BILL ANALYSIS Ó
AB 2216
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Date of Hearing: April 27, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2216 (Bonta) - As Amended April 14, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill establishes the Teaching Health Center Primary Care
Graduate Medical Education Fund (Fund) for purposes of funding
primary care residency programs. Specifically, this bill:
1)Establishes the Fund in the State Treasury, and requires the
Office of Statewide Health Planning and Development (OSHPD) to
award grants from the Fund.
2)Pursuant to an appropriation by the Legislature, specifies
that grants be used to cover the costs of either:
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a) Establishing or expanding a primary care residency
training program, with a maximum grant amount of $500,000
over three years.
b) Maintaining funding for existing primary care residency
training programs, in amounts per resident to be determined
by OSHPD based on training costs.
FISCAL EFFECT:
1)GF cost pressure, ranging from the low millions to over $10
million, to fund primary care residency programs as envisioned
by this bill. The program could be funded at a anywhere
within this range, as it would scale to the size of the
appropriation, but a program smaller in size than the low
millions would be limited in effectiveness.
2)GF costs to OSHPD to administer the new grant program. For
example, administrative costs of 5% on a $15.5 million program
would be around $750,000.
3)The California Primary Care Association (CPCA), the sponsor of
this bill, has submitted to the budget committees a related
budget request for an annual GF investment of $16.5 million GF
annually as follows: $1 million for OSHPD administration, $10
million for creating new programs, and $5.5 million to sustain
the existing six programs in Modesto, Fresno, San Bernardino,
Redding, Bakersfield, and San Diego.
COMMENTS:
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1)Purpose. This bill is intended to provide ongoing funding to
maintain and expand teaching health centers, which are primary
care clinics that provide primary care residency programs.
2)Background. Most medical education is conducted at teaching
hospitals, though not all. The federal Affordable Care Act
created the Teaching Health Center Graduate Medical Education
(THC GME) program to create and sustain residency programs
where education is provided at primary care clinics. The
program was funded for a period of four years, from 2011 to
2015, and was funded at a lower level through an extension
pursuant to the federal Medicare Access and CHIP
Reauthorization Act of 2015. The extension of funding
provided per-resident amounts of $95,000, instead of the
previous $150,000 per-resident amounts, at already-established
centers, through 2017. The federal extension only applied to
existing sites and did not allow for new sites to be funded.
Many regions in California face a primary care shortage, which
is particularly acute in rural and disadvantaged communities.
Evidence suggests doctors trained in teaching health centers
are more likely to stay in a primary care practice setting and
work with underserved communities, since the training location
has a large influence on where and how physicians choose to
practice. A preliminary evaluation of the federal THC GME
program showed the following: 91% of doctors trained in the
program stay in primary care compared to less than one-quarter
of traditional GME graduates, and forty percent remain working
in underserved communities as opposed to just 2% of
traditional GME graduates.
3)Related Legislation.
a) AB 2048 (Gray) requires OSHPD, in its administration of
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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 and provide state matching
funds. AB 2048 is pending on this committee's Suspense
File.
b) SB 22 (Roth) appropriates $300 million from the General
Fund to the director of OSHPD for the purpose of funding
new and existing GME physician residency positions, and
supporting training faculty. SB 22 is pending in the
Assembly Rules Committee.
1)Prior Legislation.
a) SB 1416 (Rubio) of 2012 created the Graduate Medical
Education Trust Fund for the purpose of funding grants to
GME residency programs in California, and required OSHPD to
develop criteria for distribution of available moneys. SB
1416 was held on the Suspense File of this committee.
b) AB 589 (Perea), Chapter 339, Statutes of 2012,
established the Steven M. Thompson Medical School
Scholarship Program and provides that the program is open
to persons who agree in writing, prior to entering an
accredited medical or osteopathic school, to serve in an
eligible practice setting, as defined, for at least three
years.
c) SB 635 (Ed Hernandez) of 2011 required funds deposited
in the Managed Care Administrative Fines and Penalties Fund
in excess of $1 million be transferred each year to OSHPD
for the purposes of the Song-Brown Program. SB 635 was
held on the Suspense File of this committee.
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2)Support and Opposition. Numerous primary care clinics, the
County Health Executives of California, and the Association of
California Healthcare Districts support this bill. The
California Right to Life Committee expresses opposition about
the inclusion of family planning education in primary care
training programs.
3)Staff Comments. According to the author and sponsor,
providing ongoing funding to sustain existing training sites
is necessary because in the absence of state funding, the
programs may end. However, the bill also envisions providing
funds to establish new centers or expand existing centers.
Given the inability of existing sites to sustain their
programs without state funds, it appears as if each new or
expanded center would also demand sustaining grants once
established. If centers are not viable without ongoing state
assistance, the author may wish to address the balance between
establishment/expansion and sustaining grants, perhaps by
limiting the number of establishment/expansion grants to
ensure the programs that are established either have a stable
revenue source to sustain themselves, or can be supported on
an ongoing basis within the resources of the program created
by the bill.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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