BILL NUMBER: SB 308 CHAPTERED 07/22/99 CHAPTER 149 FILED WITH SECRETARY OF STATE JULY 22, 1999 APPROVED BY GOVERNOR JULY 22, 1999 PASSED THE ASSEMBLY JULY 8, 1999 PASSED THE SENATE MAY 25, 1999 AMENDED IN SENATE MAY 17, 1999 AMENDED IN SENATE MAY 6, 1999 INTRODUCED BY Senator Escutia FEBRUARY 4, 1999 An act to amend Section 2815.1 of the Business and Professions Code, and to amend Sections 128230, 128280, 128330, 128335, 128345, 128350, 128355, 128375, 128385, 128395, 128400, 128435, 128445, and 128450 of, to amend the heading of Article 1 (commencing with Section 128330) of Chapter 5 of, to amend the heading of Chapter 5 (commencing with Section 128330) of, Part 5 of Division 107 of, and to repeal Sections 128405 and 128455 of, the Health and Safety Code, relating to nursing, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST SB 308, Escutia. Nurses. Existing law authorizes the Board of Registered Nursing to establish fee schedules in connection with the issuance of licenses for registered nurses, not to exceed certain amounts. These provisions authorize a biennial fee to be paid upon the filing of an application for renewal of the license for registered nurses. Existing law authorizes a separate additional $5 assessment at the time of the biennial licensure renewal. This latter provision is repealed as of January 1, 2000. This bill would delete the repeal of the provisions authorizing the imposition of the $5 separate assessment at the time of the biennial licensure renewal, thereby extending that authority indefinitely. Existing law requires the Office of Statewide Health Planning and Development to establish the Minority Health Professions Education Foundation and prescribes the powers of the foundation, to include soliciting and receiving funds from various entities for the purpose of providing financial assistance in the form of scholarships or loans to students from various underrepresented minority groups, as defined. Existing law establishes within the office a Minority Health Professions Education Fund, a continuously appropriated fund, to provide scholarships and loans to students from underrepresented minority groups who are accepted to or enrolled in schools of medicine, dentistry, nursing, or other health professions, and to fund the Geriatric Nurse Practitioner and Clinical Nurse Specialist Scholarship Program. Existing law authorizes the foundation to recommend to the director the disbursement of private sector moneys deposited in the fund. This bill would rename the Minority Health Professions Education Foundation and the Minority Health Professions Education Fund as the Health Professions Education Foundation and the Health Professions Education Fund, respectively. The bill also would delete references to "underrepresented minority groups" and refer instead to "underrepresented groups," as defined, for these purposes. Existing law establishes within the Minority Health Professions Education Foundation, the Registered Nurse Education Program which provides procedures under which persons either from demographically underrepresented groups or who agree in writing prior to graduation to serve in an eligible county health facility or a health manpower shortage area, as defined, may apply for awards under the program. Existing law requires the foundation to solicit the advice of representatives of certain organizations and entities in developing the program. This bill would restrict participation in the program to persons who agree in writing prior to graduation to serve in an eligible county health facility or a health manpower shortage area. The bill would require the foundation to solicit the advice of representatives who reflect the demographic diversity of California in developing the program. Under existing law, the Registered Nurse Education Program and the Geriatric Nurse Practitioner and Clinical Nurse Specialist Scholarship Program would be repealed on January 1, 2000. This bill would delete those repeal dates, thereby extending those programs indefinitely. This bill would declare that it is to take effect immediately as an urgency statute. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 2815.1 of the Business and Professions Code is amended to read: 2815.1. As provided in subdivision (d) of Section 2815, the Board of Registered Nursing shall collect an additional five dollar ($5) assessment at the time of the biennial licensure renewal. This amount shall be credited to the Registered Nurse Education Fund. This assessment is separate from those fees prescribed in Section 2815. SEC. 2. Section 128230 of the Health and Safety Code is amended to read: 128230. When making recommendations to the Director of the Office of Statewide Health Planning and Development concerning the funding of family practice programs or departments, family practice residencies, and programs for the training of primary care physician assistants and primary care nurse practitioners, the commission shall give priority to programs that have demonstrated success in the following areas: (a) Actual placement of individuals in medically underserved areas. (b) Success in attracting and admitting members of minority groups to the program. (c) Success in attracting and admitting individuals who were former residents of medically underserved areas. (d) Location of the program