BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2048|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2048
Author: Gray (D), et al.
Amended: 8/15/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 6/29/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 80-0, 6/1/16 - See last page for vote
SUBJECT: National Health Service Corps State Loan Repayment
Program
SOURCE: Central Valley Health Network
DIGEST: This bill requires the Office of Statewide Planning and
Development (OSHPD), in its administration of the State Loan
Repayment Program (SLRP), to include all federally qualified
health centers (FQHCs) located in California on the certified
eligible site (CES) list. This bill 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.
ANALYSIS: Existing law requires OSHPD, in administering SLRP to
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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 FQHCs located in California in
the SLRP's CES list.
2)Requires OSHPD to notify all CESs when the SLRP opens each
application cycle and to strive, to the extent possible, to
maximize the number of applications received each cycle.
3)Requires applicants, as part of the applicant's initial
application, to agree to provide matching funds.
Comments
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
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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
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:
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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:
-----------------------------------------------------------
|Year|Available|# |# Awarded |New |Extension |
| | Funding |Applicants | |Applicants|Applicants|
| | | | | Awarded | Awarded |
|----+---------+-----------+----------+----------+----------|
|2011|$1M |51 |45 |Unknown |Unknown |
| | | | | | |
|----+---------+-----------+----------+----------+----------|
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|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 |
| | | | | | |
-----------------------------------------------------------
*2013 funding was reduced due to Federal Sequester
The table below shows the areas of the state where current
awarded providers are practicing:
-----------------------------------------------------------
| 2013 | 2014 | 2015 |
-----------------------------------------------------------
|--------+-------+-----------+-------+----------+------------|
|Central |Frontie|Central |Frontie|Central |Frontier |
| 13 |r 0 | 28 |r 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 |
| | | | | | |
------------------------------------------------------------
4)SLRP participation. Currently, there are 415 SLRP CESs: 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 Web site 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
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to the implementation of OSHPDs online application system.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, no significant
fiscal impact is anticipated by automatically making all FQHCs
eligible to participate. Automatically putting all FQHCs on the
eligible list does not guarantee any funding from the state, it
only makes them automatically eligible to participate, providing
they meet other program requirements.
SUPPORT: (Verified8/15/16)
Central Valley Health Network (source)
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
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
OPPOSITION: (Verified8/15/16)
Department of Finance
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Office of Statewide Health Planning and Development
ASSEMBLY FLOOR: 80-0, 6/1/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,
Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
Prepared by:Melanie Moreno / HEALTH / (916) 651-4111
8/15/16 20:10:13
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