BILL ANALYSIS
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|Hearing Date:August 5, |Bill No:AB |
|2002 |982 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 982Author:Firebaugh
As Amended:August 5, 2002 Fiscal: Yes
SUBJECT: Health Care.
SUMMARY: Establishes the Dental Loan Repayment Program of
2002 (administered by the Dental Board), the Physician Loan
Repayment Program of 2002 (administered by the Medical
Board) and the California Medical and Dental Student Loan
Repayment Program of 2002 (administered by the Office of
Statewide Health Planning and Development).
Existing law:
1)Provides for the licensing and regulation of physicians
by the Medical Board of California (Medical Board), and
authorizes the imposition of a $600 license fee and a
$600 license renewal fee for a physician's license
(license is good for 2 years).
2)Provides for the licensing and regulation of dentists by
the Dental Board of California (Dental Board), and
authorizes the imposition of a $365 initial license fee
and a $365 annual license renewal fee for a dentist's
license (license is good for 2 years).
3)Establishes the Office of Statewide Health Planning and
Development (OSHPD) which administers several programs as
part of its health manpower objectives, including the
federal National Health Service Corps Scholarship Program
and the federal National Health Service Corps Loan
Repayment Program. These Programs provide federal funds
to states for the purpose of providing scholarships to
health profession students or repaying qualifying
educational loans of specified health care professionals
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who commit to serve a specified time period as a provider
of health services at practice sites in designated health
professional shortage areas.
4)Requires the practice sites under the federal loan
repayment program to repay a portion of the health care
professional's outstanding loan amount.
5)Establishes the Health Manpower Policy Commission
(Commission) within the OSHPD, and prescribes its powers
and duties, which include adopting standards for
determining funding eligibility for various health
manpower programs and identifying specific areas of the
state where there exists an unmet priority need for
medical services.
This bill (relative to the Dental Corps Loan Repayment
Program):
1)Establishes the Dental Corps Loan Repayment Program of
2002 (Dental Corps Program) to be administered by the
Dental Board.
2)States intent language for the Dental Board, in
developing and implementing the Dental Corp Program, to
consult with the OSHPD, the dental community, including
ethnic representatives, dental schools, health advocates
representing ethnic communities, primary care clinics,
public hospitals and health systems, statewide agencies
administering state and federally funded programs
targeting underserved communities, and members of the
public with health care issue-area expertise.
3)Defines "dentally underserved area" as, a geographic area
eligible to be designated as having a shortage of dental
professionals pursuant to Federal Regulations or an area
of the state where unmet priority needs for dentists
exist as determined by the Commission.
4)Defines "dentally underserved population" as persons
without dental insurance and persons eligible for the
Denti-Cal and Healthy Families Programs who are
population groups described as having a shortage of
dental care professionals pursuant to Federal
Regulations.
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5)Defines "practice setting" as: (a) a community clinic
and a clinic owned and operated by a hospital that
maintains the primary contract with a county government
to fulfill the county's role, which is located in a
dentally underserved area and at least 50% of whose
patients are from a dentally underserved population; or,
(b) a dental practice or dental corporation located in a
dentally underserved area and at least 50% of whose
patients are from a dentally underserved population.
6)Requires Dental Corps Program participants to possess a
current valid license to practice dentistry in
California, to have full-time status and to commit to a
minimum of three years of service in a dentally
underserved area. Authorizes the Dental Board to define
full time status and establish exemptions on a
case-by-case basis.
7)Provides that the guidelines created by the Dental Board
shall provide priority consideration to applicants who
are best suited to meet the cultural and linguistic needs
and demands of dentally underserved populations and that
meet one or more of the following criteria: (a) speak a
Medi-Cal threshold language; (b) come from an
economically disadvantaged background; (c) have received
significant training in cultural and linguistically
appropriate service delivery; (d) have worked with
dentally underserved communities for at least three
years; or, (e) recently received a license to practice
dentistry.
8)Provides that the practice setting shall be located in a
dentally underserved area and that the Dental Corps
Program participant serves a patient population that
consists of at least 50% dentally underserved
populations.
9)Creates the Community Healthcare Service Expansion Fund
and the Dentally Underserved Account within that Fund.
10)Transfers $3,000,000 from the State Dentistry Fund to
the Dentally Underserved Account. Provides that the
funds shall be placed in the account in order to repay
the loans per agreements made with dentists.
11)Provides that after a Dental Corps Program participant
has completed 1 year of service the Dental Board shall
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provide up to $25,000 for loan repayment. Provides that
after a Dental Corps Program participant has completed 2
consecutive years of service the Dental Board shall
provide up to an additional $35,000 for loan repayment.
Provides that after a Dental Corps Program participant
has completed 3 consecutive years of service the Dental
Board shall provide up to an additional $45,000 for loan
repayment. Limits loan repayments to $105,000 per
individual.
