BILL ANALYSIS Ó
AB 2485
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Date of Hearing: April 5, 2016
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Rudy Salas, Chair
AB 2485
(Santiago) - As Amended March 30, 2016
SUBJECT: Dental Corps Loan Repayment Program.
SUMMARY: Transfers the California Dental Corps Loan Repayment
Program of 2002 (DCLRP) under the jurisdiction of the Health
Professions Education Foundation (HPEF), housed within the
Office of Statewide Health Planning and Development (OSHPD),
expands eligibility of applicants to the program, and
reschedules the timeline that loan repayments may be disbursed.
EXISTING LAW:
1)Establishes the Dental Board of California (DBC) within the
Department of Consumer Affairs (DCA) for the purpose of
licensing and regulating the practice of dentistry and
requires these activities to be funded from fees imposed upon
licensees. (Business and Professions Code (BPC) Section 1600
et seq.)
2)Provides that the DCLRP is to be administered by the DBC;
provides loan repayments for dental practitioners who serve in
underserved areas; establishes the Dentally Underserved
Account in the State Dentistry Fund, and transfers $3 million
from the Dentistry Fund to the Dental Account over three
years, starting July 1, 2003. (BPC Section 1973)
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3)Specifies that after a Dental Corps participant has completed
one year of service, the DBC shall provide up to $25,000 for
loan repayment; a participant who serves a second consecutive
year shall receive up to an additional $35,000; and, a third
consecutive year would earn an additional $45,000 in loan
repayment from the Dental Account, but may not exceed
$105,000. (BPC Section 1975)
4)Establishes a nonprofit public benefit corporation within the
OSHPD to be known as the HPEF that is governed by a board
consisting of 11 members, as specified. (Health and Safety
Code (HSC) Section 128335)
5)Authorizes the HPEF to solicit and receive funds from private
or public sources for the purpose of providing financial
assistance in the form of scholarships or loans to students
from underrepresented groups. (HSC Section 128345(a))
6)Provides that the HPEF may recommend the disbursement of
moneys deposited in the Health Professions Education Fund to
students from underrepresented groups accepted to or enrolled
in schools of dentistry or other health professions, as
specified, in the form of loans or scholarships. (HSC Section
128345(b))
7)Provides that the HPEF develop criteria for selecting
applicants including, but not limited to, the likelihood of
remaining in the designated service area to practice his or
her profession; develop an application form; and, encourage
private sector institutions to identify and provide
educational experiences. (HSC Section 128345(c)-(f))
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8)Authorizes the HPEF to implement the Steven M. Thompson
Physician Corps Loan Repayment Program and the Volunteer
Physician Program. (HSC Section 128345(i))
THIS BILL:
1)Repeals provisions for the DCLRP to be administered by the
DBC.
2)Renames the Dental Account to be called the Dental Corps Loan
Repayment Account.
3)Makes funds in the Dental Corps Loan Repayment Account
available upon appropriation by the Legislature, which are to
be used to repay the loans per agreements made with dentists.
4)Establishes the DCLRP within the HPEF within the OSHPD so the
ongoing program can be administered and managed by the HPEF.
5)Defines for purposes of establishing the HPEF within the
OSHPD:
a) "Account" to be the Dentally Underserved Account, which
is contained within the fund.
b) "Board" to be the DBC.
c) "Dentally underserved area" to be a geographic area
eligible to be designated as having a shortage of dental
professionals, as specified.
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d) "Dentally underserved population" to be persons without
dental insurance and persons eligible for Denti-Cal who are
population groups, as specified.
e) "Fund" to be the State Dentistry Fund.
f) "Medi-Cal threshold languages" to be primary languages
spoken by limited-English-proficient population groups, as
specified.
g) "Office" to be the OSHPD.
h) "Program" to be the California DCLRP.
i) "Practice Setting" to be either:
i) A community clinic, as specified, or a clinic owned
and operated by a hospital that maintains the primary
contract with a county government, as specified; or,
ii) A dental practice or dental corporation, as
specified, which is located in a dentally underserved
area.
6)Provides that a program applicant must possess a current valid
license to practice dentistry in this state issued by the DBC,
or be eligible for graduation from an approved pre or
post-doctoral dental education program, as specified, and meet
all criteria for licensure, subject to successful completion
of applicable requirements.
7)Provides that the foundation shall develop the guidelines for
selection and placement of applicants and guidelines for the
DCLRP must:
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a) Provide priority consideration to applicants who are
best suited to meet the cultural and linguistic needs and
demands of dentally underserved populations and who also
speak a Medi-Cal language; come from an economically
disadvantaged background; have received significant
training in cultural and linguistically appropriate service
delivery; have worked in a health field in an underserved
area or with an underserved population; recently received a
license to practice dentistry, or has received an offer of
unemployment in an underserved area; and,
b) Include a process for determining the needs for dental
services identified by the practice setting; provides that
the practice setting must be located in a dentally
underserved area and seeks to place the most qualified
applicants in areas with the greatest need.
