BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1116
                                                                  Page  1

          Date of Hearing:   June 17, 2014

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                               Susan A. Bonilla, Chair
                 SB 1116 (Torres) - As Introduced:  February 19, 2014

           SENATE VOTE  :   33-0
           
          SUBJECT  :   Physicians and surgeons.

           SUMMARY  :  Permits a physician and surgeon to pay an additional  
          $75 to the Steven M. Thompson Physician Corps Loan Repayment  
          Program (STLRP).

           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.  (Health and Safety Code (HSC) Section  
            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 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 (BPC) Sections 2001, 2001.1)

          5)Requires the MBC to assess a $25 licensure fee on physicians  
            and surgeons upon license issuance or renewal for the purpose  
            of funding the STLRP.  (BPC 2436.5)

          6)Licenses and regulates osteopathic physicians and surgeons by  








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            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 upon license issuance or renewal for the purpose  
            of funding the STLRP.  (BPC 2455.1)

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           1)Purpose of this bill  .  This bill would authorize allopathic  
            and osteopathic physicians and surgeons to voluntarily  
            contribute an additional $75 to fund STLRP when being issued  
            or renewing a license, in addition to the $25 they already pay  
            under existing law.  This bill is author-sponsored.  

           2)Author's statement  .  According to the author's office, "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  
            [presented awards to] 135 physicians due to limited funding."

           3)STLRP  .  STLRP encourages recently licensed physicians to  
            practice in Health Professional Shortage Areas (HPSAs) in  
            California by repaying up to $105,000 in educational loans in  
            exchange for a minimum of three years of full-time service.

            The following requirements must be met to be considered for an  
            award:

             a)   Be an allopathic or osteopathic physician;

             b)   Be free of any contractual service obligations (i.e. the  
               National Health Service Corps Federal Loan Repayment  
               Program or other financial incentive programs);

             c)   Have outstanding educational debt from a government or  
               commercial lending institution;

             d)   Have a valid, unrestricted license to practice medicine  








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               in California;

             e)   Be currently employed or have accepted employment in a  
               HPSA in California; and,

             f)   Commit to providing full-time direct patient care in a  
               HPSA for a minimum of three years. 

            HPSAs are designated by the U.S. Department of Health and  
            Human Services' 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). 

            STLRP is funded by a $25 physician and surgeon license fee,  
            California Department of Managed Health Care fines and  
            penalties, donations and grants, and the Surplus Money  
            Investment Fund.  It should be noted that, while approximately  
            only one in three STRLP applications received funding from  
            2007 to 2011, not all applicants were eligible for the award,  
            suggesting that a much larger proportion of eligible  
            applicants have received aid under STRLP. 

            STLRP also received a $6 million dollar grant from The  
            California Endowment for the 2013/14 cycle to help implement  
            the Affordable Care Act, effectively tripling STLRP's revenue.  
             It is anticipated that a commensurate additional number of  
            applicants will be awarded based on this increased funding. 

            This bill is intended to further augment STLRP funds by  
            explicitly permitting physicians and surgeons to pay an  
            additional $75 into STLRP when issued or renewing their  
            license.  

           4)Committee comments  .  Given that there is no known barrier to a  
            physician and surgeon being able to contribute additional  
            funds to the STLRP now, the Committee members may wish to  
            inquire of the author as to the practical effect of this bill.  
             To that point, in 2011/2012, STLRP received $835,098 in  
            donations and grants and $312,891 in 2012/2013.   

             If this bill becomes law, MBC states that it plans to include  
            information on the ability of a physician to donate additional  








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            funds to the STLRP in any amount, including a suggested  
            donation of $75.    
                
           5)Arguments in support  .  MBC writes, "This bill would allow for  
            additional funding for the STLRP, which will help allow for  
            more loans for the STLRP and more physicians to serve in  
            underserved areas.  This bill would further support the  
            Board's mission of promoting access to care and [MBC] will  
            continue to be supportive of any measures that help fund or  
            make improvements to the STLRP."     

           6)Arguments in opposition  .  The California Medical Association  
            writes, "While we support the goal of allowing physicians an  
            additional pathway to make a voluntary contribution, we have  
            requested the author amend SB 1116 to allow a contribution of  
            any amount other than $75, just as they can under the existing  
            scheme of the Health Professions Education Foundation."

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Arthritis Foundation Council
          California Chapter of the American College of Emergency  
          Physicians
          California Primary Care Association
          California Rheumatology Alliance
          Medical Board of California
           
            Opposition 
           
          California Medical Association

           Analysis Prepared by  :    Sarah Huchel / B.,P. & C.P. / (916)  
          319-3301