Amended in Assembly February 29, 2016

Amended in Senate January 25, 2016

Amended in Senate June 4, 2015

Amended in Senate June 2, 2015

Amended in Senate May 5, 2015

Amended in Senate April 21, 2015

Senate Bill No. 22

Introduced by begin delete Senator Roth end delete begin insert Senators Roth, Cannella, and Galgiani end insert

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(Principal coauthors: Assembly Members Alejo, Brown, Calderon, Eduardo Garcia, Gipson, Gonzalez, Gray, Jones-Sawyer, Linder, Olsen, Ridley-Thomas, and Salas)

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December 1, 2014

An act begin delete to add Article 7 (commencing with Section 128590) to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, end delete relating to health care, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

SB 22, as amended, Roth. Residency begin delete training. end delete begin insert training: funding. end insert

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The Song-Brown Health Care Workforce Training Act creates a state medical contract program to increase the number of students and residents receiving quality education and training in specified primary care specialties or in nursing, and to maximize the delivery of primary care and family physician services to specific areas of California where there is a recognized unmet priority need for those services. The act requires the Director of Statewide Health Planning and Development to, among other things, contract with accredited medical schools, teaching health centers, training programs, hospitals, and other health care delivery systems for those purposes, based on recommendations of the California Healthcare Workforce Policy Commission and in conformity with the contract criteria and program standards established by the commission.

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This bill would appropriate $300,000,000 from the General Fund to the director for the purpose of funding new and existing graduate medical education physician residency positions, and supporting training faculty, pursuant to the act, for expenditure as specified. The bill would also make related findings and declarations.

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Existing law, the Song-Brown Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physician’s assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physician’s assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.

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Existing law requires the Office of Statewide Health Planning and Development to establish the Health Professions Education Foundation to solicit and receive funds for the purpose of providing financial assistance in the form of scholarships or loans to medical students from underrepresented groups. Under existing law, the foundation also administers other programs for the advancement of health professions, including the Registered Nurse Education Program.

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This bill would establish the Medical Residency Training Advisory Panel, consisting of a total of 13 members to be appointed as specified, within the Health Professions Education Foundation.

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The bill would create the Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the panel to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in specified areas of the state, including medically underserved areas. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the foundation to provide technical support and financial management for the panel and to approve and send panel recommendations for new residency programs to the Office of Statewide Health Planning and Development for implementation if specified requirements are met, including sufficient funding. The bill would require the office to enter into contracts with public and private sector institutions and other health agencies and organizations in order to fund and establish recommended residency positions. The bill would authorize the Governor to include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated for this purpose. The bill, if the Legislature appropriates money for this purpose, would require the office to hold the funds and distribute them into the fund, upon request of the panel, in an amount matching the amount deposited into the fund, as specified. The bill would require money that was appropriated, but that has not been distributed to the fund at the end of each fiscal year, to be returned to the General Fund.

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Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

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This bill would make legislative findings to that effect.

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Vote:  begin delete majority end delete begin insert ²⁄₃ end insert . Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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The Legislature finds and declares as follows:

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(a) More than $40 million of funding for the training of
California’s primary care physicians is expiring in 2016.

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(b) Each year in California, only 368 slots are available to the
thousands of medical students seeking to train in family medicine.
If the funding is not replaced, 158 of those slots will be lost,
creating a terrible deficit of primary care physicians in California’s
underserved communities.

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(c) Only 36 percent of California’s active patient care physicians
practice primary care. Twenty-three of California’s 58 counties
fall below the minimum required primary care physician to
population ratio.

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(d) As of 2010, California needed an estimated additional 8,243
primary care physicians by 2030 to prevent projected shortages
in the state, which is about 412 new primary care physicians per
year.

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(e) More than 32 percent of California’s practicing primary
care physicians are 60 years of age or older - only four other
states have a larger percentage of soon-to-retire physicians.

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(f) States with higher ratios of primary care physicians to
population have better health outcomes, including decreased
mortality from cancer, heart disease, and stroke.