8)Requires a program applicant to be working in, or have a
signed agreement with, an eligible practice setting and be
employed on a full-time basis, which is to be defined by the
HPEF.
9)Provides that a program participant is required to commit to a
minimum of three years of service in a qualified practice
setting, but may be eligible for leave of absence as
determined by the HPEF; that the HPEF develop a process to use
if a dentist is not able to complete his or her three-year
obligation; that the HPEF may adopt any other standards of
eligibility, placement, and termination.
10)Defers loan repayment until the dentist is employed on a
full-time basis.
11)Provides that funds paid out for loan repayment may have a
funding match from foundations or other private sources.
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12)Limits loan repayments to a total of one hundred five
thousand dollars ($105,000) per individual licensed dentist.
13)Provides that after a participant has completed six months of
service, the HPEF may award up to $35,000 for repayment from
the Dental Account; upon completion of a 18 months of service,
a participant is eligible for up to an additional $35,000; and
upon completion of 30 months of service, would earn an
additional $35,000 in loan repayment; and specifies that loan
repayments from the Dental Account may not exceed $105,000.
14)Requires the HPEF to submit a report to the Legislature by
January 1, 2019 regarding the experience of the program, an
evaluation of its effectiveness in improving access to dental
care for underserved populations, and recommendations for
maintaining or expanding its operation, as specified.
15)Declares that an adequate supply of dentists to all
communities in the state is imperative to the well-being of
California residents.
16)Describes the initiation of the California DCLRP and the HPEF
and the intention of those programs to provide access to
healthcare in underserved areas.
17)Declares the intent of the Legislature to transfer the DCLRP
from the DBC to the HPEF.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the
Legislative Counsel.
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COMMENTS:
Purpose. This bill is sponsored by the California Dental
Association (CDA). The bill would move the California DCLRP
under the jurisdiction of the HPEF, housed within the OSHPD, and
remove some of the statutory requirements, which have been
identified as deterrents to potential applicants.
According to the author, "The [DCLRP] was created to be a first
step in a long-term effort to improve access to dental care by
increasing the number of providers in underserved communities in
California, yet it never realized its full potential due to
administrative and statutory limits on its effectiveness. The
funding is still available for this program, and many
Californians still face barriers accessing dental care. The
[L]egislature should act to remove the deterrents that keep away
potential applicants to the [DCLRP] and encourage participation
so that the state can better serve those individuals with the
most critical oral health needs."
Background. The Legislature passed the DCLRP in 2002 with an
initial investment of $3 million from the State Dentistry fund,
to be disbursed to eligible candidates over the course of three
years. Fourteen years later, a little more than half of those
funds are still sitting in the grant program account, yet to be
awarded.
The lack of program participants stems from extensive and
burdensome qualification requirements, and a general lack of
awareness of the program's existence. There is approximately
$1.6 million left in the account with very few or no applicants
to the DCLRP in almost 10 years. When the DBC was reviewed in
2015, as part of the joint Senate Committee on Business,
Professions and Economic Development and the Assembly Committee
on Business and Professions (Committees) Sunset Review process,
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the DBC stated that it had promoted the program on its website,
included information about the program in its presentation to
senior students in California dental schools, and distributed
information through their stakeholder and professional
association publications. At the time, DBC staff and its Access
to Care Committee was researching other loan repayment programs
offered by the California Dental Association, the Medical Board
of California (MBC), and the OSHPD. During the 2015 Sunset
Review hearings, the Committees recommended that the DBC
consider transferring the DCLRP to HPEF in order to increase
participation in the program and more effectively administer the
funds. This bill would move the loan repayment grant program out
of the DBC's management and oversight and place it under the
HPEF.
HPEF Scholarship Programs. There are currently a number of
scholarship programs administered and managed by the HPEF
including: the Allied Healthcare Scholarship Program (AHSP),
Advanced Practice Healthcare Scholarship Program (APHSP)
(Formerly Health Professions Education Scholarship Program)
(HPSP), Associate Degree Nursing Scholarship Program (ADN),
Bachelor of Science Nursing Scholarship Program (BSN), Licensed
Vocational Nurse to Associate Degree Nursing Scholarship Program
(LVN to ADN), and the Vocational Nurse Scholarship Program
(VNSP).
HPEF Loan Repayment Programs. There are currently a number of
loan repayment programs administered and managed by the HPEF
including: the Allied Healthcare Loan Repayment Program (AHLRP),
Advanced Practice Healthcare Loan Repayment Program (APHLRP)
(Formerly Health Professions Loan Repayment Program) (HPLRP),
Bachelor of Science Nursing Loan Repayment Program (BSNLRP),
Licensed Mental Health Services Provider Education Program
(LMHSPEP), Licensed Vocational Nurse Loan Repayment Program
(LVNLRP), Mental Health Loan Assumption Program (MHLAP), and the
Steven M. Thompson Physician Corp Loan Repayment Program
(STLRP).
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The National Health Service Corp (NHSC) Repayment Program.
According to the NHSC, "the NHSC Loan Repayment Program (LRP) is
administered by the Bureau of Health Workforce (BHW) in the
Health Resources and Services Administration (HRSA) of the U.S.