12)Requires the Dental Board, no later than October 1,
2004, to report to the Legislature on various items,
including an evaluation of the effectiveness of the
Dental Corps Program and recommendations for maintaining
or expanding its operation.
This bill (relative to the Physician Corps Loan Repayment
Program):
1)Makes a minor, technical amendment by renumbering a
section.
2)Establishes the Physician Corps Loan Repayment Program of
2002 (Physician Corps Program) to be administered by the
Division of Licensing of the Medical Board.
3)States intent language for the Division of Licensing, in
developing and implementing the Physician Corps Program,
to consult with the OSHPD, the medical community,
including ethnic representatives, medical schools, health
advocates representing ethnic communities, primary care
clinics, public hospitals and health systems, statewide
agencies administering state and federally funded
programs targeting underserved communities, and members
of the public with health care issue-area expertise.
4)Defines "medically underserved area" as, an area as
defined pursuant to Federal Regulations or an area of the
state where unmet priority needs for physicians exist as
determined by the Health Manpower Policy Commission.
5)Defines "medically underserved population" as, the
Medi-Cal, Healthy Families and uninsured populations.
6)Defines "practice setting" as: (a) a community clinic
and a clinic owned and operated by a hospital that
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maintains the primary contract with a county government
to fulfill the county's role, which is located in a
medically underserved area and at least 50% of whose
patients are from a medically underserved population; or,
(b) a medical practice located in a medically underserved
area and at least 50% of whose patients are from a
medically underserved population.
7)Requires Physician Corps Program participants to possess
a current valid license to practice medicine in
California, to have full-time status and to commit to a
minimum of three years of service in a medically
underserved area. Authorizes the Division of Licensing
to define full time status and establish exemptions on a
case-by-case basis.
8)Provides that the guidelines created by the Division of
Licensing shall provide priority consideration to
applicants who are best suited to meet the cultural and
linguistic needs and demands of patients from medically
underserved populations and that meet one or more of the
following criteria: (a) speak a Medi-Cal threshold
language; (b) come from an economically disadvantaged
background; (c) have received significant training in
cultural and linguistically appropriate service delivery;
(d) have 3 years experience working in medically
underserved areas or with medically underserved
populations; or, (e) recently received a license to
practice medicine.
9)Provides that the practice setting shall be located in a
medically underserved area and that the Medical Corps
Program participant serves a patient population that
consists of at least 50% medically underserved
populations.
10)Creates the Community Healthcare Service Expansion Fund
and the Medically Underserved Account within that Fund.
11)Transfers $3,000,000 from the Medical Board's Contingent
Fund to the Medically Underserved Account. Provides that
the funds shall be placed in the account in order to
repay the loans per agreements made with physicians.
12)Provides that after a Physician Corps Program
participant has completed 1 year of service the Division
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of Licensing shall provide up to $25,000 for loan
repayment. Provides that after a Physician Corps Program
participant has completed 2 consecutive years of service
the Division of Licensing shall provide up to an
additional $35,000 for loan repayment. Provides that
after a Physician Corps Program participant has completed
3 consecutive years of service the Division of Licensing
shall provide up to an additional $45,000 for loan
repayment. Limits loan repayments to $105,000 per
individual.
13)Requires the Division of Licensing, no later than
October 1, 2004, to report to the Legislature on various
items, including an evaluation of the effectiveness of
the Physician Corps Program and recommendations for
maintaining or expanding its operation.
This bill (relative to the California Medical and Dental
Student Loan Repayment Program):
1)Establishes the California Medical and Dental Student
Loan Repayment Program of 2002 (Student Loan Repayment
Program) to be administered by the OSHPD.
2)States intent language for the OSHPD, in developing and
implementing the Student Loan Repayment Program, to
consult with the Dental Board, the Medical Board, the
medical and dental community, including ethnic
representatives, medical and dental schools, health
advocates representing ethnic communities, primary care
clinics, public hospitals and health systems, statewide
agencies administering state and federally funded
programs targeting underserved communities, and members
of the public with health care issue-area expertise.
3)Provides that any individual enrolled in an institution
of postsecondary education participating in the Student
Loan Repayment Program may be eligible to receive a
conditional warrant for loan repayment to be redeemed
upon becoming employed as a physician or dentist in a
medically or dentally underserved area.
4)Provides that in order to be eligible to receive a
conditional loan repayment warrant, an applicant must
have been judged by his or her postsecondary institution
to have outstanding ability on the basis of criteria that
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may include, but not be limited to, any of the following:
(a) grade point average; (b) test scores; (c) faculty
evaluations; (d) interviews; (e) or, other
recommendations.
5)Provides that to be eligible, the applicant has to have
received, or is approved to receive, a loan under
certain, specified loan programs.
