BILL ANALYSIS Ó
AB 2216
Page 1
ASSEMBLY THIRD READING
AB
2216 (Bonta)
As Amended May 27, 2016
Majority vote
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|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
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| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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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
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(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
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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,
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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
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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