BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 565|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 565
Author: Salas (D)
Amended: 9/3/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/26/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 8/30/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 70-0, 5/16/13 (Consent) - See last page for
vote
SUBJECT : California Physician Corps Program
SOURCE : California Medical Association
DIGEST : This bill revises the criteria required for the
selection and placement of California Physician Corps Program
(Corps Program) applicants. This bill also revises the criteria
that Corps Program participants must meet.
ANALYSIS :
Existing law:
1. Establishes the Health Professions Education Foundation
(HPEF) within the Office of Statewide Health Planning and
CONTINUED
AB 565
Page
2
Development (OSHPD) to, among other functions, develop
criteria for evaluating applicants for various scholarships
and loans.
2. Establishes the Corps Program, which consists of the Stephen
M. Thompson Loan Repayment Program (SMT Program) and the
Physician Volunteer Program, administered by HPEF. Requires
the Corps Program 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.
3. Defines medically underserved area (MUA) as consistent with
the federal definition of a Health Professional Shortage Area
(HPSA) or an area of the state where unmet priority needs for
physicians exist as determined by the California Healthcare
Workforce Policy Commission.
4. Defines medically underserved populations (MUP) as those
covered under the Medi-Cal and Healthy Families programs and
the uninsured.
5. Requires applicants to the Corps Program to be working
full-time in a practice setting or have signed an agreement
to work full-time in a practice setting. Defines "practice
setting" 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.
This bill:
1. Expands the definition of "practice setting" to include a
physician-owned and operated medical practice setting that
provides primary care located in a MUA and has a minimum of
50% uninsured, Medi-Cal, or other publicly funded programs
CONTINUED
AB 565
Page
3
that serve patients who earn less than 250% of the federal
poverty level.
2. Revises criteria to be met by guidelines developed by the
HPEF and OSHPD for the selection and placement of Corps
Program applicants to:
A. Require that an applicant have three years providing
health care services to MUP or MUA instead of working in
MUAs or with MUPs;
B. Delete guideline criteria seeking to place the most
qualified applicants in the areas with the greatest need
and replaces it with the giving preference to applicants
who agree to practice in an HPSA or MUA and who agree to
serve an MUP; and,
C. Give priority consideration to applicants from rural
communities who agree to practice in a physician-owned and
operated medical practice setting located in an MUA with
at least 50% of patients from an MUP.
Comments
Primary care physician workforce shortage . According to a
report commissioned by the California Health Care Foundation,
the number of primary care physicians actively practicing in
California is at the very bottom range of, or below, the state's
need. The distribution of these physicians is equally as poor.
In 2008, there were 69,460 actively practicing physicians in
California (this includes Doctors of Medicine and Doctors of
Osteopathic Medicine) with only 35% of these physicians reported
practicing primary care. This equates to 63 active primary care
physicians per 100,000 persons. According to the Council on
Graduate Medical Education, a range of 60 to 80 primary care
physicians is needed per 100,000 persons to adequately meet the
needs of the population. When the same metric is applied
regionally, only 16 of California's 58 counties fall within the
needed supply range for primary care physicians.
Corps Program . The Corps Program consists of two programs: the
Volunteer Physicians Program and the SMT Program. According to
OSHPD, the Volunteer Physicians Program has never been
implemented. The SMT Program encourages recently licensed
CONTINUED
AB 565
Page
4
physicians to practice in HPSAs in California and repays up to
$105,000 in educational loans in exchange for full-time service
for at least three years. To be considered eligible for an
award, applicants must:
1. Be an allopathic or osteopathic physician;
2. Be free of any contractual service obligations (i.e. the
National Health Service Corps Federal Loan Repayment Program
or other financial incentive programs);
3. Have outstanding educational debt from a government or
commercial lending institution;
4. Have a valid, unrestricted license to practice medicine in
California;
5. Be employed or have accepted employment in a HPSA in
California; and,
6. Commit to providing full-time direct patient care in a HPSA.
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.