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(g) The Song-Brown program provides an existing state
infrastructure to support an increase in the number of primary
care providers serving California’s underserved populations. By
investing in Song-Brown, California will realize an immediate
return on investment as each primary care resident provides an
average of 600 additional patient visits per physician per year
during training alone.

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(h) California’s long-term workforce will also grow significantly
as the vast majority of physicians who train in a region stay there
to practice. California leads all fifty states in the percentage of
residency program graduates who stay in the state in which they
are trained.

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begin insert SEC. 2. end insert   

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Notwithstanding Section 13340 of the Government
Code, there is hereby continuously appropriated from the General
Fund the sum of three hundred million dollars ($300,000,000) to
the Director of Statewide Health Planning and Development, for
the purpose of funding new and existing graduate medical
education physician residency positions, and supporting training
faculty, pursuant to the Song-Brown Health Care Workforce
Training Act (Article 1 (commencing with Section 128200) of
Chapter 4 of Part 3 of Division 107 of the Health and Safety Code).
The moneys shall be expended as follows:

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(a) The sum of one hundred million dollars ($100,000,000) shall
be expended in the 2016-17 fiscal year.

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(b) The sum of one hundred million dollars ($100,000,000) shall
be expended in the 2017-18 fiscal year.

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(c) The sum of one hundred million dollars ($100,000,000) shall
be expended in the 2018-19 fiscal year.

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SECTION 1.  

Article 7 (commencing with Section 128590) is
added to Chapter 5 of Part 3 of Division 107 of the Health and
Safety Code, to read:

 

Article 7.  California Medical Residency Training Program

 

128590.  

As used in this article:

(a) “Director” means the Director of Statewide Health Planning
and Development.

(b) “Foundation” means the Health Professions Education
Foundation.

(c) “Fund” means the Medical Residency Training Fund.

(d) “Office” means the Office of Statewide Health Planning and
Development.

(e) “Panel” means the Medical Residency Training Advisory
Panel, established pursuant to Section 128591.

(f) “Primary care” means the medical practice areas of family
medicine, general surgery, internal medicine, obstetrics and
gynecology, pediatrics, psychiatry, and related specialties and
subspecialties as the office deems appropriate.

(g) “Residency position” means a graduate medical education
residency position in the field of primary care.

128591.  

(a) (1) There is established within the foundation the
Medical Residency Training Advisory Panel.

(2) The panel shall consist of 13 members. Seven members shall
be appointed by the Governor, one member shall be appointed by
the Speaker of the Assembly, one member shall be appointed by
the Senate Committee on Rules, two members of the Medical
Board of California shall be appointed by the Medical Board of
California, and two members of the Osteopathic Medical Board
of California shall be appointed by the Osteopathic Medical Board
of California.

(3) The members of the panel appointed by the Governor, the
Speaker of the Assembly, and the Senate Committee on Rules
shall consist of representatives of designated and nondesignated
public hospitals, private hospitals, community clinics, public and
private health insurance providers, the pharmaceutical industry,
associations of health care practitioners, and other appropriate
members of health or related professions.

(4) All persons considered for appointment shall have an interest
in increasing the number of medical residencies in the state, an
interest in increasing access to health care in underserved areas of
California, and the ability and desire to solicit funds for the
purposes of this article, as determined by the appointing power.

(b) The Governor shall appoint the president of the panel from
among those members appointed by the Governor, the Speaker of
the Assembly, the Senate Committee on Rules, the Medical Board
of California, and the Osteopathic Medical Board of California.

(c) (1) Of the members of the panel first appointed by the
Governor, three members shall be appointed to serve a one-year
term, three members shall be appointed to serve a two-year term,
and one member shall be appointed to serve a three-year term.

(2) Each member of the panel first appointed by the Speaker of
the Assembly and the Senate Committee on Rules shall be
appointed to serve a three-year term.

