BILL ANALYSIS �
SB 271
Page 1
Date of Hearing: July 2, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 271 (Ed Hernandez) - As Introduced: February 14, 2013
SENATE VOTE : 38-0
SUBJECT : Associate Degree Nursing Scholarship Program.
SUMMARY : Deletes the January 1, 2014 sunset date, and makes
permanent the Associate Degree Nursing Scholarship Pilot Program
(ADN Scholarship Program), and deletes references to the program
as a pilot.
EXISTING LAW :
1)Establishes, until January 1, 2014, the ADN Scholarship
Program in the Office of Statewide Health Planning and
Development (OSHPD) to increase the number of registered
nurses RNs) and to encourage RNs to practice direct patient
care in medically underserved areas (MUAs) of California.
2)Establishes the Health Professions Education Foundation (HPEF)
within OSHPD, among other functions, to administer the ADN
Scholarship Program.
3)Establishes the Registered Nurse Education Fund (RNEF) for
purposes of the California Registered Nurse Education Program.
Requires RNEF to receive money collected from assessments of
RNs.
4)Establishes the Board of Registered Nursing (BRN) to regulate
the practice of RNs. Requires the BRN to assess a biennial
fee for the renewal of an RN license which is not to be less
than $75 and no more than $150. Requires the BRN to
additionally collect an assessment of $10 to be credited to
the RNEF.
FISCAL EFFECT : According to the Senate Appropriations
Committee, there will be ongoing costs of about $700,000 per
year to provide scholarships and administer grants (special
fund). Over the last five years, scholarship awards (including
administrative costs) have ranged from about $400,000 to
$780,000 with an average of about $650,000.
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COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, implementation
of the Patient Protection and Affordable Care Act will bring
millions of uninsured Californians into the health care
delivery system in 2014, exacerbating an existing health
provider shortage. Coupled with a disproportionate geographic
distribution of providers and an aging workforce, this
shortage has significant potential to negatively impact
patient care. While the nation has been experiencing a
shortage of nurses for more than a decade, the shortage has
been particularly acute in California, where it is exacerbated
by higher education budget cuts. The nursing shortage has
also resulted in a diminished ability to educate the incoming
population of nursing students. This bill will ensure that
this valuable program continues to operate, providing patient
access to practitioners in MUAs.
2)BACKGROUND .
a) ADN Scholarship Program . The ADN Scholarship Program
was established to increase the number of registered nurses
and to encourage nurses to practice direct patient care in
MUAs of California. Students who are currently enrolled or
accepted into an Associate Degree Nursing Program and are
free from any other service obligation may receive up to
$10,000 for one academic year. In return for receiving the
scholarship, awardees must agree to practice direct patient
care for two years in a MUA of California. Specifically,
the ADN Scholarship Program is available only to students
in counties determined to have the most need. Need in a
county is established based on all the following factors:
a) Counties with a RN-to-population ratio equal or less
than 500 RNs per 100,000 individuals; b) County
unemployment rate; and, c) County level of poverty. The
HPEF shall consider the applicant's economic need and
cultural and linguistic skills and abilities. Funding for
the ADN Scholarship Program comes from the Registered Nurse
Education Fund which in turn is funded by $10 assessment on
the biennial renewal license fees paid for by RNs to the
BRN.
According to OSHPD, the current demand for ADN scholarships
vastly outweighs the supply of available funding for the
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program. Since May 2003 and through September 2011, HPEF
has received $10.6 million in scholarship applications and
$3.2 million in ADN scholarships were awarded. The table
below illustrates the demand for this program in the last
10 years:
----------------------------------------------------------
| Calendar | Applications | Funds |
| Year | Received | Requested |
| | Awarded | Awarded |
----------------------------------------------------------
|----------+--------+-----------+-----------+--------------|
| 2003 | 94 | 29 |$ | $ 103,500 |
| | | | 752,000| |
|----------+--------+-----------+-----------+--------------|
| 2004 | 155 | 23 |$1,240,000 | $ 152,000 |
|----------+--------+-----------+-----------+--------------|
| 2005 | 160 | 35 |$1,120,000 | $ 214,000 |
|----------+--------+-----------+-----------+--------------|
| 2006 | 110 | 29 |$ | $ 152,000 |
| | | | 524,000| |
|----------+--------+-----------+-----------+--------------|
| 2007 | 133 | 65 |$ | $ 476,000 |
| | | | 824,000| |
|----------+--------+-----------+-----------+--------------|
| 2008 | 205 | 53 |$ | $ 343,000 |
| | | | 580,000| |
|----------+--------+-----------+-----------+--------------|
| 2009 | 213 | 61 |$1,305,000 | $ 575,000 |
|----------+--------+-----------+-----------+--------------|
| 2010 | 247 | 71 |$2,215,000 | $ 615,952 |
|----------+--------+-----------+-----------+--------------|
| 2011 | 204 | 64 |$2,040,000 | $ 484,836 |
|----------+--------+-----------+-----------+--------------|
| 2012 | 203 | * |$2,030,000 | |
| | | | | * |
----------------------------------------------------------
* Funding cycle is scheduled for February 2013
b)Steven M. Thompson Physician Corps Loan Repayment Program
(STLRP) . STLRP was established in 2003 to encourage recently
licensed physicians to practice in health professions shortage
areas, as defined, 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. In 2012,
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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
supervisors, clinic directors, or other appropriate managers
of the practice settings where the participants are serving
their service obligation.
