BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 22|
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THIRD READING
Bill No: SB 22
Author: Roth (D)
Amended: 6/2/15
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Residency training
SOURCE: Author
DIGEST: This bill requires the Office of Statewide Health
Planning and Development (OSHPD) to establish a non-profit
public benefit corporation to be known as the California Medical
Residency Training Foundation (Foundation), as specified. This
bill requires the Foundation to be governed by a board of
trustees, as specified. This bill specifies the duties of the
Foundation and OSHPD for the purposes of establishing and
funding new residency positions in underserved areas of the
state.
ANALYSIS:
Existing law:
1) Establishes the California Healthcare Workforce Policy
Commission (Commission) and requires the Commission to, among
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other things, identify specific areas of the state where
unmet priority needs for primary care family physicians and
registered nurses exist; establish standards for family
practice training programs, family practice residency
programs, primary care physician assistants programs, and
programs that train primary care nurse practitioners; and
review and make recommendations to OSHPD about funding of
those programs.
2) Establishes the Health Professions Education Foundation
(HPEF) within OSHPD. Requires the HPEF to solicit and
receive funds from Foundations and other private and public
sources and to provide financial assistance in the form of
scholarships or loans to students in the health professions
who are from underrepresented groups. Establishes, under the
HPEF, scholarship, loan, and loan repayment programs for
registered nurses, vocational nurses, geriatric nurse
practitioners, clinical nurse specialists, and mental health
professionals who agree to practice for specified periods of
time in underserved areas and in designated practice
settings, as specified.
3) Establishes, under HPEF, the Steven M. Thompson Physician
Corps Loan Repayment Program, which provides for the
repayment of educational loans for licensed physicians and
surgeons who practice in medically underserved areas of the
state, as defined.
4) Establishes within OSHPD the Health Professions Education
Fund to receive funds for scholarships and loans to students
from underrepresented groups who are enrolled in or accepted
to schools of medicine, dentistry, nursing, and other health
professions.
5) Establishes the Song-Brown Health Care Workforce Training Act
of 1973, administered by OSHPD to provide financial support
to family practice residency programs, nurse practitioner and
physician assistant programs, and registered nurse education
programs to increase the number of students and residents
receiving education and training in family practice and
nursing.
This bill:
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1) Requires OSHPD to establish a non-profit public benefit
corporation to be known as the Foundation, which is required
to be governed by a board of trustees consisting of a total
of 13 members.
2) Requires seven members to be appointed by the Governor, one
member appointed by the Speaker of the Assembly, one member
by the Senate Committee on Rules, two members of the Medical
Board of California (MBC) by the MBC, and two members of the
Osteopathic Medical Board of California (OMBC). Permits the
board members appointed by the Governor, the Speaker of the
Assembly, and the Senate Committee on Rules to include
representatives of designated and nondesignated public and
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.
Specifies terms of appointees.
3) Permits the OSHPD director, after consultation with the
president of the board, to appoint a council of advisers
comprised of up to nine members, to advise the director and
the board on technical matters and programmatic issues
related to the Foundation.
4) Requires board and council members appointed by the Governor,
Assembly, and Senate to serve without compensation, but to be
reimbursed for any actual and necessary expenses incurred in
connection with their duties as a board or council member.
Requires members appointed by the MBC and OMBC to be
reimbursed by those entities for any actual and necessary
expenses, as specified.
5) Prohibits any board member from being considered to be
engaged in activities inconsistent and incompatible with his
or her duties solely as a result of membership on the MBC and
OMBC.
6) Makes the Foundation subject to the Nonprofit Public Benefit
Corporation Law, except that if there is a conflict with this
bill and that law, this bill prevails.
7) Requires the Foundation to:
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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 described in c) below;
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 described in c) below. Requires
the Foundation to solicit proposals for medical residency
programs and provide OSHPD a copy of all proposals it
receives;
c) Approve proposals and recommend to OSHPD the
establishment of new residency positions upon the
sufficient solicitation of funds and at the Foundation's
discretion. Requires a recommendation to include all
pertinent information necessary for OSHPD to enter into
the necessary contracts to establish the residency
positions. Requires the Foundation to only approve and
recommend proposals that would establish residency
positions that will serve a service area that is
designated as:
i) A primary care shortage area;
ii) A health professional shortage area (HPSA) for
primary care, by either population or geographic
designation by HRSA;
iii) A medically underserved area or medically
underserved population by HRSA.
d) Deposit into the Fund necessary moneys are required to
establish and fund the residency program, upon approval of
a recommendation;
e) Recommend to the OSHPD director that a portion of the
funds solicited from the private sector be used for the
administrative requirements of the Foundation; and
f) Prepare and submit an annual report to the Legislature
documenting the amount of money solicited, the amount of
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money deposited from the Foundation into the Fund, the
recommendations for the location and fields of practice of
future residency positions, total expenditures for the
year, and the prospective fundraising goals.