(3) Each member of the panel appointed by the Medical Board
of California and the Osteopathic Medical Board of California
shall be appointed to serve a four-year term.

(4) Upon the expiration of the initial appointments to the panel
by the Governor, the Speaker of the Assembly, the Senate
Committee on Rules, the Medical Board of California, and the
Osteopathic Medical Board of California, each member shall be
appointed to serve a four-year term.

(d) (1) Members of the panel appointed by the Governor, the
Speaker of the Assembly, and the Senate Committee on Rules
shall serve without compensation, but shall be reimbursed for any
actual and necessary expenses incurred in connection with their
duties as members of the panel.

(2) The members appointed by the Medical Board of California
and the Osteopathic Medical Board of California shall serve
without compensation, but shall be reimbursed by the Medical
Board of California and the Osteopathic Medical Board of
California, respectively, for any actual and necessary expenses
incurred in connection with their duties as members of the panel.

(e) Notwithstanding any law relating to incompatible activities,
no member of the panel shall be considered to be engaged in
activities inconsistent and incompatible with his or her duties solely
as a result of membership on the Medical Board of California or
the Osteopathic Medical Board of California.

(f) The panel shall be subject to the Nonprofit Public Benefit
Corporation Law (Part 2 (commencing with Section 5110) of
Division 2 of Title 2 of the Corporations Code), except that if there
is a conflict with this article and the Nonprofit Public Benefit
Corporation Law (Part 2 (commencing with Section 5110) of
Division 2 of Title 2 of the Corporations Code), this article shall
prevail.

128592.  

The panel shall do all of the following:

(a) Solicit and accept funds from business, industry, foundations,
and other private or public sources for the purpose of establishing
and funding new residency positions in areas of the state described
in subdivision (c).

(b) Encourage public and private sector institutions, including
hospitals, colleges, universities, community clinics, and other
health agencies and organizations to identify and provide locations
for the establishment of new residency positions in areas of the
state described in subdivision (c). The panel shall solicit proposals
for medical residency programs, as described in subdivision (c),
and shall provide to the foundation a copy of all proposals it
receives.

(c) Upon the sufficient solicitation of funds and at the panel’s
discretion, recommend to the foundation the establishment of new
residency positions. A recommendation shall include all pertinent
information required to enter into the necessary contracts to
establish the residency positions. The panel shall only approve and
recommend to the foundation proposals that would establish
residency positions that will serve in any of the following medical
service areas:

(1) A service area that is designated as a primary care shortage
area by the office.

(2) A service area that is designated as a health professional
shortage area for primary care, by either population or geographic
designation, by the Health Resources and Services Administration
of the United States Department of Health and Human Services.

(3) A service area that is designated as a medically underserved
area or medically underserved population by the Health Resources
and Services Administration of the United States Department of
Health and Human Services.

(d) Upon foundation approval of a recommendation, deposit
into the fund necessary moneys required to establish and fund the
residency position.

(e) Recommend to the director that a portion of the funds
solicited from the private sector be used for the administrative
requirements of the panel and the foundation.

(f) Prepare and submit an annual report to the Legislature
documenting the amount of money solicited, the amount of money
deposited by the panel into the fund, the recommendations for the
location and fields of practice of residency positions, total
expenditures for the year, and prospective fundraising goals.

128593.  

The foundation shall do all of the following:

(a) Provide technical and staff support to the panel in meeting
all of its responsibilities.

(b) Upon receipt of a recommendation made by the panel
pursuant to subdivision (c) of Section 128592, approve the
recommendation if the recommendation fulfills the requirements
of subdivision (c) of Section 128592 and the recommendation
fulfills the goals of this article. Upon sufficient funds being
available, an approval shall be sent to the office for implementation
pursuant to Section 128594.

128594.  

The office shall do all of the following:

(a) Establish a uniform process by which the panel may solicit
proposals from public and private sector institutions, including
hospitals, colleges, universities, community clinics, and other
health agencies and organizations that train primary care residents.
The office shall require that the proposals contain all necessary
and pertinent information, including, but not limited to, all of the
following:

(1) The location of the proposed residency position.

