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: 1/25/16
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 establishes the Medical Residency Training
Advisory Panel (Advisory Panel) within the Office of Statewide
Health Planning and Development's (OSHPD) Health Professions
Education Foundation, consisting of 13 members, as specified.
Specifies the duties of the Advisory Panel and OSHPD for the
purpose of establishing and funding new residency positions in
medically underserved areas of the state.
Senate Floor Amendments of 1/25/16 make technical changes to the
structure of the program created under this bill.
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Senate Floor Amendments of 6/4/15 provide funding for the
purposes of this bill in the annual budget.
ANALYSIS:
Existing law:
1) Establishes the Health Professions Education Foundation
(HPEF) within OSHPD. Requires 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.
2) Establishes, under 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.
This bill:
1)Establishes the Medical Residency Training Advisory Panel
within HPEF, consisting of a total of 13 members, as
specified. 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)
by the OMBC.
2)Requires the Advisory Panel members to include representatives
of 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, as
specified. Specifies the terms of and requirements placed
upon the members.
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3)Makes the Advisory Panel subject to the Nonprofit Public
Benefit Corporation Law, except that if there is a conflict
this bill prevails.
4)Requires the Advisory Panel to:
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.
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 .
c) Solicit proposals for medical residency programs, as
specified, and provide HPEF a copy of all proposals it
receives.
d) Upon the sufficient solicitation of funds and at the
Advisory Panel's discretion, recommend to HPEF the
establishment of new residency positions, as specified.
e) Only approve and recommend to HPEF proposals that would
establish residency positions that will serve in specified
medical service areas.
f) Upon HPEF approval of a recommendation, deposit into the
fund created in #7 below necessary moneys required to
establish and fund the residency position.
g) Recommend to the director of OSHPD that a portion of the
funds solicited from the private sector be used for the
administrative requirements of the Advisory Panel and HPEF.
h) Prepare and submit an annual report to the Legislature
documenting the amount of money solicited, the amount of
money deposited into the fund created in #7 below, the
recommendations for the location and fields of practice of
residency positions, total expenditures for the year, and
prospective fundraising goals.
5)Requires HPEF to:
a) Provide technical and staff support to Advisory Panel in
meeting all of its responsibilities.
b) Upon receipt of a recommendation by the Advisory Panel,
approve the recommendation if it fulfills the specified
requirements.
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c) Upon sufficient funds being available, send an approval
to OSHPD for implementation.
6)Requires OSHPD to:
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. Requires
that the proposals contain all necessary and pertinent
information, including, but not limited to, specified
information.
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 specified information to the Advisory Panel and
HPEF as requested and as specified.
e) Monitor the residencies established pursuant to this
bill.
f) Prepare and submit an annual report to the Advisory
Panel, HPEF, 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.
7)Establishes the Medical Residency Training Fund (Fund) within
the State Treasury. Specifies that the primary purpose of the
Fund is to allocate funding for new residency positions
throughout the state and requires money in the Fund to also be
used to pay for the cost of administering the goals of the
Advisory Panel, and for any other purpose authorized by this
bill.
8)Makes the level of expenditure by OSHPD for the administrative
support of HPEF subject to review and approval annually
through the state budget process.
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9)Permits OSHPD and HPEF 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 bill. Requires OSHPD to manage this fund
prudently in accordance with applicable laws.
10)Requires any regulations adopted to implement this to be
emergency regulations, as specified.
11)Permits OSHPD to exempt from public disclosure any document
in its possession that pertains to a donation made pursuant
to this bill if the donor has requested anonymity.
12)Permits the Governor to include in the annual budget
proposal an amount, as he or she deems reasonable, to be
appropriated to OSHPD, as specified.
13)Requires the money, if the Legislature appropriates it for
the purposes of this bill, to be appropriated to OSHPD.
Requires OSHPD to hold the money for distribution to the Fund
created under this bill.
14)Requires appropriated funds to be paid into the Fund, upon
request of HPEF in an amount matching the amount deposited
into the Fund for the purposes of this bill.
15)Requires any appropriated funds that has not been
distributed to the Fund at the end of each fiscal year to be
returned to the General Fund.
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
SB 22
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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 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 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.
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
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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.
4)Current workforce development programs. The state operates a
number of programs designed to increase the number of health
care professionals practicing in medically underserved areas:
a) HPEF offers six scholarships and seven loan repayment
programs in several allied health professions, including
nursing, mental health, dentistry, and medicine.
Scholarship programs 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 the Health Professional Shortage Areas
(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
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(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.
c) The Song-Brown Program 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 and 2015, 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 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
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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 to 2015, via
funding from the Mental Health Services Act (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 is
funded by Proposition 63 and seeks to remedy 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.
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, as amended
6/2/15:
1)One-time administrative costs of about $1 million to create
the Advisory Panel 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 Advisory Panel, and review and approve
grants and contracts (private funds).
3)Unknown costs to make grants to medical residency programs
(private funds). This bill will require the Advisory Panel to
solicit donations from public and private sources in order to
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fund new medical residency positions. The amount of funding
available under the program will depend on the success of
those fundraising efforts.
SUPPORT: (Verified1/26/16)
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: (Verified1/26/16)
None received
Prepared by:Melanie Moreno / HEALTH /
1/26/16 16:39:31
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