BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1031|
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THIRD READING
Bill No: SB 1031
Author: Corbett (D)
Amended: 5/28/10
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM : 7-0, 4/19/10
AYES: Negrete McLeod, Wyland, Aanestad, Correa, Oropeza,
Walters, Yee
NO VOTE RECORDED: Calderon, Florez
SENATE APPROPRIATIONS COMMITTEE : 10-0, 5/27/10
AYES: Kehoe, Alquist, Corbett, Denham, Leno, Price,
Walters, Wolk, Wyland, Yee
NO VOTE RECORDED: Cox
SUBJECT : Medical malpractice insurance: volunteer
physicians and
surgeons
SOURCE : Medical Board of California
California Medical Association
DIGEST : This bill creates a Volunteer Insured Physicians
Program, within the Medical Board of California to provide
specified medical malpractice insurance coverage to
physicians providing volunteer uncompensated care to
patients pursuant to a contract with a qualified health
care entity, as defined.
ANALYSIS : Existing law:
CONTINUED
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1. Establishes the Medical Board of California (MBC) to
license, regulate, and discipline physicians and
surgeons, specifies that the protection of the public is
the highest priority of the MBC, and imposes various
fees on those licensees.
2. Provides that the license fee and the renewal fee shall
be waived for a physician and surgeon who certifies to
the MBC that the issuance of the license or the renewal
of the license is for the sole purpose of providing
voluntary, unpaid service.
3. Establishes within the Office of Statewide Health
Planning and Development (OSHPD) the Health Professions
Education Foundation (HPE Foundation), which is a
nonprofit public benefit corporation, and establishes
under the HPE Foundation the California Physician Corps
Program which includes: (1) The Steven M. Thompson
Physician Corps Loan Repayment Program (STLRP); and, (2)
the Physician Volunteer Program (PVP) developed by the
MBC. Provides that OSHPD and the Foundation shall have
ongoing responsibility for implementation and program
management of both the STLRP and the PVP.
4. Creates within the OSHPD a "Health Professions Education
Fund" (HPE Fund) with the primary purpose to provide
scholarships and loans to students from underrepresented
groups who are accepted to or enrolled in schools of
medicine, dentistry, nursing, or other health
professions. The HPE Fund is supported entirely through
grants and contributions from public and private
agencies, hospitals, health plans, foundations,
corporations, individuals and through licensing fees of
specified health care practitioners.
5. Creates the "Medically Underserved Account for
Physicians" (MUAP) within the HPE Fund with the primary
purpose to provide funding for the ongoing operations of
STLRP and PVP.
6. Requires in addition to the fees charged for the initial
issuance or biennial renewal of a physician and
surgeon's certificate, and at the time those fees are
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charged, that the MBC charge each applicant, or renewing
licensee, an additional $25 fee and that these moneys
shall be transferred on a monthly basis to the MUAP
which is within the HPE Fund and which is administered
by OSHPD. Specified, however, that these funds shall
not be used to provide funding for the PVP.
7. Requires the MBC, in conjunction with the HPE
Foundation, to study the issue of providing medical
malpractice insurance to physicians and surgeons who
provide voluntary, unpaid services and to report its
finding to the Legislature by January 1, 2008.
This bill:
1. Creates the Volunteer Insured Physicians (VIP) Program
pursuant to the Volunteer Insured Physicians Act.
2. Provides that the following definitions shall apply:
A. "Volunteer physician" means a licensee provides
primary care medical services in California without
receiving monetary or material compensation and who is
participating in the VIP program.
B. "Qualified health care entity" means a community
clinic, as defined, a county health department or
hospital district, hospital, or a clinic owned and
operated by a governmental entity that provided
primary care to low-income patients.
C. "Low income patient" means a person who is without
health care coverage and whose family income does not
exceed 200 percent of the federal poverty level, as
defined annually by the federal Office of Management
and Budget.
D. "Voluntary service agreement" means an agreement
executed between the MBC, a licensee, and a qualified
health care entity that authorizes the health care
entity to enter into a voluntary service contract with
the licensee.
E. "Voluntary service application" means the written
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application developed by the MBC that a licensee must
complete and submit in order to be considered for
participation in the VIP Program.
F. "Voluntary service contract" means an agreement
executed between a licensee and a qualified health
care entity that authorizes the licensee to deliver
health care services to patients as an agent of the
qualified health care entity on a voluntary,
uncompensated basis.
G. "Patient" means a person who is eligible for free
or discounted services at a qualified health care
entity.
3. Provides that a licensee who wants to provide voluntary,
uncompensated care to low-income patients, but who does
not have medical professional liability insurance may
submit a voluntary service application to the MBC for
coverage under the VIP Program.
4. Requires the MBC, when it receives an application for
voluntary license to assess whether the applicant
qualifies for coverage under the VIP Program.
5. Permits a licensee who already has standard medical
professional liability insurance coverage for his or her
regular practice but who is not covered for volunteer
service may submit a voluntary service application to
participate in the VIP Program, and in conjunction with
the voluntary service application, the licensee shall
submit verification from his or her medical professional
liability insurance carrier that voluntary,
uncompensated care is not covered by his or her existing
medical professional liability insurance policy.
