BILL ANALYSIS Ó
AB 2048
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
2048 (Gray)
As Amended August 15, 2016
Majority vote
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|ASSEMBLY: |80-0 |(June 1, 2016) |SENATE: |39-0 |(August 17, |
| | | | | |2016) |
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Original Committee Reference: HEALTH
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.
The Senate amendments delete OSHPDs authority to provide state
matching funds for the program.
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.
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FISCAL EFFECT: According the Senate Appropriations Committee,
no significant fiscal impact is anticipated by automatically
making all federally qualified health centers eligible to
participate. Automatically putting all federal qualified health
centers 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.
COMMENTS: According to the author, FQHCs are safety net
providers that serve some of the nation's most vulnerable
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
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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.
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 United
States (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
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must:
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 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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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:
0004120