BILL NUMBER: AB 2439 CHAPTERED 09/30/08 CHAPTER 640 FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2008 APPROVED BY GOVERNOR SEPTEMBER 30, 2008 PASSED THE SENATE AUGUST 13, 2008 PASSED THE ASSEMBLY AUGUST 15, 2008 AMENDED IN SENATE AUGUST 11, 2008 AMENDED IN SENATE JUNE 30, 2008 AMENDED IN SENATE JUNE 19, 2008 AMENDED IN ASSEMBLY APRIL 8, 2008 AMENDED IN ASSEMBLY MARCH 28, 2008 INTRODUCED BY Assembly Member De La Torre (Coauthor: Assembly Member Berg) FEBRUARY 21, 2008 An act to amend Section 2023 of, and to amend and renumber Section 2435.2 of, the Business and Professions Code, and to amend Section 128553 of the Health and Safety Code, relating to physicians and surgeons, and making an appropriation therefor. LEGISLATIVE COUNSEL'S DIGEST AB 2439, De La Torre. Steven M. Thompson Physician Corps Loan Repayment Program: fees. Existing law establishes the Steven M. Thompson Physician Corps Loan Repayment Program in the California Physician Corps Program within the Health Professions Education Foundation, which provides financial incentives, as specified, to a physician and surgeon for practicing in a medically underserved community. Existing law requires the Medical Board of California to assess an applicant for issuance or renewal of a physician and surgeon's license a voluntary $50 fee to be deposited into the Medically Underserved Account for Physicians, which is continuously appropriated to provide funding for operations of the loan repayment program. Existing law requires the foundation to use guidelines developed by the Medical Bd. for selection and placement of program applicants, as specified. This bill would change the fee to $25 and make payment of the fee mandatory for applicants for issuance or renewal of a physician and surgeon's license. The bill would also provide that up to 15% of the funds collected shall be dedicated to loan assistance for physicians and surgeons who agree to practice in geriatric care settings or settings that primarily serve adults over the age of 65 years or adults with disabilities. The bill would require the guidelines for the selection and placement of program applicants to include criteria that would give priority consideration to program applicants who agree to practice in geriatric care settings. Because this bill would provide for the deposit of additional fees in a continuously appropriated fund, it would make an appropriation. This bill would incorporate an additional change to Section 128553 of the Health and Safety Code proposed by AB 2543 contingent on the prior enactment of that bill. This bill would make the operation of its provisions contingent upon the enactment of SB 1379 of the 2007-08 Regular Session. Appropriation: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 2023 of the Business and Professions Code is amended to read: 2023. (a) The board, in conjunction with the Health Professions Education Foundation, shall study the issue of its providing medical malpractice insurance to physicians and surgeons who provide voluntary, unpaid services as described in subdivision (b) of Section 2083, and report its findings to the Legislature on or before January 1, 2008. (b) The report shall include, but not be limited to, a discussion of the following items: (1) The cost of administering a program to provide medical malpractice insurance to the physicians and surgeons and the process for administering the program. (2) The options for providing medical malpractice insurance to the physicians and surgeons and for funding the coverage. (3) Whether the licensure surcharge fee assessed under Section 2436.5 is sufficient to fund the provision of medical malpractice insurance for the physicians and surgeons. (c) This section shall be implemented only after the Legislature has made an appropriation from the Contingent Fund of the Medical Board of California to fund the study. SEC. 2. Section 2435.2 of the Business and Professions Code, as added by Section 1 of Chapter 293 of the Statutes of 2005, is amended and renumbered to read: 2436.5. (a) In addition to the fees charged for the initial issuance or biennial renewal of a physician and surgeon's certificate pursuant to Section 2435, and at the time those fees are charged, the board shall charge each applicant or renewing licensee an additional twenty-five dollar ($25) fee for the purposes of this section. (b) This twenty-five dollar ($25) fee shall be paid at the time of application for initial licensure or biennial renewal. The twenty-five dollar ($25) fee shall be due and payable along with the fee for the initial certificate or biennial renewal. (c) The board shall transfer all funds collected pursuant to this section, on a monthly basis, to the Medically Underserved Account for Physicians created by Section 128555 of the Health and Safety Code for the Steven M. Thompson Physician Corps Loan Repayment Program. (d) Up to 15 percent of the funds collected pursuant this section shall be dedicated to loan assistance for physicians and surgeons who agree to practice in geriatric care settings or settings that primarily serve adults over the age of 65 years or adults with disabilities. Priority consideration shall be given to those physicians and surgeons who are trained in, and practice, geriatrics and who can meet the cultural and linguistic needs and demands of diverse populations of older Californians. SEC. 3. Section 128553 of the Health and Safety Code is amended to read: 128553. (a) Program applicants shall possess a current valid license to practice medicine in this state issued pursuant to Section 2050 of the Business and Professions Code. (b) The foundation, in consultation with those identified in subdivision (b) of Section 123551, shall use guidelines developed by the Medical Board of California for selection and placement of applicants until the office adopts other guidelines by regulation. (c) The guidelines shall meet all of the following criteria: (1) Provide priority consideration to applicants that are best suited to meet the cultural and linguistic needs and demands of patients from medically underserved populations and who 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 three years of experience working in medically underserved areas or with medically underserved populations. (E) Have recently obtained a license to practice medicine. (2) Include a process for determining the needs for physician services identified by the practice setting and for ensuring that the practice setting meets the definition specified in subdivision (h) of Section 128552. (3) Give preference to applicants who have completed a three-year