| R | 70 | 0 | 0 | 1 |
| D | 26 | 0 | 0 | 0 |
| Total | 101 | 0 | 0 | 1 |
| % of votes cast | 99% | 0% | 0% | 1% |
How each member voted (102)
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| R | 24 | 0 | 0 | 1 |
| D | 5 | 0 | 0 | 3 |
| Unaffiliated | 1 | 0 | 0 | 0 |
| Total | 30 | 0 | 0 | 4 |
| % of votes cast | 88% | 0% | 0% | 12% |
How each member voted (34)
| Member | Party | Vote |
|---|---|---|
| Greg J. Reed | — | Yea |
| Bobby D. Singleton | D | Yea |
| Kirk Hatcher | D | Not Voting |
| Linda Coleman-Madison | D | Not Voting |
| Merika Coleman | D | Not Voting |
| Robert Stewart | D | Yea |
| Rodger M. Smitherman | D | Yea |
| Vivian Davis Figures | D | Yea |
| William M. Beasley | D | Yea |
| Andrew Jones | R | Yea |
| April Weaver | R | Yea |
| Arthur Orr | R | Yea |
| Chris Elliott | R | Not Voting |
| Clyde Chambliss | R | Yea |
| Dan Roberts | R | Yea |
| David Sessions | R | Yea |
| Donnie Chesteen | R | Yea |
| Garlan Gudger | R | Yea |
| Gerald H. Allen | R | Yea |
| Greg Albritton | R | Yea |
| J. T. 'Jabo' Waggoner | R | Yea |
| Jack W. Williams | R | Yea |
| Jay Hovey | R | Yea |
| Josh Carnley | R | Yea |
| Keith Kelley | R | Yea |
| Lance Bell | R | Yea |
| Larry Stutts | R | Yea |
| Randy Price | R | Yea |
| Sam Givhan | R | Yea |
| Shay Shelnutt | R | Yea |
| Steve Livingston | R | Yea |
| Tim Melson | R | Yea |
| Tom Butler | R | Yea |
| Will Barfoot | R | Yea |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| R | 24 | 0 | 0 | 1 |
| D | 5 | 0 | 0 | 3 |
| Unaffiliated | 1 | 0 | 0 | 0 |
| Total | 30 | 0 | 0 | 4 |
| % of votes cast | 88% | 0% | 0% | 12% |
How each member voted (34)
| Member | Party | Vote |
|---|---|---|
| Greg J. Reed | — | Yea |
| Bobby D. Singleton | D | Yea |
| Kirk Hatcher | D | Not Voting |
| Linda Coleman-Madison | D | Not Voting |
| Merika Coleman | D | Not Voting |
| Robert Stewart | D | Yea |
| Rodger M. Smitherman | D | Yea |
| Vivian Davis Figures | D | Yea |
| William M. Beasley | D | Yea |
| Andrew Jones | R | Yea |
| April Weaver | R | Yea |
| Arthur Orr | R | Yea |
| Chris Elliott | R | Not Voting |
| Clyde Chambliss | R | Yea |
| Dan Roberts | R | Yea |
| David Sessions | R | Yea |
| Donnie Chesteen | R | Yea |
| Garlan Gudger | R | Yea |
| Gerald H. Allen | R | Yea |
| Greg Albritton | R | Yea |
| J. T. 'Jabo' Waggoner | R | Yea |
| Jack W. Williams | R | Yea |
| Jay Hovey | R | Yea |
| Josh Carnley | R | Yea |
| Keith Kelley | R | Yea |
| Lance Bell | R | Yea |
| Larry Stutts | R | Yea |
| Randy Price | R | Yea |
| Sam Givhan | R | Yea |
| Shay Shelnutt | R | Yea |
| Steve Livingston | R | Yea |
| Tim Melson | R | Yea |
| Tom Butler | R | Yea |
| Will Barfoot | R | Yea |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Unaffiliated | 4 | 0 | 0 | 1 |
| R | 71 | 0 | 0 | 0 |
| D | 26 | 0 | 0 | 0 |
| Total | 101 | 0 | 0 | 1 |
| % of votes cast | 99% | 0% | 0% | 1% |
How each member voted (102)
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Unaffiliated | 4 | 0 | 0 | 1 |
| R | 70 | 0 | 0 | 1 |
| D | 26 | 0 | 0 | 0 |
| Total | 100 | 0 | 0 | 2 |
| % of votes cast | 98% | 0% | 0% | 2% |
How each member voted (102)
Subjects
Frequently asked questions
- What does HB 133 do?
- Preceptor Tax Incentive Program created; students enrolled in certain health professions training programs to train in rural and underserved counties in the state and to address primary care shortages in the state
- Who sponsors HB 133?
- HB 133 is sponsored by Neil Rafferty (D).
- What is the current status of HB 133?
- This bill has been enacted into law. Introduced March 21, 2023. Enacted.
- Where can I track HB 133?
- Track HB 133 free on One Click Politics — get push/email alerts when it moves.
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