BILL ANALYSIS Ķ
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|Hearing Date:April 21, 2014 |Bill No:SB |
| |1116 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: SB 1116Author:Torres
As Introduced: February 16, 2014 Fiscal:Yes
SUBJECT: Physicians and surgeons.
SUMMARY: Authorizes the voluntary payment of an additional $75, by a
physician and surgeon to the Medical Board of California, and by an
osteopathic physician to the Osteopathic Medical Board of California,
for purposes of the Steven M. Thompson Physician Corps Loan Repayment
Program.
Existing law:
1)Establishes the Medically Underserved Account for Physicians
(Account) within the Health Professions Education Fund that is
managed by the Health Professions Education Foundation (Foundation)
and the Office of Statewide Health Planning and Development (OSHPD),
and specifies that the primary purpose of the Account is to fund the
Steven M. Thompson Physician Corps Loan Repayment Program (STLRP).
(Health and Safety Code (HSC) § 128555)
2)Authorizes the Foundation to seek and receive matching funds from
foundations and private sources to be placed in the Account. (HSC §
128555 (d))
3)Establishes the STLRP which provides for the repayment of educational
loans, as specified, obtained by a physician and surgeon or
osteopathic physician and surgeon who agrees to practice in a
medically underserved area of the state, as defined. (HSC § 128553)
4)Licenses and regulates physicians and surgeons by the Medical Board
of California (MBC), and specifies that the protection of the public
is the highest priority of the MBC. (Business and Professions Code
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(BPC) §§ 2001, 2001.1)
5)Requires the MBC to assess a $25 licensure fee on physicians and
surgeons for the purpose of the STLRP. (BPC § 2436.5)
6)Licenses and regulates osteopathic physicians and surgeons by the
Osteopathic Medical Board of California (OMBC), and specifies that
the protection of the public is the highest priority of the OMBC.
(BPC §§ 2450, 2450.1)
7)Requires the OMBC to assess a $25 licensure fee on physicians and
surgeons for the purpose of the STLRP. (BPC § 2455.1)
This bill:
1)Authorizes a physician and surgeon to pay an additional $75 to the
MBC to fund the STLRP.
2)Authorizes an osteopathic physician and surgeon to pay an additional
$75 to the OMBC to fund the STLRP.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the Author to create flexibility
for the Medical Board of California to collect an additional $75
from those physicians and surgeons who elect to support the Steve
Thompson Physician Corps Loan Repayment Program (STLRP) at the time
of initial licensing or renewal.
In expressing the need for the bill, the Author states, "Since its
inception, the STLRP has awarded more than $28 million dollars to
338 individuals. The loan repayment program continues to receive
competitive and quality applications. High demand for the program
has resulted in only one out of every three applicants successfully
receiving funding. From 2007 to 2011, the STLRP received 323
applications and only awarded 135 physicians due to limited
funding."
2.Background.
a. Steven M. Thompson Physician Corps Loan Repayment Program
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(STLRP). The STLRP, previously the California Physician Corps
Loan Repayment Program, was established in 2003 by AB 982
(Firebaugh, Chapter 1131, Statutes of 2002) to increase
accessibility to healthcare and to encourage physicians to
practice in medically underserved areas (MUA) of California by
authorizing a plan for repayment of their educational loans.
The STLRP is administered by the OSHPD and allows licensed
physician graduates who are practicing direct patient care within
the State of California to apply for a grant under the program.
An awardee may receive up to $105,000 to repay educational debt
if he or she commits to a three-year service obligation
practicing in direct patient care in a MUA in California.
Subsequent legislation, SB 606 (Ducheny, Chapter 607, Statutes of
2009), expanded participation in the program to osteopathic
physicians and surgeons. In 2005, AB 920 (Aghazarian, Chapter
317, Statutes of 2005) transferred administration of STLRP from
the Medical Board of California to the Health Professions
Education Foundation (Foundation). AB 2439 (De La Torre, Chapter
640, Statutes of 2008) established a mandatory $25 fee physicians
and surgeons at the time of initial licensure or biennial renewal
to support the STLRP.
The Foundation must use guidelines developed by the MBC for
selection of applicants to the STLRP. The guidelines must give
priority to applicants that have three years of experience
working in medically underserved areas or with medically
underserved populations, and to applicants from rural communities
who agree to practice in a physician owned and operated practice
settings, as specified, and who have recently obtained a license
to practice medicine.