8) Requires OSHPD to:
a) Provide technical and staff support to the Foundation
in meeting all of its responsibilities.
b) Provide financial management for the Foundation.
c) Approve the recommendation, upon receipt from the
Foundation, if it fulfills the requirements of this bill.
Requires an approval to signal OSHPD's intent to establish
the residency position upon sufficient funds being
available.
d) Establish a uniform process by which the Foundation 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.
e) Require that these proposals contain all necessary and
pertinent information, including, but not limited to, the
location of the proposed residency position; the medical
practice area of the proposed residency position;
information that demonstrates the area's need for the
proposed residency position and for additional primary
care practitioners;
amount of funding required to establish and operate the
residency position;
f) 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.
g) Ensure that the residency position has been, or will
be, approved by the Accreditation Council for Graduate
Medical Education;
h) Provide the following information to the board:
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i) The areas of the state that are deficient in
primary care services;
ii) 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;
iii) The proposals received from institutions that
train primary care physicians pursuant d) above; and
iv) Other information that OSHPD or the board finds
relevant to assist the board in making its
recommendations on possible locations for new residency
positions.
i) Monitor the residencies established pursuant to this
chapter; and
j) Prepare and submit an annual report to the Foundation
and the Legislature documenting the amount of money
contributed to the fund by the Foundation, 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.
9) Establishes the Medical Residency Training Fund within the
State Treasury, as specified.
10)Makes the level of expenditure by OSHPD for the
administrative support of the Foundation is subject to review
and approval annually through the State Budget process.
11)Permits OSHPD and the Foundation to solicit and accept public
and private donations for deposit in the fund, and makes all
money in the fund continuously appropriated to OSHPD for the
purposes of this chapter. Requires OSHPD to manage this fund
prudently in accordance with applicable laws.
12)Requires any regulations adopted to implement this to be
emergency regulations, as specified.
13)Permits OSHPD to exempt from public disclosure any document
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in its possession that pertains to a donation made pursuant
to this bill if the donor has requested anonymity.
Comments
1)Author's statement. According to the author, California has a
critical shortage of primary care physicians. In order to
maintain our current rate of utilizations, we must train 8,000
more primary care physicians by 2030. Our statewide shortage
is further aggravated by misdistribution. Only 16 of
California's 58 counties meet the recommended 60-80 primary
care physicians per 1,000 people. With an increasing Medi-Cal
population, these already underserved areas will see their
services stretched even thinner. SB 22 will create a voluntary
public-private partnership to fund additional primary care
physician residency positions to be placed in these
underserved areas of California. By providing a state match of
up to $20 million for private contributions, SB 22 creates a
fund to provide additional residency positions while allowing
a state sanctioned but privately run non-profit organization
have a say in the distribution of the positions within these
areas. By working closely with private and public
stakeholders, this bill aims to create a consensus based
solution to meet the need for more doctors in California as
access to healthcare continues to grow.
2)Primary Care in California. California is home to the largest
number of primary care physicians and nurse practitioner in
the country. However, the state 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. The number of primary care physicians actively
practicing in California counties is, in too many cases, at
the bottom range of, or below, the state's need. 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
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they need.
3)The Affordable Care Act (ACA). Under the ACA, about five
million Californians have enrolled in either private insurance
or Medi-Cal. There are now 12 million Medi-Cal enrollees,
about one third of California's population. The newly insured
will increase demand for health care from an already strained
system. Furthermore, the ACA will change how care is
delivered. It provides incentives for expanded and improved
primary care, which may affect demand for some health care
professionals more than others, and encourages the creation of
team-based models of service delivery. Research indicates
that health care reform will place higher skill demands on all
members of the health care workforce as systems try to improve
quality while limiting costs. The scale of change with health
care reform is unlike anything that California has previously
faced. Studies have found that persons with health insurance
use more health care services than uninsured persons,
particularly in primary care and preventive services. This
was found in Massachusetts, which experienced a substantial
increase in demand for primary care services as a result of
its 2006 health reform. A February 2, 2015 article in the San
Jose Mercury News reported that the primary care physician
shortage combined with the millions of newly insured has
resulted in significant delays in seeing a doctor and crowded
emergency rooms. According to the Mercury News article, "?
many experts say the problems are so widespread they shouldn't
be ignored."
4)Current workforce development programs. The state currently
operates a number of programs designed to increase the number
of health care professionals practicing in medically
underserved areas:
a) HPEF established in 1987 and housed within OSHPD
non-profit, HPEF is a non-profit Foundation statutorily
created to provide financial incentives to aspiring and
practicing health professionals. HPEF offers six
scholarships and seven loan repayment programs in several
allied health professions, including nursing, mental
health, dentistry, and medicine. Scholarship programs
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provide financial assistance to healthcare students who are
attending a California accredited college or university and
agree to practice in California's underserved communities
upon graduation. Loan repayment programs are offered to
working health professionals to assist in repayment of
their education debt in exchange for a service obligation.