in a medically underserved area. (e) The degree to which the program has agreed to accept individuals with an obligation to repay loans awarded pursuant to the Health Professions Education Fund. SEC. 3. Section 128280 of the Health and Safety Code is amended to read: 128280. Each publicly funded medical school in California shall inform incoming medical students of all student loan, loan repayment, and medical student scholarship programs available to them. This information shall include, but need not be limited to, information concerning the National Health Service Corps program, the Health Professions Education Foundation Program, and the Loan Assumption Program created pursuant to this article. SEC. 4. The heading of Chapter 5 (commencing with Section 128330) of Division 107 of the Health and Safety Code is amended to read: CHAPTER 5. HEALTH PROFESSIONS EDUCATION FOUNDATION PROGRAMS SEC. 5. The heading of Article 1 (commencing with Section 128330) of Chapter 5 of Division 107 of the Health and Safety Code is amended to read: Article 1. Health Professions Education Foundation SEC. 6. Section 128330 of the Health and Safety Code is amended to read: 128330. As used in this article: (a) "Board" means the Board of Trustees of the Health Professions Education Foundation. (b) "Commission" means the Health Manpower Policy Commission. (c) "Director" means the Director of the Office of Statewide Health Planning and Development. (d) "Foundation" means the Health Professions Education Foundation. (e) "Health professions" or "health professionals" means physicians and surgeons licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, dentists, registered nurses, and other health professionals determined by the office to be needed in medically underserved areas. (f) "Office" means the Office of Statewide Health Planning and Development. (g) "Underrepresented groups" means African-Americans, American Indians, Hispanic-Americans, or other persons underrepresented in medicine, dentistry, nursing, or other health professions as determined by the board. After January 1, 1990, the board, upon a finding that the action is necessary to meet the health care needs of medically underserved areas, may add a group comprising the economically disadvantaged to those groups authorized to receive assistance under this article. SEC. 7. Section 128335 of the Health and Safety Code is amended to read: 128335. (a) The office shall establish a nonprofit public benefit corporation, to be known as the Health Professions Education Foundation, that shall be governed by a board consisting of nine members appointed by the Governor, one member appointed by the Speaker of the Assembly, and one member appointed by the Senate Committee on Rules. The members of the foundation board appointed by the Governor, Speaker of the Assembly, and Senate Committee on Rules may include representatives of minority groups which are underrepresented in the health professions, persons employed as health professionals, and other appropriate members of health or related professions. All persons considered for appointment shall have an interest in health programs, an interest in health educational opportunities for underrepresented groups, and the ability and desire to solicit funds for the purposes of this article as determined by the appointing power. The chairperson of the commission shall also be a nonvoting, ex officio member of the board. (b) The Governor shall appoint the president of the board of trustees from among those members appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules. (c) The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the Health Professions Education Foundation Program. (d) Members of the board and members of the council shall serve without compensation but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the board or the council. (e) The foundation 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. SEC. 8. Section 128345 of the Health and Safety Code is amended to read: 128345. The Health Professions Education Foundation may do any of the following: (a) Solicit and receive funds from business, industry, foundations, and other private or public sources for the purpose of providing financial assistance in the form of scholarships or loans to African-American students, American Indian students, Hispanic-American students, and other students from underrepresented groups. These funds shall be expended by the office after transfer to the Health Professions Education Fund, created pursuant to Section 128355. (b) Recommend to the director the disbursement of private sector moneys deposited in the Health Professions Education Fund to students from underrepresented groups accepted to or enrolled in schools of medicine, dentistry, nursing, or other health professions in the form of loans or scholarships. (c) Recommend to the director a standard contractual agreement to be signed by the director and any participating student, that would require a period of obligated professional service in the areas in California designated by the commission as deficient in primary care services. The agreement shall include a clause entitling the state to recover the funds awarded plus the maximum allowable interest for failure to begin or complete the service obligation. (d) Develop criteria for evaluating the