In its latest report to the Legislature on the STLRP (dated March
2012), OSHPD indicates that since its establishment, the STLRP
has awarded $17 million to 223 individuals. In 2011, more than
$4.1 million was awarded to 76 physicians (out of 185 applicants
requesting approximately $17.6 million in loan repayments).
b. Medically Underserved Areas (MUAs). According to OSHPD, MUAs
are based on the evaluation of criteria established through
federal regulation to identify geographic areas based on
demographic data. MUAs and medically underserved populations
have shortages of primary medical care, dental or mental health
providers and may be designated based on geographic (a county or
service area), or demographic (low income, Medicaid-eligible
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populations, cultural and/or linguistic access barriers to
primary medical care services) criteria. According to OSHPD,
there are 168 MUAs in 47 California counties and approximately
17% of Californians live in a MUA.
3.Prior Legislation. AB 982 (Firebaugh, Chapter 1131, Statutes of
2002) established the California Physician Corps Loan Repayment
Program within the MBC.
AB 1403 (Nuņez, Chapter 367, Statutes of 2004) renamed the California
Physician Corps Loan Repayment Program as the STLRP effective
January 1, 2005.
AB 327 (De La Torre, Chapter 293, Statutes of 2005) permitted the
Medical Board of California to give a physician and surgeon the
option of making a $50 voluntary donation upon the initial issuance
or biennial renewal of a physician and surgeon's certificate in
order to fund the STLRP.
AB 920 (Aghazarian, Chapter 317, Statutes of 2005) transferred of the
STLRP and the Physician Volunteer Program from the MBC to the
California Physician Corps Program within the Health Professions
Education Foundation, effective July 1, 2006.
AB 2439 (De La Torre, Chapter 640, Statutes of 2008) changed the $50
fee assessed voluntarily on an applicant for issuance or biennial
renewal of a physician and surgeon's license to a mandatory $25 fee
to be deposited into the Medically Underserved Account for
Physicians, which is continuously appropriated to provide funding
for operations of the STLRP as administered by the Health
Professions Education Foundation.
SB 606 (Ducheny, Chapter 600, Statutes of 2009) required the
Osteopathic Medical Board of California to assess an additional $25
fee to an osteopathic physician and surgeon applying for an initial
or renewal license for the STLRP, and allowed osteopathic physicians
and surgeons to be eligible to apply for and participate in the
STLRP.
AB 565 (Salas, Chapter 378, Statutes of 2013) made various revisions
regarding STLRP applicants and participants.
4.Arguments in Support. California Primary Care Association , states,
"At a time when health care reform promises access to millions more
Californians, the increased funding from
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SB 1116 would provide incentives and resources to alleviate physician
shortages at CCHCs, help our vulnerable patients receive vital
health care services, and improve the state's overall health care
system."
5.Oppose Unless Amended. The California Medical Association (CMA)
supports allowing physicians an additional pathway to make voluntary
contributions in support of the STLRP, however, CMA points out that
the Foundation already allows an individual or organization to make
a charitable, tax-deductible contribution in various forms and
amounts (such as gifts of case, stock/securities, and bequests), and
further allows a donor to designate which program to fund and which
geographic area to allocate the gift. In light of these existing
provisions, CMA requests amendments to the bill to allow a
contribution of any amount other than $75. CMA states that under
the current language of the bill, if a physician wanted to donate an
additional $1,000 to the STLRP, SB 1116 would not allow it.
Allowing a donation of any amount could potentially bring in
significant additional revenue to the program, according to CMA.
6.Policy Issue. HSC § 128555 (d) authorizes the Foundation to seek and
receive matching funds from other foundations and private sources to
be placed in the Account which supports the STLRP. These matching
funds are not limited to a dollar-for-dollar matching of the funds
transferred to the Account from the licensing fees already required
for physicians and surgeons and osteopathic physicians and surgeons
in the Business and Professions Code. The Author may wish to
discuss why an additional donation provision is appropriate,
considering there is already a mechanism for donations to be made to
support the STLRP.
SUPPORT AND OPPOSITION:
Support: California Primary Care Association
Oppose Unless Amended: California Medical Association
Consultant:G. V. Ayers