BILL ANALYSIS Ó
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THIRD READING
Bill No: SB 1116
Author: Torres (D)
Amended: As introduced
Vote: 21
SENATE BUSINESS, PROFESSIONS & ECON. DEV. COMM. : 8-0, 4/21/14
AYES: Lieu, Berryhill, Block, Corbett, Galgiani, Hernandez,
Hill, Padilla
NO VOTE RECORDED: Wyland
SENATE APPROPRIATIONS COMMITTEE : 6-0, 5/5/14
AYES: De León, Walters, Gaines, Hill, Lara, Steinberg
NO VOTE RECORDED: Padilla
SUBJECT : Physicians and surgeons
SOURCE : Author
DIGEST : This bill authorizes the voluntary payment of an
additional $75 by a physician and surgeon to the Medical Board
of California (MBC), and by an osteopathic physician to the
Osteopathic Medical Board of California (OMBC), for purposes of
the Steven M. Thompson Physician Corps Loan Repayment Program
(STLRP).
ANALYSIS :
Existing law:
1. Establishes the Medically Underserved Account for Physicians
CONTINUED
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(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 STLRP.
2. Authorizes the Foundation to seek and receive matching funds
from foundations and private sources to be placed in the
Account.
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.
4. Licenses and regulates physicians and surgeons by MBC, and
specifies that the protection of the public is the highest
priority of the MBC.
5. Requires MBC to assess a $25 licensure fee on physicians and
surgeons for the purpose of the STLRP.
6. Licenses and regulates osteopathic physicians and surgeons by
OMBC, and specifies that the protection of the public is the
highest priority of OMBC.
7. Requires OMBC to assess a $25 licensure fee on physicians and
surgeons for the purpose of the STLRP.
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 OMBC to fund the STLRP.
Background
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
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practice in medically underserved areas (MUA) of California by
authorizing a plan for repayment of their educational loans.
The STLRP is administered by OSHPD and allows licensed physician
graduates who are practicing direct patient care within
California to apply for a grant under the program. An awardee
may receive up to $105,000 to repay educational debt if he/she
commits to a three-year service obligation practicing in direct
patient care in an 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
MBC to the 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 MBC for
selection of applicants to the STLRP. The guidelines must give
priority to applicants that have three years of experience
working in MUAs 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).
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 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
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in an MUA.
Comments
According to the author's office, this bill creates flexibility
for MBC to collect an additional $75 from those physicians and
surgeons who elect to support the STLRP at the time of initial
licensing or renewal.
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."
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Potential one-time costs up to $75,000 to amend existing
regulations by MBC (Contingent Fund of MBC).
Potential one-time costs up to $75,000 to amend existing
regulations by OMBC (OMBC Contingent Fund).
Ongoing revenues and expenditures likely between $150,000 and
$300,000 per year for physician loan repayments (Health
Professions Education Fund). Under existing law, MBC collects
a voluntary $25 contribution from licensed physicians and
surgeons at the time of initial licensing and renewal. About
3% of licensees make this voluntary contribution. If the rate
of contributions authorized under this bill is similar to
current practice, this bill will generate about $300,000 per
year in contributions from physicians and surgeons and
osteopathic physicians and surgeons. If the larger
contribution amount reduces participation by half, revenues
will be about $150,000 per year.
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Under existing law, monies in the Medically Underserved
Account for Physicians within the Health Professions Education
Fund are continuously appropriated for loan repayments by
OSHPD. By increasing revenues into this Fund, this bill will
also appropriate those revenues.
SUPPORT : (Verified 5/9/14)
American College of Emergency Physicians
California Arthritis Foundation Council
California Primary Care Association
California Rheumatology Alliance
Medical Board of California
OPPOSITION : (Verified 5/9/14)
California Medical Association
ARGUMENTS IN SUPPORT : The California Primary Care Association
states, "At a time when health care reform promises access to
millions more Californians, the increased funding from 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."
ARGUMENTS IN OPPOSITION : 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. CMA states that under the current language
of this bill, if a physician wanted to donate an additional
$1,000 to the STLRP, this bill will not allow it. Allowing a
donation of any amount could potentially bring in significant
additional revenue to the program, according to CMA.
MW:d 5/12/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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