(2) The medical practice area of the proposed residency position.

(3) Information that demonstrates the area’s need for the
proposed residency position and for additional primary care
practitioners.

(4) The amount of funding required to establish and operate the
residency position.

(b) Enter into contracts with public and private sector
institutions, including hospitals, colleges, universities, community
clinics, and other health agencies and organizations in order to
fund and establish residency positions at, or in association with,
these institutions.

(c) Ensure that the residency position has been, or will be,
approved by the Accreditation Council for Graduate Medical
Education.

(d) Provide all of the following information to the panel and the
foundation as requested:

(1) The areas of the state that are deficient in primary care
services.

(2) The areas of the state that have the highest number of
Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by
proportion of population.

(3) Other information relevant to assist the panel and the
foundation in making recommendations on possible locations for
new residency positions.

(e) Monitor the residencies established pursuant to this article.

(f) (1) Prepare and submit an annual report to the panel, the
foundation, and the Legislature documenting the amount of money
contributed to the fund by the panel, the amount of money
expended from the fund, the purposes of those expenditures, the
number and location of residency positions established and funded,
and recommendations for the location of future residency positions.

(2) The report pursuant to paragraph (1) shall be made to the
Legislature pursuant to Section 9795 of the Government Code.

128595.  

(a) The Medical Residency Training Fund is hereby
created within the State Treasury.

(b) The primary purpose of the fund is to allocate funding for
new residency positions throughout the state. Money in the fund
shall also be used to pay for the cost of administering the goals of
the panel and the foundation as established by this article, and for
any other purpose authorized by this article.

(c) The level of expenditure by the office for the administrative
support of the panel and the foundation is subject to review and
approval annually through the state budget process.

(d) In addition to funds raised by the panel, the office and the
foundation may solicit and accept public and private donations to
be deposited into the fund. All money in the fund is continuously
appropriated to the office for the purposes of this article. The office
shall manage this fund prudently in accordance with applicable
laws.

128596.  

Any regulations the office adopts to implement this
article shall be adopted as emergency regulations in accordance
with Section 11346.1 of the Government Code, except that the
regulations shall be exempt from the requirements of subdivisions
(e), (f), and (g) of that section. The regulations shall be deemed to
be emergency regulations for the purposes of Section 11346.1 of
the Government Code.

128597.  

Notwithstanding any other law, the office may exempt
from public disclosure any document in the possession of the office
that pertains to a donation made pursuant to this article if the donor
has requested anonymity.

128598.  

(a) The Governor may include in the annual budget
proposal an amount, as he or she deems reasonable, to be
appropriated to the office to be used as provided in this article.

(b) If the Legislature appropriates money for purposes of this
article, the money shall be appropriated to the office, which shall
hold the money for distribution to the fund.

(c) Funds appropriated to the office shall be paid into the fund,
upon request of the panel, in an amount matching the amount
deposited into the fund by the panel or by the foundation and office
pursuant to subdivision (d) of Section 128595 for the purposes of
this article. Any money that was appropriated to the office and
that has not been distributed to the fund at the end of each fiscal
year shall be returned to the General Fund.

SEC. 2.  

The Legislature finds and declares that Section 1 of
this act, which adds Article 7 (commencing with Section 128590)
to Chapter 5 of Part 3 of Division 107 of the Health and Safety
Code, imposes a limitation on the public’s right of access to the
meetings of public bodies or the writings of public officials and
agencies within the meaning of Section 3 of Article I of the
California Constitution. Pursuant to that constitutional provision,
the Legislature makes the following findings to demonstrate the
interest protected by this limitation and the need for protecting
that interest:

The need to protect individual privacy of donations made by a
donor to fund new medical residency positions in underserved
areas of the state outweighs the interest in the public disclosure of
that information.

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