6. Provides that the criteria for participation in the VIP
Program includes holding a license in good standing and
no record of disciplinary action by the MBC or any other
regulatory board.
7. Provides that eligibility for the VIP Program shall be
reassessed by the MBC during each license renewal cycle.
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8. Provides that licensees approved by the MBC for
participation in the VIP Program may enter into a
voluntary service agreement with the MBC and a qualified
health care entity that acknowledges the terms of the
VIP Program and transfers responsibility from the
volunteer physician to the state for medical
professional liability insurance, including premiums,
defense and indemnity costs, for voluntary,
uncompensated medical care that is provided in
accordance with an executed and signed voluntary service
contract between the volunteer physician and the
qualified health care entity and that complies with the
terms of the VIP Program.
9. Specifies what the voluntary service contract between
the volunteer physician and the qualified health care
entity shall include.
10.Requires volunteer physicians participating in the VIP
Program to agree to limit the scope of volunteer medical
care to primary care medical services.
11.Provides that the fact that a volunteer physician is
insured under the VIP Program in relation to particular
medical services rendered shall not operate to change or
affect the laws applicable to any claims arising from or
related to those medical services, and that all laws
applicable to a claim remain the same regardless of
whether a licensee is insured through the VIP Program.
12.Requires that when a volunteer physician covered by the
VIP Program receives notice or otherwise obtains
knowledge that a claim of professional medical
negligence has been or may be filed, that they
immediately notify the VIP Program or the contracted
liability carrier.
13.Provides that all costs for administering the VIP
Program, including the cost of medical professional
liability insurance for premiums, defense, and indemnity
coverage for program participants, shall be paid from
the Contingent Fund of the MBC.
14.Requires the MBC to annually report to the Legislature
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on the efficiency, access and treatment outcomes of the
care provided through this program.
Prior Legislation
AB 2439 (De La Torre, Chapter 640, Statutes of 2008)
required the MBC to charge physicians and surgeons an
additional $25 as part of their initial license fee or
renewal fee to support the STLRP.
AB 2342 (Nakanishi, Chapter 276, Statutes of 2006) required
the MBC, in conjunction with the Health Professions
Education Foundation, to study the issue of providing
medical malpractice insurance to physicians who provide
voluntary, unpaid services and report its findings to the
Legislature on or before January 1, 2008.
AB 621 (Nakanishi, 2003) would have created within the
Department of Health Services (DHS) the "Physicians and
Surgeons Liability Insurance Pilot Program" (PSLIPP) to
purchase liability insurance for physicians who are
eligible under existing law for waiver of license renewal
fees if the sole purpose of license renewal is to provide
voluntary, unpaid services to specified agencies. Made the
PSLIPP contingent upon receiving private funding sufficient
to pay for the administrative costs of the program and the
cost of liability insurance. Estimated costs for DHS to
establish and administer the PSLIPP was $100,000 and costs
for liability insurance estimated to be $1.1 to $1.9
million. That bill was held in the Senate Appropriations
Committee.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
VIP Program administration
and purchase of insurance $125 $360
$360Special*
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*Contingent Fund of the Medical Board of California
SUPPORT : (Verified 5/27/10)
Medical Board of California (co-source)
California Medical Association (co-source)
California Academy of Family Physicians
ARGUMENTS IN SUPPORT : According to the author's office,
the California HealthCare Foundation has reported that the
number of Californians without medical insurance coverage
has risen to 6.7 million, including 1 million uninsured
children and that 76 percent of California's uninsured are
from minority communities. The Author and CMA states that
it has long been recognized by health care leaders that one
of the challenges and potential barriers to physician
volunteerism is the concern about medical malpractice
liability associated with providing uncompensated care and
that the federal government and 43 states have established
a program to promote volunteerism by physicians.
California, the Author argues, is one of the seven
remaining states in the U.S. that have no program to cover
physicians that provide unpaid, voluntary services.
The MBC reports that there are over 125,000 licensed
physicians in California, yet California's clinics suffer
from an inadequate supply of physicians to care for the
under- or non-insured population. The MBC indicates that
many physicians who would like to volunteer their services
are unable to do so due to the cost of medical practice
insurance and believes that providing this insurance would
undoubtedly encourage more physicians to volunteer their
time and services to communities and consumers in need and
would lead to expanded access to health care for consumers
in California.
The CMA believes that in the absence of a sufficient supply
of physicians providing services at free community clinics
and health centers, patients without the ability to pay for
medical care would most likely go without care or seek
services at an emergency room and that within the emergency
room setting, the cost of care will be shifted to the
government who is likely to pay for part of the costs, to
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physicians who end up providing involuntary uncompensated
care, to the hospital, and to other paying patients when
costs are increased to cover any operating shortfall. So,
the CMA argues, it is clearly in the public interest to
facilitate the provision of primary care services in
clinics to patients who cannot afford to pay.
JA:nl 5/28/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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