Department of Health and Human Services (HHS). The purpose of
the NHSC LRP is to recruit and retain medical, nursing, dental,
and behavioral/mental health clinicians in eligible communities
of need designated as health professional shortage areas.to
provide culturally competent, interdisciplinary primary health
care services to underserved populations located in selected
Health Professional Shortage Areas (HPSAs) identified by the
Secretary of the HHS. HPSAs can be found in rural and urban
communities across the nation. In return, the NHSC LRP assists
clinicians in their repayment of outstanding qualifying
educational loans. The NHSC Loan Repayment funds are exempt
from Federal income and employment taxes. These funds are not
included as wages when determining benefits under the Social
Security Act."
California's State Loan Repayment Program (SLRP). According to
the OSHPD, "SLRP is federally funded through a grant from the
Health Resources and Services Administration (HRSA), Bureau of
Health Professions (BHPR), National Health Service Corps (NHSC)
and is administered by the State of California's Office of
Statewide Health Planning and Development (OSHPD). SLRP
increases the number of medical, nursing, dental, and
behavioral/mental health providers practicing in federally
designated California Health Professional Shortage Areas
(HPSAs). SLRP authorizes repayment of qualified educational
loans for eligible primary health care professionals, who must
commit to an initial 2-year, full-time or 4-year, half-time
service agreement to provide direct patient care in a primary,
dental, or mental health HPSA. SLRP requires the providers site
to: match the award, on a dollar-for-dollar basis, with
non-federal contributions (directly or through donations from
public or private entities), in addition to the providers
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prevailing salary and must located on the SLRP Certified
Eligible Site List."
Prior Related Legislation. AB 982 (Firebaugh), Chapter 1131,
Statutes of 2002 created both the DCLRP to be administered by
the DBC; and the Steven M. Thompson California Physician Corps
Loan Repayment Program, to be administered by the Medical Board
of California (MBC).
SB 599 (Negrete-McLeod), Chapter 642, Statutes of 2009 extended
the sunset date of the DCLRP to 2012.
SB 540 (Price), Chapter 385, Statutes of 2011 extended the DCLRP
until all monies are expended.
AB 920 (Aghazarian), Chapter 317, Statutes of 2005 transferred
administration of the Steven M. Thompson Physician Corps Loan
Repayment Program from the MBC to the HPEF under the OSHPD.
ARGUMENTS IN SUPPORT:
The California Dental Association (CDA) writes in support, "The
lack of program participants stems from extensive and burdensome
qualification requirements, and a general lack of awareness of
the program's existence. CDA believes these revisions to the
program will enable qualified and willing dentists to serve the
state's most vulnerable populations and most effectively use the
funds dedicated by the [L]egislature so many years ago."
POLICY ISSUES FOR CONSIDERATION:
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1)In moving the DCLRP to HPEF within the OSPHD, it is unclear
whether the additional administration and management would
overburden the current HPEF resources. The DCLRP, as it
exists under the DBC, allotted $135,000 in the first three
years to address administrative costs associated with
implementing this program. If any of this specific fund to
cover administrative costs is still unused, the author may
wish to consider specifying a portion of the funds to be used
for implementing this program under the HPEF.
2)The Committees recommended, during the 2015 Sunset Review
process, that the DBC advise the Committees on whether the
DCLRP should be administered by HPEF; as such, this issue will
be discussed when the DBC is reviewed again in 2019. This
bill requires the HPEF to report to the Legislature on the
efficacy of the DCLRP under the administration and management
of the HPEF. The author may wish to require the HPEF to also
submit the report to the DBC, or to require HPEF to submit the
report in consultation with the DBC, so that both entities
benefit from the information gathered.
IMPLEMENTATION ISSUES:
1)The boards and bureaus under the DCA that will be reviewed in
a given year are required to submit a Background Report to the
Committees in November of the preceding year. For example,
the DBC will be reviewed in 2019; therefore its Sunset Review
Report will be due to the Committees in November 2018. In
order for the DBC to adequately address the Committees'
recommendation to transfer the DCLRP to the HPEF, the author
may wish to adjust the deadline for the HPEF report to be
submitted to the Legislature before the DBC's background paper
is submitted to the Committees.
AMENDMENT:
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1)To address the policy and implementation concerns regarding
the deadline for the HPEF to report to the Legislature, and
the DBC's involvement in the report, the following amendment
will require the HPEF to submit its report to the DBC before
the DBC Sunset Review Report is submitted to the Committees:
On page 7, line 34-35, strike "January 1, 2019, the
foundation shall submit a report to the Legislature" and
insert "July 1, 2018, the foundation shall submit a report
to the Dental Board of California and the Legislature."
2)The author should make the following technical amendment:
On page 6, line19, strike both references to the "board"
and after both "the" insert "foundation"
REGISTERED SUPPORT:
California Dental Association (sponsor)
REGISTERED OPPOSITION:
None on File.
Analysis Prepared by:Gabby Nepomuceno / B. & P. / (916) 319-3301
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