BILL ANALYSIS Ķ
AB 565
Page 1
Date of Hearing: April 16, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 565 (Salas) - As Amended: April 10, 2013
SUBJECT : California Physician Corps Program.
SUMMARY : Revises the definition of community clinic for
purposes of the Steven M. Thompson Physician Corps Loan
Repayment Program (STLRP) to include a private practice that
provides primary care located in a medically underserved area
(MUA) and has a minimum of 30% uninsured, Medi-Cal, or other
publicly funded program that serves patients who earn less than
250% of the federal poverty level. Revises one of the criteria
of the STLRP to require that an applicant have three years
providing health care services to medically underserved
populations (MUPs) in a federally designated health professional
shortage area (HPSA) or MUA instead of working in medically
underserved areas or with MUPs. Deletes the STLRP guideline
that seeks to place the most qualified applicants in the areas
with the greatest need and replaces it with the requirement that
the STLRP gives preference to applicants who agree to practice
in a HPSA or MUA and who agree to serve a MUP.
EXISTING LAW :
1)Establishes the Health Professions Education Foundation (HPEF)
within the Office of Statewide Health Planning and Development
(OSHPD) to, among other functions, develop criteria for
evaluating applicants for various scholarships or loans.
2)Establishes the California Physician Corps Program, which
consists of the STLRP and the Physician Volunteer Program,
administered by HPEF.
3)Requires STLRP to provide financial incentives, as specified,
to applicants who possess a current valid medical or
osteopathic license who practice in medically underserved
communities, as specified. Allows up to 20% of the available
positions to be awarded to applicants from specialties outside
of primary care. Requires up to 15% of funds to be dedicated
to loan assistance for physician and surgeons who agree to
practice in geriatric settings.
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4)Defines MUA as consistent with the federal definition of a
HPSA or an area of the state where unmet priority needs for
physicians exist as determined by the California Healthcare
Workforce Policy Commission.
5)Defines MUP as the Medi-Cal program, the Healthy Families
program, and uninsured population.
6)Defines practice setting for purposes of the STLRP as either:
a) A community clinic as defined, a clinic owned or
operated by a public hospital and health system, or a
clinic owned and operated by a hospital that maintains the
primary contract with a county government to fulfill the
county's role to serve indigent population, which is
located in a MUA and at least 50% of whose patients are
from a MUP; or,
b) A medical practice located in a MUA and at least 50% of
whose patients are from a MUP.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The California Medical Association is
the sponsor of this bill. According to the author, despite
certain areas of the state facing drastic physician shortages,
some regions have not received a STLRP placement. This bill
ensures STLRP awards are going to the most medically
underserved communities.
2)BACKGROUND .
a) STLRP . STLRP was established in 2003 to encourage
recently licensed physicians to practice in HPSAs in
California. STLRP authorizes a plan for repaying up to
$105,000 in educational loans in exchange for full-time
service for a minimum of three years. STLRP guidelines
include:
i) Priority consideration to applicants that are best
suited to meet the cultural and linguistic needs and
demands of patients from MUPs and who meet one or more of
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the following criteria:
(1) Speak a Medi-Cal threshold language;
(2) Come from an economically disadvantaged
background;
(3) Have received significant training in cultural
and linguistically appropriate service delivery;
(4) Have three years of experience working in MUAs
or with MUPs; and/or,
(5) Have recently obtained a license to practice
medicine.
ii) A process for determining the need for physician
services identified by the practice setting, and for
ensuring that the practice setting qualifies;
iii) Preference to applicants who have completed a
three-year residency in a primary specialty (family
practice, internal medicine, pediatrics, or
obstetrics/gynecology);
iv) Placing the most qualified applicants in areas with
the greatest need;
v) A factor ensuring geographic distribution of
placements; and,
vi) Priority consideration to applicants who agree to
practice in a geriatric setting and are trained in
geriatrics, as specified.
b) Program Report to the Legislature . In 2012, OSHPD
submitted its annual STLRP report to the Legislature.
According to the report, since inception, the STLRP has
awarded $17 million to 223 individuals. In 2011, HPEF
awarded more than $4.1 million to 76 physicians (out of 185
applicants requesting approximately $17.6 million in loan
repayments). Award recipients include individuals
practicing at federally qualified health centers or look
alikes, community health centers, rural health centers,
migrant health centers, public housing health centers,
correctional facilities, and Indian health clinics. The
report indicates that performance reviews of STLRP
participants are conducted by HPEF through mandatory
biannual reports which are completed and submitted by
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supervisors, clinic directors, or other appropriate
managers of the practice settings where the participants
are serving their service obligation.
