BILL ANALYSIS Ó
AB 2048
Page 1
ASSEMBLY THIRD READING
AB
2048 (Gray)
As Amended May 27, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, Chiu, | |
| | |Dababneh, Gomez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |20-0 |Gonzalez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
AB 2048
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| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires the Office of Statewide Health Planning and
Development (OSHPD), in its administration of the National
Health Service Corps State Loan Repayment Program (SLRP), to
include all federally qualified health centers (FQHCs) located
in California on the program's certified eligible site list.
Specifically, this bill:
1)Requires OSHPD to notify all certified eligible sites when the
program opens each application cycle, and to maximize, to the
extent possible, the number of applications received each
cycle.
2)Specifies, as part of the initial application process, program
applicants must agree to provide matching funds in any year
that OSHPD does not receive the required matching funds, and
prohibits OSHPD from requiring program applicants and
participants to provide matching funds in any year that OSHPD
receives the required matching funds.
3)Requires OSHPD to submit an annual report to the Senate and
Assembly Committees on Health that includes all of the
following information:
a) The number of applications received during the annual
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application cycle;
b) The percentage of applicants who were awarded funding
under the program; and,
c) The percentage of funding that went to each geographic
region in the state.
4)Authorized OSHPD to use state funds for purposes of providing
required matching funds for the SLRP in any year in which
funding is appropriated by the annual Budget Act for that
purpose.
EXISTING LAW: Requires OSHPD, in its administration of the SLRP
to strive, whenever feasible, to equitably distribute loan
repayment awards between eligible urban and rural program
sites, after taking into account the availability of health
care services in the communities to be served and the number
of individuals to be served in each program site.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Up to $200,000 in one-time costs to OSHPD to update policies,
procedures, forms, as well as handle a significant influx of
applications (California Health Planning Fund).
2)General Fund cost pressure to appropriate state funding for
the SLRP in future years.
COMMENTS: According to the author, FQHCs are safety net
providers that serve some of the nation's most vulnerable
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populations. The author states they are required to offer
services to all persons regardless of their ability to pay, be a
nonprofit or public organization, serve a medically underserved
area, and provide comprehensive primary care services. The
author contends that FQHCs reduce health disparities by serving
populations that would otherwise not have access to services,
and care received at these centers is ranked among the most
cost-effective, producing $24 billion in annual health system
savings, yet studies have found that the quality of care
provided is equal to or even greater that the quality of care
provided elsewhere.
The author notes the SLRP was created in 1987 to increase and
retain the number of primary care physicians, dentists, nurse
practitioners, pharmacists, and mental and behavioral
specialists in Health Professional Shortage Areas (HPSAs), and
while the SLRP is an important program to recruit healthcare
professionals to communities in need, FQHCs face burdensome
obstacles to participation. The author states that, despite
their federal designation, each FQHC is required to submit an
application to be placed on the list of Certified Eligible Sites
(CES) before applicants from their facility may be considered
for loan repayment. Additionally, FQHCs must renew their
application every three years to continue participation in the
SLRP. The author contends that, as a result of these
requirements, less than one-third of the health centers in the
state are currently listed on the CES. The author also notes
that federal SLRP dollars require a state match, and, while
other states provide this match themselves, California has
shifted that cost onto the health centers. The author points
out that California receives only $1 million in federal funding
annually, and many small and medium size health centers that
cannot afford to provide matching funds are precluded from SLRP
participation.
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The author concludes that this bill will streamline
participation in the SLRP by eliminating CES application and
renewal requirements for FQHCs, creating notification and
reporting requirements to keep health centers and the
Legislature informed about the program, and lifting the
financial burden of providing matching funds off the shoulders
of the health centers.
As noted by the author, FQHCs serve a significant portion of the
uninsured and underinsured in California. They are open-door
providers that treat patients on a sliding scale fee structure
and make their services available regardless of a patient's
ability to pay. There are approximately 600 FQHCs in
California. All FQHCs are either non-profit community clinics
or government entities Community clinics and health centers
provide health care to 14% of Californians. This figure is even
higher in rural or remote areas that struggle to attract and
retain health care providers.
SLRP was congressionally authorized in 1987 under the U.S.
Public Health Services Act. SLRP increases the number of
primary care physicians, dentists, dental hygienists, physician
assistants, nurse practitioners, certified nurse midwives,
pharmacists and mental/behavioral health providers practicing in
federally designated California HPSAs. SLRP authorizes repayment
of qualified educational loans for eligible primary health care
professionals, who must commit to an initial two year full-time
or four year half-time service agreement to provide direct
patient care in a primary, dental, or mental health HPSA.
In order for a site to be eligible to host SLRP providers, it
must:
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1)Be located in a federally designated HPSA;
2)Be a public or private, not-for-profit, out-patient facility;
3)Match the SLRP award, on a dollar-for-dollar basis;
4)Pay the provider a prevailing wage; and,
5)Provide services on a free or reduced fee schedule basis to
individuals at or below 200% of the federal poverty level.
The purpose of the CES list is to identify those sites that are
located in a HPSA and agree to match the SLRP award amount.
When a site submits a CES application, SLRP determines if the
site is located in a HPSA, if the site is in Northern, Central,
or Southern California, and if it is in a Rural, Urban, or
Frontier area. (A "Frontier area" by federal definition, is an
area with population density of less than 11 persons per square
mile). HPSA site designations are valid for three years; then
they must be recertified by SLRP to ensure they are still
located in a HPSA. If a site loses its HPSA designation, it is
no longer an eligible site. FQHCs are automatically approved
HPSA designations through the NHSC. However, SLRP does not
currently automatically approve all FQHCs; if SLRP did, it would
be assuming all FQHCs could match the SLRP award amount. SLRP
is federally funded through a grant from the Health Resources
and Services Administration. SLRP receives $1 million per grant
year. The number of awards given out depends upon how many
applications are received. Because the purpose of SLRP is to
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recruit and retain high quality healthcare professionals working
in HPSAs, applicants requesting an extension usually receive an
award.
The table below shows the areas of the state where current
awarded providers are practicing:
--------------------------------------------------------
| 2013 | 2014 | 2015 |
--------------------------------------------------------
|----------+--------+----------+--------+----------+--------|
|Central |Frontier|Central |Frontier|Central |Frontier|
| 13 | 0 | 28 | 0 | 26 | 0 |
|----------+--------+----------+--------+----------+--------|
|Northern |Rural |Northern |Rural |Northern |Rural |
|10 | 11 |10 | 21 |12 | 15 |
|----------+--------+----------+--------+----------+--------|
|Southern |Urban |Southern |Urban |Southern |Urban |
|21 |33 |32 |49 |25 |48 |
| | | | | | |
| | | | | | |
| | | | | | |
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Currently, there are 415 SLRP Certified Eligible Sites: 392
primary care, 165 mental health, and 135 dental health. Four
are located in Frontier areas, 140 in Rural areas, and 271 in
Urban areas.
OSHPD notifies all CES when the application cycle opens up each
year. OSHPD/SLRP sends stakeholder announcements, updates the
SLRP Website and contacts current awardees (healthcare
providers) who are eligible for an extension award. The CES
application is open year-round. The provider application cycle
is tentatively set for August 1 to October 1 of each year but
has varied the last few years due to the implementation of
OSHPDs online application system.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0003223