6)Provides that to be eligible, the applicant has to agree
to provide services as a licensed physician for up to
three consecutive years, after obtaining a license from
the Medical Board in a medically underserved area, or the
applicant has agreed to provide services as a licensed
dentist for up to three consecutive years, after
obtaining a license from the Dental Board in a dentally
underserved area.
7)Provides that the OSHPD shall ensure that priority
consideration be given to applicants who are best suited
to meet the cultural and linguistic needs and demands of
patients from medically and dentally underserved
populations and that meet one or more of the following
criteria: (a) speak a Medi-Cal threshold language; (b)
come from an economically disadvantaged background; (c)
have received significant training in cultural and
linguistically appropriate service delivery; or, (d) have
done a medical rotation serving medically underserved
populations or provided dental services to members of a
dentally underserved population.
FISCAL EFFECT: Unknown.
COMMENTS:
1.Measure Aimed at Increasing Access to Care. According to
information provided by the Author's office, this measure
is a collaborative effort involving such organizations as
the California Primary Care Association (CPCA), the
Latino Coalition for a Healthy California (LCHC), the
California Medical Association (CMA), the California
Dental Association (CDA) and the Medical Board. The
Author states that this measure addresses the lack of
culturally and linguistically competent physicians and
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dentists to adequately care for California's diverse
medically/dentally underserved populations.
The proponents point out that in order to become a
physician or dentist, most medical and dental students
must incur significant education-related debt. Because
this debt prevents many physicians and dentists from
working in shortage designation areas serving medically
underserved populations, this measure's loan repayment
program is critical for reducing greater numbers of
doctors and dentists to needy areas.
2.California's Dentist and Physician Shortage Problem. A
variety of studies and reports in recent years, most
notably the Oral Health Needs Assessment sponsored
jointly by the Dental Health Foundation and the
Department of Health Services, have documented the
significant unmet need for comprehensive dental care
services in California, especially in underserved areas.
The CDA notes that efforts to encourage dental school
graduates to practice in these areas are made difficult
by the significant student loan debt which most new
dentists face when they graduate and begin practicing -
often exceeding $150,000.
The CMA argues that California has a physician
maldistribution problem.
According to information provided by the CPCA and the
LCHC, California's uninsured, Medi-Cal, and Healthy
Families populations are disproportionately comprised of
racial and ethnic minorities. 40% of Latinos, 23% of
African Americans and 22% of Asian and Pacific Islanders
are uninsured as compared to 15% for non-Latino whites.
Of the children eligible for the Medi-Cal and Healthy
Families programs, 62% are Latino children, 11% are Asian
and Pacific Islander children and 5% are African American
children. In addition, almost 40% of the state's
population speaks a language other than English at home.
The number of underrepresented minority Californians who
entered any medical school fell from a high of 310 in
1994 to 258 in 1999, a decline of 17%. The decline is
due in part to the lack of resources available for
underrepresented minorities and other culturally and
linguistically competent individuals interested in
serving low-income communities.
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3.National Health Service Corps. Through funding by the
federal National Health Service Corp, the OSHPD
administers the State Loan Repayment Program for repaying
educational loans of primary care providers, including
physicians in family practice, general internal medicine,
general pediatrics, and obstetrics/gynecology, as well as
dentists, physician assistants, nurse practitioners and
nurse midwives. In order to be eligible, the health
providers must commit to practicing in federally
designated health professional shortage areas for a
minimum of two years. Other specific requirements
include requiring the health professional to practice in
public or private non-profit settings (not in private
practice), and requiring a 50% match from the practice
site. For the first two years, the existing State Loan
Repayment Program will provide $12,500 per year, which is
required to be matched by the practice site for a total
of $25,000 each year. In years three and four, if the
health provider continues working at the practice site in
the underserved area, the repayment amount grows to
$35,000 each of those two years ($17,500 from the
program, and $17,500 from the practice site). The total
possible loan repayment amount is $120,000.
There are currently 21 dentists and 205 physicians
participating in the California State Loan Repayment
Program.
4.Provisions Regarding the Implementation of the Student
Loan Repayment Program Will Be Amended. The measure
creates three programs, the Dental Corps Program, the
Physician Corps Program and the Student Loan Repayment
Program. As their names would indicate, 2 of the
programs are aimed at existing licensees while the other
is aimed at students. The 2 programs aimed at licensees
are the programs that are each being funded with 3
million dollars. There is no funding allocated for the
program for students. The apparent intent of the
Sponsors is to have a program in place (as the interested
parties have come together and agree on the language) for
when or if money becomes available (General Fund or
otherwise). The Author and Sponsors have agreed to amend
the bill to provide that implementation is contingent
upon securing adequate funding.