3)SUPPORT . The Association of California Healthcare Districts
states that this bill provides a process to increase health
care services and helps increase access to care in the most
underserved areas of California. According to SEIU
California, scholarships are an effective means of increasing
the supply of educated and trained health professionals. The
HPEF's applicants and awardees for the ADN Scholarship Program
represent the state's diverse populations, increasing access
to quality and to culturally and linguistically appropriate
practitioners in MUAs. The California Hospital Association
states that while the supply of RNs is presently stable, 50%
of California's RNs with active licenses are over the age of
50 and are predicted to retire or reduce hours as the economy
improves. While the RN supply numbers are fairly steady, the
demand-drivers for nurses for the coming decade are very
uncertain, and this bill would assist in alleviating the
shortage.
4)RELATED LEGISLATION .
a) AB 565 (Salas) revises program criteria of the Steven M.
Thompson Physician Corps Loan Repayment Program (STLRP) and
revises the definition of practice setting for purposes of
the STLRP to include a private practice that provides
primary care located in a MUA and has a minimum of 30%
uninsured, Medi-Cal, or other publicly funded program that
serve patients under 250% of the federal poverty level. AB
565 is pending in Senate Health Committee.
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b) AB 860 (Perea and Bocanegra) appropriates $600,000 from
the Managed Care Administrative Fines and Penalties Fund to
the Steven M. Thompson Medical School Scholarship Program
Account within HPEF. AB 860 was held in the Assembly
Appropriations Committee's suspense file.
c) AB 1176 (Bocanegra and Bonta) establishes the Medical
Residency Training Program (MRT Program) to fund graduate
medical education (GME) residency programs in California.
Requires every health insurer or health care service plan
that provides health care coverage in this state to pay an
annual GME assessment of $5 for each covered life for
purposes of the MRT Program. AB 1176 was held in the
Assembly Appropriations Committee's suspense file.
d) SB 20 (Ed Hernandez) requires, beginning on the date
that the California Major Risk Medical Insurance Program
becomes inoperative, all the fines and administrative
penalties deposited into the Managed Care Administrative
Fines and Penalties Fund to be transferred by the
Department of Managed Health Care to the Medically
Underserved Account for Physicians within HPEF for purposes
of the STLRP, as specified. SB 20 is pending in this
Committee.
5)TECHNICAL AMENDMENTS . The Health and Safety Code reference for
the source of funding for the RNEF, which funds ADN
Scholarships, should be updated as follows:
128400 . There is hereby established in the State Treasury the
Registered Nurse Education Fund. All money in the fund shall
be used for the purposes specified in the California
Registered Nurse Education Program established pursuant to
this article. This fund shall receive money collected pursuant
to subdivision (c) (d) of Section 2815 and Section 2815.1 of
the Business and Professions Code.
6)POLICY SUGGESTION . Similar to the general data that is
submitted to the Legislature for purposes of the STLRP, the
Committee may wish to recommend that OSHPD publish on its
Website program updates and statistics about the ADN
Scholarship Program.
REGISTERED SUPPORT / OPPOSITION :
Support
SB 271
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American Federation of State, County and Municipal Employees,
AFL-CIO
Association of California Healthcare Districts
California Association for Health Services at Home
California Hospital Association
California Nurses Association
California Optometric Association
California Primary Care Association
Hospital Corporation of America
Rural County Representatives of California
SEIU California
United Nurses Association of California/Union of Health Care
Professionals
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097