likelihood that applicants for scholarships or loans would remain to practice their profession in designated areas deficient in primary care services. (e) Develop application forms, that shall be disseminated to students from underrepresented groups interested in applying for scholarships or loans. (f) Encourage private sector institutions, including hospitals, community clinics, and other health agencies to identify and provide educational experiences to students from underrepresented groups who are potential applicants to schools of medicine, dentistry, nursing, or other health professions. (g) Prepare and submit an annual report to the office documenting the amount of money solicited from the private sector, the number of scholarships and loans awarded, the enrollment levels of students from underrepresented groups in schools of medicine, dentistry, nursing, and other health professions, and the projected need for scholarships and loans in the future. (h) Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation. SEC. 9. Section 128350 of the Health and Safety Code is amended to read: 128350. The office shall do all of the following: (a) Provide technical and staff support to the foundation in meeting all of its responsibilities. (b) Provide financial management for the Health Professions Education Fund. (c) Enter into contractual agreements with students from underrepresented groups for the disbursement of scholarships or loans in return for the commitment of these students to practice their profession in an area in California designated as deficient in primary care services. (d) Disseminate information regarding the areas in the state that are deficient in primary care services to potential applicants for the scholarships or loans. (e) Monitor the practice locations of the recipients of the scholarships or loans. (f) Recover funds, in accordance with the terms of the contractual agreements, from recipients of scholarships or loans who fail to begin or complete their obligated service. Funds so recovered shall be redeposited in the Health Professions Education Fund. (g) Contract with the institutions that train family practice residents, in order to increase the participation of students from underrepresented groups in entering the specialty of family practice. The director may seek the recommendations of the commission or foundation as to what programs best demonstrate the ability to meet this objective. (h) Contract with training institutions that are involved in osteopathic postgraduate training in general or family practice medicine, in order to increase the participation of students from underrepresented groups participating in the practice of osteopathic medicine. The director may seek the recommendations of the commission or foundation as to what programs have demonstrated the ability to meet this objective. (i) Enter into contractual agreements with graduated health professionals to repay some or all of the debts they incurred in health professional schools in return for practicing their professions in an area in California designated as deficient in primary care services. (j) Contract with institutions that award baccalaureate of science degrees in nursing in order to increase the participation of students from underrepresented groups in the nursing profession. The director may seek the recommendations of the commission as to what programs have demonstrated the ability to meet this objective. SEC. 10. Section 128355 of the Health and Safety Code is amended to read: 128355. There is hereby created within the office a Health Professions Education Fund. The primary purpose of this fund is to provide scholarships and loans to students from underrepresented groups who are accepted to or enrolled in schools of medicine, dentistry, nursing, or other health professions, and to fund the Geriatric Nurse Practitioner and Clinical Nurse Specialist Scholarship Program pursuant to Article 3 (commencing with Section 128425). The fund shall also be used to pay for the cost of administering the program and for any other purpose authorized by this article. The level of expenditure by the office for the administrative support of the program created pursuant to this article shall be subject to review and approval annually through the State Budget process. The office may receive private donations to be deposited into this fund. All money in the fund is continuously appropriated to the office for the purposes of this article and Article 3 (commencing with Section 128425). The office shall manage this fund prudently in accordance with other provisions of law. SEC. 11. Section 128375 of the Health and Safety Code is amended to read: 128375. (a) The Legislature hereby finds and declares that an adequate supply of professional nurses is critical to assuring the health and well-being of the citizens of California, particularly those who live in medically underserved areas. (b) The Legislature further finds that changes in the health care system of this state have increased the need for more highly skilled nurses. These changes include advances in medical technology and pharmacology, that necessitate the use of more highly skilled nurses in acute care facilities. Further, the containment of health care costs has led to increased reliance on home health care and outpatient services and to a higher proportion of more acutely ill patients in acute care facilities. Long-term care facilities also need more highly educated nursing personnel. Both shifts require a larger number of skilled nursing personnel. (c) The Legislature further finds and declares that in nursing, as in other professions, certain populations are underrepresented. The Legislature also finds and declares that it is especially important that nursing care be provided in a way that is sensitive to the sociocultural variables that affect a person's health. The Legislature recognizes that the financial burden of obtaining a baccalaureate degree is considerable and that persons from families lacking adequate financial resources may need financial assistance to complete a baccalaureate degree. (d) The Legislature further finds and declares that approximately 54.1 percent of all Californians live in rural and urban areas that have been designated underserved. The shortage of professional nurses in these areas makes it more difficult for those citizens to obtain health care and more difficult to attract and retain other health care professionals to those areas. (e) The Legislature further finds and declares that since July 1, 1989, the Registered Nurse Education Fund has collected five million two hundred eight thousand five hundred seventy-four dollars ($5,208,574) to support the education of professional nurses and nursing students in California. (f) The Legislature further finds and declares that since 1990, the Health Professions Education Foundation has awarded over four million dollars ($4,000,000) in scholarship and loan repayment to 754 nursing students and nurses in California. (g) The Legislature further finds and declares that 107 award recipients are baccalaureate of science degree prepared nurses who have made a commitment to practice in medically underserved areas of California for a period of two years in exchange for loan repayment. (h) The Legislature further finds that 485 of the award recipients are baccalaureate of science degree nursing students. Since 1990, 199 nurses have completed their contractual obligation with the Office of Statewide Planning and Development. (i) The Legislature further finds and declares that, since 1994, 112 associate degree nursing scholarship awards have been made to students who have signed a contract with the office to complete a baccalaureate of science degree within five years of completing their associate degree. Six students have completed the articulations pilot program. (j) The Legislature further finds that recipients of the foundation's financial assistance program have come from very diverse backgrounds. Scholarships have been awarded to African-Americans, American Indians, Asian-Pacific Islanders, Caucasians, Hispanic-Americans, and other individuals. SEC. 12. Section 128385 of the Health and Safety Code is amended to read: 128385. (a) There is hereby created the Registered Nurse Education Program within the Health Professions Education Foundation. Persons participating in this program shall be persons who agree in writing prior to graduation to serve in an eligible county health facility or a health manpower shortage area, as designated by the director of the office. Persons agreeing to serve in eligible county health facilities or health manpower shortage areas may apply for scholarship or loan repayment. The Registered Nurse Education Program shall be administered in accordance with Article 1 (commencing with Section 128330), except that all funds in the Registered Nurse Education Fund shall be used only for the purpose of promoting the education of registered nurses and related administrative costs. The Health Professions Education Foundation shall make recommendations to the director of the office concerning both the following: (1) A standard contractual agreement to be signed by the director and any student who has received an award to work in an eligible county health facility or in a health manpower shortage area that would require a period of obligated professional service in the areas of California designated by the Health Manpower Policy Commission as deficient in primary care services. The obligated professional service shall be in direct patient care. The agreement shall include a clause entitling the state to recover the funds awarded plus the maximum allowable interest for failure to begin or complete the service obligation. (2) Maximum allowable amounts for scholarships, educational loans, and loan repayment programs in order to assure the most effective use of these funds. (b) Applicants may be persons licensed as registered nurses or graduates of associate degree nursing programs prior to entering a program granting a baccalaureate of science degree in nursing. Priority shall be given to applicants who hold associate degrees in nursing. (c) Not more than 5 percent of the funds available under the Registered Nurse Education Program shall be available for a pilot project designed to test whether it is possible to encourage articulation from associate degree nursing programs to baccalaureate of science degree nursing programs. Persons who otherwise meet the standards of subdivision (a) shall be eligible for educational loans when they are enrolled in associate degree nursing programs. If these persons complete a baccalaureate