Prior Legislation
SB 635 (Hernandez, 2012) was substantially similar to SB 20
(Hernandez, 2013), but would have instead transferred the
Managed Care Administrative Fines and Penalties (MCAFP) funds to
a newly created Song-Brown Program Account, which supports
training for health care professionals. The bill was held on
suspense in the Assembly Appropriations Committee.
SB 606 (Ducheny, Chapter 600, Statutes of 2009) requires the
Osteopathic Medical Board of California to assess an additional
$25 fee to an osteopathic physician and surgeon applying for
CONTINUED
AB 565
Page
5
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 SMT Program.
Allows osteopathic physicians and surgeons to be eligible to
apply for the SMT Program.
SB 1379 (Ducheny, Chapter 607, Statutes of 2008) requires fines
and administrative penalties levied against health plans under
the Knox-Keene Act to be placed in the MCAFP Fund and used, upon
appropriation by the Legislature, for a physician loan-repayment
program and Major Risk Medical Insurance Program (MRMIP).
Requires the Department of Managed Health Care to make a
one-time transfer of fine and administrative penalty revenue of
$10 million to MRMIP and $1 million to the loan repayment
program. Prohibits using the fines and administrative penalties
authorized by the Knox-Keene Act to reduce assessments on health
plans.
AB 2439 (De La Torre, Chapter 640, Statutes of 2008) mandates
the Medical Board of California (MBC) assess a $25 fee to
applicants for issuance or renewal of a physician and surgeon's
license. Provides 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 or adults with
disabilities.
AB 1403 (Nuñez, Chapter 367, Statutes of 2004) renames the
California Physician Corps Loan Repayment Program as the SMT
Program effective January 1, 2005.
AB 982 (Firebaugh, Chapter 1131, Statutes of 2002) establishes
the California Physician Corps Loan Repayment Program within the
MBC.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, minor impact
for loan repayment funds (Health Professions Education Fund).
SUPPORT : (Verified 9/1/13)
California Medical Association (source)
CONTINUED
AB 565
Page
6
American Academy of Pediatrics, California
Association of California Healthcare Districts
Board of Trustees of the Delano Joint Union High School District
California Academy of Physician Assistants
California Chapter of the American College of Emergency
Physicians
California Optometric Association
City of Hanford
Community Action Partnership of Kern
Community Clinic Association of Los Angeles County
Kern Medical Center
Medical Board of California
Osteopathic Physicians and Surgeons of California
Rural County Representatives of California
Semitropic Elementary School District
ARGUMENTS IN SUPPORT : According to the author's office, there
are many communities in California that have physician shortages
that put people's health at risk. In Kern County alone, there
are 1,200 patients for every primary care physician-nearly
double the national average. This bill ensures that physicians
participating in the loan repayment program are serving low
income populations in medically underserved communities. This
bill has the potential to bring much needed physicians to some
of the most MUPs in the Central Valley and throughout
California.
According to the Medical Board of California and Community
Clinic Association of Los Angeles County, this bill tightens
existing guidelines by which health care providers are selected
for the SMT Program and that it will help address the shortage
and poor distribution of qualified primary care providers
practicing in underserved areas. The Association of California
Healthcare Districts states 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. The California Chapter of the
American College of Emergency Physicians states this bill will
improve access to health care for patients in underserved
communities by changing the selection and placement guidelines
of the California Physician Corps Program. The American Academy
of Pediatrics, California writes that by broadening the
definition of qualified practice sites to include private
practice, this bill has the potential to draw a new population
CONTINUED
AB 565
Page
7
of physicians to underserved areas.
ASSEMBLY FLOOR : 70-0, 5/16/13
AYES: Achadjian, Alejo, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Donnelly, Fong, Fox, Frazier, Garcia,
Gatto, Gomez, Gordon, Gorell, Gray, Hagman, Hall, Harkey,
Roger Hernández, Jones, Jones-Sawyer, Levine, Linder, Logue,
Lowenthal, Maienschein, Mansoor, Medina, Mitchell, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Ting, Torres, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Allen, Buchanan, Eggman, Beth Gaines, Grove,
Holden, Melendez, Morrell, Stone, Vacancy
JL:k 9/3/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED