BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2048
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|AUTHOR: |Gray |
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|VERSION: |May 27, 2016 |
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|HEARING DATE: | June 29, 2016 | | |
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|CONSULTANT: |Melanie Moreno |
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SUBJECT : National Health Service Corps State Loan Repayment
Program
SUMMARY :1) Requires the Office of Statewide Planning and Development
(OSHPD), in its administration of the State Loan Repayment
Program, to include all federally qualified health centers
located in California on the certified eligible site list.
Permits OSHPD to use state funds for purposes of providing
required matching funds for the National Health Service Corps
State Loan Repayment Program in any year in which funding is
appropriated by the annual Budget Act for that purpose.
Existing law: Requires OSHPD, in administering the State Loan
Repayment Program (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. Requires OSHPD to set a reasonable deadline for
when applications are required to be received and requires all
eligible applications to be given consideration before any award
is granted.
This bill:
1)Requires OSHPD to include all federally qualified health
centers (FQHCs) located in California in the SLRP's certified
eligible site (CES) list.
2)Requires OSHPD to notify all certified eligible sites when the
SLRP opens each application cycle and to strive, to the extent
possible, to maximize the number of applications received each
cycle.
AB 2048 (Gray) Page 2 of ?
3)Requires applicants, as part of the initial application
process, to agree to provide matching funds in any year that
OSHPD does not receive required matching funds in the annual
Budget Act, but prohibits OSHPD from requiring applicants and
participants to provide matching funds in that case.
4)Requires OSHPD, until January 1, 2021, to submit an annual
report, as specified, to the Senate and Assembly Committees on
Health that includes:
a) The number of applications received during the
annual application cycle;
b) The percentage of applicants that were awarded
funding under the program;
c) The percentage of applicants that were not
awarded funding under the program; and,
d) The percentage of funding that went to each
geographic region in the state.
5)Permits 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.
FISCAL
EFFECT : According to the Assembly Appropriations Committee: 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). General Fund
cost pressure to appropriate state funding for the SLRP in
future years
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
AB 2048 (Gray) Page 3 of ?
1)Author's statement. According to the author, 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. While the SLRP is an important program to
recruit healthcare professionals to communities in need, FQHCs
face burdensome obstacles to participation. Despite their
federal designation, each FQHC is required to submit an
application to be placed on the list of CES before applicants
from their facility may be considered for loan repayment. In
addition, FQHCs must renew their application every three years
to continue participation in the SLRP. Finally, federal SLRP
dollars require a state match, but, while other states provide
this match themselves, California has shifted the cost onto
the health centers. California receives just $1 million in
federal funding annually, but many small and medium size
health centers that cannot afford to provide matching funds
are precluded from SLRP participation. As a result of these
requirements, less than one third of the health centers in the
state are currently listed on the CES.
2)FQHCs. 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 of which 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.
3)The California State Loan Repayment Program. According to the
National Health Services Corp, SLRP is a federally-funded
grant program to states and territories that provides
cost-sharing grants to assist them in operating their own
state educational loan repayment programs for primary care
providers working in Health Professional Shortage Areas
(HPSAs) within their state. SLRP does not provide loan
repayment directly to individual health professionals. SLRP
requires matching funds from the state applicant and
administration of the program by a state agency. States must
agree to make available (directly or through donations from
public or private entities) non-federal contributions in cash
toward SLRP contracts. States are not required to include all
AB 2048 (Gray) Page 4 of ?
eligible disciplines in their program, but eligible
professions include: physicians, nurse practitioners,
physician assistants, dental professionals, mental health
professionals, registered nurses, and pharmacists. 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 California, in order for a site to
be eligible to host SLRP providers, it must:
a) Be located in a federally designated HPSA;
b) Be a public or private, not-for-profit, out-patient
facility;
c) Match the SLRP award, on a dollar-for-dollar basis;
d) Pay the provider a prevailing wage; and,
e) 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 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 recruit and retain high
quality healthcare professionals working in HPSAs, applicants
requesting an extension usually receive an award.
The table below shows funding, applicant, and award amounts:
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|Year |Available |# |# Awarded |New |Extension |
AB 2048 (Gray) Page 5 of ?
| |Funding |Applicants| |Applicants|Applicants|
| | | | | Awarded | Awarded |
|-----+----------+----------+----------+----------+----------|
|2011 |$1M |51 |45 |Unknown |Unknown |
|-----+----------+----------+----------+----------+----------|
|2012 |$1M |53 |50 |Unknown |Unknown |
|-----+----------+----------+----------+----------+----------|
|2013 |$949,000* |112 |44 |30 |14 |
|-----+----------+----------+----------+----------+----------|
|2014 |$1M |134 |70 |36 |34 |
|-----+----------+----------+----------+----------+----------|
|2015 |$1M |113 |63 |41 |22 |
| | | | | | |
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*2013 funding was reduced due to Federal Sequester
The table below shows the areas of the state where current
awarded providers are practicing:
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| 2013 | 2014 | 2015 |
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|---------+--------+----------+--------+---------+-----------|
|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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4)SLRP participation. 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
AB 2048 (Gray) Page 6 of ?
application system.
5)Prior legislation. AB 820 (Nakanishi, Chapter 682, Statutes of
2003), requires OSHPD, in administering SLRP, to strive,
whenever feasible, to equitably distribute loan repayment
awards between 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. Requires that all eligible
applications be given consideration before any award is
granted.
6)Support. The California Primary Care Association, Community
Clinic Association of Los Angeles, and Redwood Community
Health Coalition all support this bill stating that it is a
simple, yet effective way to support community health centers
ability to recruit and retain providers by strengthening SLRP.
The proponents note that at a time when our state's
underserved communities are grappling with a severe and
growing primary care provider shortage, SLRP increases the
number of primary care providers practicing in federally
designated HPSAs, however SLRP is currently structured in a
way that disincentives participation among FQHCs who serve
low-income and uninsured communities. The supporters conclude
that this bill will address these challenges by streamlining
participation in the SLRP through automatic enrollment for
FQHCs as CES. The Association of California Healthcare
Districts (ACHD) notes that as the demand for physicians rises
with the implementation of the Patient Protection and
Affordable Care Act, it is of utmost importance that
California be innovative in addressing physician shortage
issues in underserved areas, where many FQHC's operate. ACHD
also states, by appropriating the necessary funds for the
SLRP, California will continue to promote access to healthcare
in the most underserved areas of the state.
SUPPORT AND OPPOSITION :
Support: Central Valley Health Health Network (sponsor)
APLA Health & Wellness
Association of California Healthcare Districts
California Primary Care Association
Coalition of Orange County Community Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Family Health Centers of San Diego
AB 2048 (Gray) Page 7 of ?
Health Alliance of Northern California
La Clinica de La Raza
Los Angeles LGBT Center
Neighborhood Healthcare
North Coast Clinics Network
Northeast Valley Health Corporation
Sacramento Native American Health Center, Inc.
San Ysidro Health Center
South Central Family Health Center
White Memorial Community Health Center
Oppose: None Received
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