Service obligations are typically one to three years, and
vary depending on the program and awards range from $4,000
to $105,000 depending on profession and length of service
obligation. HPEF has increased access to care in the
state's underserved areas via 6,693 awards totaling more
than $60 million to health practitioner awardees serving in
57 of the state's 58 counties.
b) California State Loan Repayment Program (SLRP) provides
educational loan repayment assistance to primary health
care professionals who provide health care services in
federally designated HPSAs. Eligible health professionals
include physicians specializing in primary care fields,
nurse practitioners, certified nurse-midwives, general
practice dentists, registered dental hygienists, clinical
or counseling psychologists, clinical social workers,
licensed counselors, pharmacists, physician assistants,
psychiatric nurse specialists, and marriage and family
therapists. Eligible health professionals must be employed
by or have accepted employment at a SLRP Certified Eligible
Site (which includes rural health clinics, community health
clinics, county facilities, and federally qualified health
centers) and must commit to providing full-time or
half-time primary care services in a HPSA for a minimum of
two years. Health professionals may receive up to $50,000
in exchange for a two year full-time service obligation
and/or $25,000 for a two year half-time service obligation;
individuals can receive up to $150,000 over six years at
full-time and $75,00 for half-time. SLRP award amounts are
matched by the site(s) in which the health professional is
practicing, on a dollar-for-dollar basis, in addition to
salary. The SLRP is funded through a grant from the HRSA,
Bureau of Clinician Recruitment and Service, National
Health Service Corps and is administered by OSHPD.
c) Song-Brown Program. The Song-Brown Program was
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established to increase the number of family physicians in
the state and increase the number of family medicine
residency programs. Currently, Song-Brown provides
financial support to family medicine and primary care
residency (Internal Medicine, OB/GYN and Pediatric)
programs, family nurse practitioner programs, primary care
physician assistant training programs, and registered nurse
education programs. Funding is provided to institutions
that provide clinical training and education in underserved
areas, and healthcare to the state's underserved
population.
d) Mini Grants Program provides grants to organizations
supporting underrepresented and economically disadvantaged
students in pursuit of careers in health care.
Organizations receive grants of up to $15,000 to engage in
health career conferences, workshops, and/or career
exploration activities. Since 2005, over $2.2 million has
been awarded to support organizations engaging in these
activities serving nearly 56,000 students statewide. In
2014 to2015, via partial funding from Mental Health
Services Act Workforce Education and Training, the
California Endowment, and the California State Office of
Rural Health, OSHPD awarded 46 Mini Grants to organizations
for a sum of $603,706. This will help support 16,555
students from demographically underrepresented groups to
pursue healthcare careers.
e) California Student/Resident Experiences and Rotations in
Community Health (CalSEARCH) provides grants to
organizations that support student and resident rotations
from primary care and mental health disciplines in
community clinics, health centers, and public mental health
system sites which expose students, residents and
practitioners to underserved communities. Organizations
awarded receive funding to administer the program and to
provide students, residents, and preceptors and mentors a
small stipend for completing the program. In addition to
completing a rotation in an underserved area, participants
are also required to complete a community project. From
2009 to 2012, 150 students and residents were supported via
an American Recovery and Reinvestment Act grant. In 2014
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to2015, via funding from the MHSA Workforce Education and
Training and The California Endowment, OSHPD granted 12
awards to organizations for a sum of $317,000 which will
help support 92 participants statewide.
f) MHSA Workforce Education and Training (WET) Program
funded by Proposition 63, this program remedies the
shortage of mental health practitioners in the public
mental health system (PMHS) via: career awareness; PMHS
rotations; retention grants; stipends; loan repayments;
grants to expand capacity of education and residency
programs; grants to increase and retain consumer and family
member employment; and grants to support regional
partnerships.
Prior Legislation
SB 1416 (Rubio, 2012) would have created the Graduate Medical
Education Trust Fund for the purpose of funding grants to
graduate medical education residency programs in California, and
would have required OSHPD to develop criteria for distribution
of available moneys. SB 1416 was held in the Assembly
Appropriations Committee
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)One-time administrative costs of about $1 million to create
the foundation and develop criteria for making grants (General
Fund). In the long-run, donations may support some or all of
the activities of the proposed program. In the near term,
however, state funds will likely be needed to create the
program.
2)Ongoing costs of about $800,000 per year to administer the
program, support the Foundation, and review and approve grants
and contracts (private funds).
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3)Unknown costs to make grants to medical residency programs
(private funds). The bill would require the Foundation to
solicit donations from public and private sources in order to
fund new medical residency positions. The amount of funding
available under the program will depend on the success of
those fundraising efforts.
SUPPORT: (Verified6/1/15)
AARP
Association of California Healthcare Districts
California Academy of Physician Assistants
California Chapter of the American College of Emergency
Physicians
California Physical Therapy Association
California Primary Care Association
Community Clinic Association of Los Angeles County
OPPOSITION: (Verified6/1/15)
None received
Prepared by:Melanie Moreno / HEALTH /
6/2/15 20:28:34
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