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To assure the bill can be heard next week in Senate
Appropriations Committee, the author has committed to
adopting the amendments in that Committee.
5.Do the Medical Board and Dental Board Have Enough Money
to Pay for this Measure and Is this an Appropriate Use of
it? The Dental Board has approximately $7,388,144 in the
State Dentistry Fund and $2,480,667 in reserve. The
Medical Board has approximately $38.7 million in their
Contingent Fund and $12 million in reserve. The Author
and Sponsors have agreed to amend the bill to have the
Boards transfer the money into the accounts on a
quarterly basis.
6.Arguments in Support. The CMA (Co-Sponsor) believes that
this bill will focus on developing methods, strategies
and financial incentives to increase physician supply in
California and to strengthen existing programs aimed at
medical students, residents and physicians that could
eliminate the mal-distribution and ease the current
access to care crisis in California.
The CDA believes that this bill provides an excellent
first step in what should be a long-term commitment to
improving access to dental care by increasing the number
of providers in undeserved communities throughout
California.
7.Support if Amended. The California Association of Public
Hospitals and Health Systems and the County Health
Executives Association of California took a support if
amended position on the prior version of the bill June
17, 2002. They expressed concern that their clinics,
owned and operated by public hospitals and health system
representatives, were not included in the bill. It
appears that the amendments that they requested are
contained in the current version (August 5, 2002) of the
bill.
8.Related Measures Aimed at Addressing Underserved
Populations. AB 1045 (Firebaugh) is scheduled to be
heard by this Committee today (8/5/02). AB 1045 would,
among other things, create the Licensed Physicians and
Dentists from Mexico Pilot Program, and would create a
separate pilot program aimed at placing international
medical graduates in underserved areas.
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AB 2872 (Thomson) was approved by this Committee on June
24, 2002. AB 2872 requires the Medical Board to convene
a working group to study methods to reactivate the Fifth
Pathway Program in California medical schools, and to
submit a report to the Legislature including options for
the Legislature to consider in order to facilitate the
establishment of one or more Fifth Pathway Programs.
9.Current and Prior Loan Repayment Measures. AB 2935
(Strom-Martin) was approved by this Committee on June 24,
2002. AB 2935 establishes the California Pharmacist
Scholarship and Loan Repayment Program, funded by a
voluntary $25 contribution by pharmacists, to pay for the
educational expense and repay qualifying educational
loans of pharmacists who agree to practice in medically
underserved areas.
AB 668 (Chan, Chapter 249, Statutes of 2001) requires the
OSHPD to report to the Legislature on the feasibility of
establishing a California Dental Loan Forgiveness
Program. It should be noted that the OSHPD has not yet
completed this report.
SB 760 (Murray, 2001) would have appropriated $1 million
to the OSHPD to create a new program patterned on the
National Health Service Corps Loan Repayment Program, but
with exceptions that were similar to those in this bill.
The governor vetoed that bill stating that he believed
local practice sites should contribute some matching
funds to "make an investment in the health professionals
they attract with the assistance of a government loan
program." However, it should be noted that SB 760 was to
be funded from the state's General Fund, while this bill
will completely fund the scholarship and loan program
from licensee fees (loan repayment) or if funds become
available in the future (scholarship).
SUPPORT AND OPPOSITION:
Support :
California Medical Association (CMA) (Co-Sponsor)
California Medical Association - Medical Student Section
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California Primary Care Association (CPCA) (Co-Sponsor)
Latino Coalition for a Healthy California (LCHC)
(Co-Sponsor)
Alliance Medical Center
Alliance for Rural Community Health
Arroyo Vista Family Health Center
Asian & Pacific Islander American Health Forum
Asian Health Services
Association of Asian Pacific Community Health Organizations
Borrego Community Health Foundation
California Dental Association
California Pan-Ethnic Health Network
California Psychiatric Association
California Rural Indian Health Board, Inc.
Central Valley Health Network
CommuniCare Health Centers
Community Health Partnership
Consumers Union
Council of Community Clinics
Lieutenant Governor Cruz Bustamante
LifeLong Medical Care
Long Valley Health Center
Medical Board of California
Mexican American Legal Defense and Educational Fund
National Council of La Raza
National Latina Health Orgainizations
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
Open Door Community Health Centers
Planned Parenthood Affiliates of California
Queens Care Family Clinics
San Ysidro Health Center
Six Rivers Planned Parenthood
Southern Trinity Health Services
Supervisor Blanca Alvarado, County of Santa Clara, Second
District
Supervisor Juan Arambula, County of Fresno, District 3
Tarzana Treatment Centers
Tiburcio Vasquez Health Center, Inc.
Support if Amended :
California Association of Public Hospitals and Health
Systems
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Opposition :None reported to Committee as of July 31, 2002.
Consultant:Kristin J. Triepke