residency in a primary specialty. (4) Seek to place the most qualified applicants under this section in the areas with the greatest need. (5) Include a factor ensuring geographic distribution of placements. (6) Provide priority consideration to applicants who agree to practice in a geriatric care setting and are trained in geriatrics, and who can meet the cultural and linguistic needs and demands of a diverse population of older Californians. On and after January 1, 2009, up to 15 percent of the funds collected pursuant to Section 2436.5 of the Business and Professions Code shall be dedicated to loan assistance for physicians and surgeons who agree to practice in geriatric care settings or settings that primarily serve adults over the age of 65 years or adults with disabilities. (d) (1) The foundation may appoint a selection committee that provides policy direction and guidance over the program and that complies with the requirements of subdivision (l) of Section 128552. (2) The selection committee may fill up to 20 percent of the available positions with program applicants from specialties outside of the primary care specialties. (e) Program participants shall meet all of the following requirements: (1) Shall be working in or have a signed agreement with an eligible practice setting. (2) Shall have full-time status at the practice setting. Full-time status shall be defined by the board and the selection committee may establish exemptions from this requirement on a case-by-case basis. (3) Shall commit to a minimum of three years of service in a medically underserved area. Leaves of absence shall be permitted for serious illness, pregnancy, or other natural causes. The selection committee shall develop the process for determining the maximum permissible length of an absence and the process for reinstatement. Loan repayment shall be deferred until the physician is back to full-time status. (f) The office shall adopt a process that applies if a physician is unable to complete his or her three-year obligation. (g) The foundation, in consultation with those identified in subdivision (b) of Section 128551, shall develop a process for outreach to potentially eligible applicants. (h) The foundation may recommend to the office any other standards of eligibility, placement, and termination appropriate to achieve the aim of providing competent health care services in approved practice settings. SEC. 3.5. Section 128553 of the Health and Safety Code is amended to read: 128553. (a) Program applicants shall possess a current valid license to practice medicine in this state issued pursuant to Section 2050 of the Business and Professions Code. (b) The foundation, in consultation with those identified in subdivision (b) of Section 123551, shall use guidelines developed by the Medical Board of California for selection and placement of applicants until the office adopts other guidelines by regulation. (c) The guidelines shall meet all of the following criteria: (1) Provide priority consideration to applicants that are best suited to meet the cultural and linguistic needs and demands of patients from medically underserved populations and who 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 three years of experience working in medically underserved areas or with medically underserved populations. (E) Have recently obtained a license to practice medicine. (2) Include a process for determining the needs for physician services identified by the practice setting and for ensuring that the practice setting meets the definition specified in subdivision (h) of Section 128552. (3) Give preference to applicants who have completed a three-year residency in a primary specialty. (4) Seek to place the most qualified applicants under this section in the areas with the greatest need. (5) Include a factor ensuring geographic distribution of placements. (6) Provide priority consideration to applicants who agree to practice in a geriatric care setting and are trained in geriatrics, and who can meet the cultural and linguistic needs and demands of a diverse population of older Californians. On and after January 1, 2009, up to 15 percent of the funds collected pursuant to Section 2436.5 of the Business and Professions Code shall be dedicated to loan assistance for physicians and surgeons who agree to practice in geriatric care settings or settings that primarily serve adults over the age of 65 years or adults with disabilities. (d) (1) The foundation may appoint a selection committee that provides policy direction and guidance over the program and that complies with the requirements of subdivision (l) of Section 128552. (2) The selection committee may fill up to 20 percent of the available positions with program applicants from specialties outside of the primary care specialties. (e) Program participants shall meet all of the following requirements: (1) Shall be working in or have a signed agreement with an eligible practice setting. (2) Shall have full-time status at the practice setting. Full-time status shall be defined by the board and the selection committee may establish exemptions from this requirement on a case-by-case basis. (3) Shall commit to a minimum of three years of service in a medically underserved area. Leaves of absence shall be permitted for serious illness, pregnancy, or other natural causes. The selection committee shall develop the process for determining the maximum permissible length of an absence and the process for reinstatement. Loan repayment shall be deferred until the physician is back to full-time status. (f) The office shall adopt a process to reconcile the loan should a physician be unable to complete his or her three-year obligation. (g) The foundation, in consultation with those identified in subdivision (b) of Section 128551, shall develop a process for outreach to potentially eligible applicants. (h) The foundation may recommend to the office any other standards of eligibility, placement, and termination appropriate to achieve the aim of providing competent health care services in approved practice settings. SEC. 4. Section 3.5 of this bill incorporates amendments to Section 128553 of the Health and Safety Code proposed by both this bill and AB 2543. It shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2009, (2) each bill amends Section 128553 of the Health and Safety Code, and (3) this bill is enacted after AB 2543, in which case Section 3 of this bill shall not become operative. SEC. 5. This act shall become operative only if Senate Bill 1379 of the 2007-08 Regular Session is enacted and becomes effective on or before January 1, 2009.