The report indicates that throughout the Spring of 2011, HPEF
developed a partnership with the Healthcare Workforce
Development Council to leverage STLRP awards with matching
funds from the Federal American Recovery and Reinvestment
Act of 2009, and these matching funds were awarded to 61 of
the 76 physicians selected.
c) Federally designated HPSAs . HPSAs are designated by the
Health Resources and Services Administration (HRSA) as
having shortages of primary medical care, dental or mental
health providers and may be geographic (a county or service
area), demographic (low income population), or
institutional (comprehensive health center, federally
qualified health center, or other public facility).
MUAs/MUPs are areas or populations designated by HRSA as
having: too few primary care providers, high infant
mortality, high poverty, and/or high elderly populations.
3)SUPPORT . According to the Community Clinic Association of Los
Angeles County, this bill tightens existing guidelines by
which health care providers are selected for the STLRP. This
bill would help address the shortage and poor distribution of
qualified primary care providers practicing in underserved
areas. The Association of California Healthcare Districts
state that this bill has the potential to encourage physicians
to remain in underserved areas, thereby bringing qualified
physicians to areas that may not otherwise have a physician to
provide care.
4)RELATED LEGISLATION .
a) AB 860 (Perea and Bocanegra) appropriates $600,000 from
the Managed Care Administrative Fines and Penalties Fund
(Managed Care Fund) to the Steven Thompson Medical School
Scholarship Program within HPEF. AB 860 is pending in
Assembly Appropriations Committee.
b) AB 1176 (Bocanegra and Bonta) establishes the Medical
Residency Training Program within OSHPD to fund graduate
medical education residency programs in California, as
specified. AB 1176 is pending in this Committee.
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c) SB 20 (Ed Hernandez), pending in Senate Appropriations
Committee, requires, beginning on the date that the Major
Risk Medical Insurance Program (MRMIP) becomes inoperative,
all the funds in the Managed Care Fund to be transferred
each year for purposes of the STLRP.
5)PREVIOUS LEGISLATION .
a) SB 606 (Ducheny), Chapter 600, Statutes of 2009,
requires the Osteopathic Medical Board of California to
assess an additional $25 fee from an osteopathic physician
and surgeon applying for initial or reciprocity licensure,
or for a biennial renewal license. Requires the funds
collected to be transferred to the Medically Underserved
Account for Physicians for STLRP. Allows osteopathic
physicians and surgeons to be eligible to apply for the
STLRP.
b) SB 1379 (Ducheny), Chapter 607, Statutes of 2008,
requires fines and administrative penalties levied against
health plans under the Knox-Keene Health Care Service Plan
Act of 1975 to be placed in the Managed Care Fund and used,
upon appropriation by the Legislature, for STLRP and MRMIP.
SB 1379 also appropriates $1 million annually for purposes
of the STLRP.
c) AB 2439 (De la Torre), Chapter 640, Statutes of 2008,
requires the Medical Board of California (MBC) to charge
physicians and surgeons an additional $25 as part of their
initial license fee or renewal fee to support the STLRP.
d) AB 920 (Aghazarian), Chapter 317, Statutes of 2005,
transfers the administration of the STLRP from the MBC to
the HPEF.
e) AB 327 (De la Torre), Chapter 293, Statutes of 2005,
requires the MBC to assess a $50 voluntary donation from
physicians and surgeons at the time of licensure or
renewal.
f) AB 1403 (Nuņez), Chapter 367, Statutes of 2004, renames
the California Physician Corps Loan Repayment Program as
the STLRP effective January 1, 2005.
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g) AB 982 (Firebaugh), Chapter 1131, Statutes of 2002,
establishes the California Physician Corps Loan Repayment
Program within the MBC.
6)SUGGESTED AMENDMENTS :
a) Technical amendments . Since existing law already
defines a MUA as a federal HPSA, the Committee may wish to
amend this bill to instead refer to existing law's
definition of MUA.
b) Definition of Practice Setting . This bill revises the
definition of a community clinic eligible for STLRP grants
to include a private practice that provides primary care in
a MUA and has a minimum of 30% uninsured, Medi-Cal, or
other publicly funded programs that serve patients who earn
less than 250% of the federal poverty level. Current law
defines a practice setting eligible to apply for grants to
include a medical practice located in a MUA and at least
50% of whose patients are from medically underserved
population. The Committee may wish to amend this bill
require HPEF to give priority consideration to applicants
from rural communities who agree to practice in a physician
owned and operated medical practice setting as defined in
Section 128552 (i) (2).
REGISTERED SUPPORT / OPPOSITION :
Support
California Medical Association (sponsor)
American College of Emergency Physicians, California Chapter
Association of California Healthcare Districts
California Optometric Association
Community Clinic Association of Los Angeles County
Rural County Representatives of California
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
AB 565
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