of science degree nursing program in California within five years of obtaining an associate degree in nursing and meet the standards of this article, these loans shall be completely forgiven. (d) As used in this section, "eligible county health facility" means a county health facility that has been determined by the office to have a nursing vacancy rate greater than noncounty health facilities located in the same health facility planning area. SEC. 13. Section 128395 of the Health and Safety Code is amended to read: 128395. In developing this program, the Health Professions Education Foundation shall solicit the advice of representatives of the Board of Registered Nurses, the California Nurses Association and other professional nurse organizations, the Chancellor of the California Community Colleges, the Chancellor of the California State University, and the California Association of Hospitals and Health Systems. The foundation shall solicit the advice of representatives who reflect the demographic diversity of California. SEC. 14. Section 128400 of the Health and Safety Code is amended to read: 128400. There is hereby established in the State Treasury the Registered Nurse Education Fund. All money in the fund shall be used for the purposes specified in the California Registered Nurse Education Program established pursuant to this article. This fund shall receive money collected pursuant to subdivision (c) of Section 2815 of the Business and Professions Code. SEC. 15. Section 128405 of the Health and Safety Code is repealed. SEC. 16. Section 128435 of the Health and Safety Code is amended to read: 128435. (a) There is hereby created the Geriatric Nurse Practitioner and Clinical Nurse Specialist Scholarship Program within the Health Professions Education Foundation. Persons participating in this program shall be persons enrolled in nurse practitioner or clinical nurse specialist programs in this state who agree in writing prior to graduation to practice for a period of time, to be determined in accordance with paragraph (1) of subdivision (b), as geriatric nurse practitioners or geriatric clinical nurse specialists either in skilled nursing facilities licensed pursuant to Section 1250 or in other settings where care is provided primarily to geriatric patients. This program shall be administered in accordance with Article 1 (commencing with Section 128330), and Article 2 (commencing with Section 128375), except that all funds shall be used only for geriatric nurse practitioners and geriatric clinical nurse specialists and except that the programs shall be available only to those geriatric nurse practitioners and geriatric clinical nurse specialists who agree to practice in skilled nursing facilities or other settings caring for geriatric patients. (b) The Health Professions Education Foundation shall make recommendations to the director of the office concerning both of the following: (1) A standard contractual agreement to be signed by the director and any student who has received an award to practice in a skilled nursing facility or other setting caring for geriatric patients that would require a period of obligated professional service. The obligated professional service shall be in direct patient care. The obligated professional service may be performed by a geriatric nurse practitioner or geriatric clinical nurse specialist either as an employee or independent contractor of a skilled nursing facility or other setting caring for geriatric patients, or as an employee or independent contractor of a physician providing care for geriatric patients in a skilled nursing facility or other setting. The agreement shall include a clause entitling the state to recover the funds awarded plus the maximum allowable interest for failure to begin or complete the service obligation. (2) Maximum allowable amounts for scholarships and other financial assistance in order to assure the most effective use of these funds. (c) To the extent feasible and appropriate, the Health Professions Education Foundation shall assure that the standard contractual agreement and other aspects of the Geriatric Nurse Practitioner and Clinical Nurse Specialist Scholarship Program are substantially similar to those developed for the Registered Nurse Education Program. SEC. 17. Section 128445 of the Health and Safety Code is amended to read: 128445. In developing this program, the Health Professions Education Foundation shall solicit the advice of the representatives of the Board of Registered Nursing, the Student Aid Commission, the California Nurses Association, the California Association of Health Facilities, the California Association of Homes for the Aging, the Chancellor of the California State University, the President of the University of California, and other entities as may be appropriate. SEC. 18. Section 128450 of the Health and Safety Code is amended to read: 128450. This program shall be funded through the Health Professions Education Fund pursuant to Section 128355. SEC. 19. Section 128455 of the Health and Safety Code is repealed. SEC. 20. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to ensure that vital scholarship funding may be distributed to students who will pursue degrees in health education during the 1999-2000 fiscal year, it is necessary that this act take effect immediately.