BILL ANALYSIS Ó AB 2216 Page 1 ASSEMBLY THIRD READING AB 2216 (Bonta) As Amended May 27, 2016 Majority vote ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Health |19-0 |Wood, Maienschein, | | | | |Bonilla, Burke, | | | | |Campos, 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 2216 Page 2 | | |Garcia, Roger | | | | |Hernández, Holden, | | | | |Jones, Obernolte, | | | | |Quirk, Santiago, | | | | |Wagner, Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Establishes the Teaching Health Center (THC) Primary Care Graduate Medical Education Fund (Fund) for purposes of funding primary care residency programs. Specifically, this bill: 1)Establishes the THC Fund in the State Treasury. 2)Requires the Director of the Office of Statewide Health Planning and Development (OSHPD) to award planning and development grants from the Fund to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs. 3)Provides that grants awarded must not be for more than three years and that the maximum award to a teaching health center must not be more than five hundred thousand dollars ($500,000). 4)Specifies that grants be used to cover the costs of establishing or expanding a primary care residency training program, including costs associated with curriculum development, recruitment, training, and retention of residents and faculty, accreditation by the Accreditation Council for Graduate Medical Education (ACGME), the American Dental Association (ADA), or the American Osteopathic Association AB 2216 Page 3 (AOA), faculty salaries during the development phase, and technical assistance. 5)Requires OSHPD, subject to an appropriation by the Legislature, to award sustaining grants from the Fund to THCs operating primary care residency programs accredited by the ACGME, ADA, or AOA, and requires OSPHD to determine the amount of grants awarded per resident by taking into account the direct and indirect costs of graduate medical education. Requires OSHPD to promulgate emergency regulations to implement this bill. 6)Makes implementation of this bill subject to an appropriation in the annual Budget Act. FISCAL EFFECT: According to the Assembly Appropriations Committee: 1)General Fund (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 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 AB 2216 Page 4 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. 4)Assembly Budget Subcommittee 1 and Senate Subcommittee 3 have each approved $17.5 million GF to support teaching health centers' residency programs in the 2016-17 budget, similar what is proposed by this bill. COMMENTS: According to the author THCs are a proven model for addressing the primary care provider shortage that six of nine California regions face. The author notes that 40% of THC graduates entering into primary care practice in nonprofit, community health centers in underserved communities as opposed to just 4% of traditional medical residents. The author concludes that this bill will help ensure California has a sufficient supply of health workforce professionals to serve the needs of our diverse state. California ranks 23rd in the number of primary care physicians per resident. An August 2014 report by the California HealthCare Foundation states that California has only 35 to 49 primary care physicians per 100,000 Medi-Cal enrollees. Federal guidelines call for the state to have 60 to 80 doctors per 100,000 patients. The supply of primary care physicians also varies substantially across California's counties. According to 2011 Health Resources and Services Administration (HRSA) data, 29 of California's 58 counties fall at the lower end, or below, the needed supply range for primary care physicians. In other words, half of Californians live in a community where they do not have adequate access to the health care services they need. The Teaching Health Center Graduate Medical Education (THCGME) program. THCGME, funded since 2011 and set to expire in 2016, AB 2216 Page 5 has increased the numbers of primary care physicians and dentists training to care for underserved populations nationwide. Without continued federal funding, most of these THCs report that they would be unlikely to continue current residency recruitment and enrollment, threatening the initial program investments and even the viability of the program itself. According to a 2015 Robert Graham Center report, "Teaching Health Center GME Funding Instability Threatens Program Viability," residents who train in underserved settings are more likely to continue to practice in similar environments. The THCGME program supports new and expanded community-based primary care training programs. Organizations that can qualify to be THCs include federally qualified health centers, rural health clinics, and tribal clinics-all organizations that care for the underserved. Unlike most other GME payments, funds flow directly to the community-based, ambulatory patient care centers where residents train, instead of teaching hospitals. The investment of $230 million over five years (2011 to 2015) represents 0.3% of the annual $15 billion federal GME funding that supports more than 120,000 residents in training each year nationwide. THCGME will expire in 2016 if there is no congressional action to extend it. Since their creation under the Patient Protection and Affordable Care Act six THCs have opened in California, however they are in danger of closing due to the uncertain funding. They are located in Modesto, Fresno, San Bernardino, Redding, Bakersfield, and San Diego. CPCA is the sponsor of this bill and states that this bill will help address California's primary care provider shortage by establishing the Fund, providing planning and development grants to THCs for the purpose of establishing new accredited or expanded primary care residency programs, and make available AB 2216 Page 6 sustaining grants to ensure the continued operation of accredited THCs. CPCA estimates that 8,243 additional primary care physicians will be needed in California by 2030, and notes that with dwindling federal support for current THC sites and no federal investment to develop new sites, California must prioritize and demonstrate its commitment to providing access to primary care through a greater investment in the THC model. The California Right to Life Committee, Inc. opposes this bill stating that because the definition of a California Primary Care Residency Program includes obstetrics and gynecology, they are assuming that Title X and family planning education will be included in the medical education for the residency program. Analysis Prepared by: Lara Flynn/ HEALTH / (916) 319-2097 FN: 0003251