BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J. Kuehl, Chair
BILL NO: SB 139
S
AUTHOR: Scott
B
AMENDED: As Introduced
HEARING DATE: April 18, 2007
1
REFERRAL: Health and Education
3
FISCAL: Appropriations
9
CONSULTANT:
Moreno/cjt
SUBJECT
Nursing education
SUMMARY
Makes changes to the terms of loan assumption agreements
made under the State Nursing Assumption Program of Loans
for Education - State Facilities (SNAPLE-SF) program.
Establishes the Health Care Workforce Clearinghouse within
the Office of Statewide Health Planning and Development
(OSHPD) to serve as the central source of health care
workforce and educational data in the state.
CHANGES TO EXISTING LAW
Existing law:
Existing law establishes the SNAPLE program administered by
the Student Aid Commission, under which any person enrolled
in an institution of postsecondary education and
participating in the program is eligible to receive a
conditional warrant for loan assumption, to be redeemed
upon becoming employed as a full-time nursing faculty
member at a California college or university.
Continued---
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
2
Existing law establishes a loan assumption program for
employees of specified state facilities within the
SNAPLE-SF program. This program provides loan assumption
benefits to persons who fulfill agreements to work
full-time for four consecutive years as clinical registered
nurses (RNs) in state-operated 24-hour facilities, as
specified, that employ RNs and that have a vacancy rate of
greater than ten percent in clinical RN positions at the
time the person commences employment at the facility. The
program provides for a progressive assumption of the amount
of a qualifying loan over four consecutive years of
qualifying clinical RN service, up to a total loan
assumption of $20,000. Under existing law, this program
becomes inoperative on July 1, 2012, and is repealed on
January 1, 2013.
Existing law establishes OSHPD, which is charged with the
administration of health policy and planning. Existing law
establishes the California Health Data and Planning Fund,
and authorizes monies from that fund to be appropriated for
expenditure for health-related programs of OSHPD.
This bill:
SB 139 prohibits a person who is currently employed as a RN
in a state-operated 24-hour facility from being eligible
for SNAPLE-SF.
This bill clarifies that if a natural disaster prevents a
participant from completing a year of work required under
SNAPLE-SF, the loan assumption agreement is extended for
the amount of time equal to the period between the
interruption of employment in a state facility to the
resumption of employment. The bill prohibits the Student
Aid Commission from making further payments under the loan
assumption agreement until specified employment
requirements have been satisfied.
This bill states legislative intent that the funding for
enrollment expansions at the California State University
(CSU) and the University of California (UC) be funded
within the general enrollment growth funding that is
traditionally provided to those institutions during the
annual State Budget process.
This bill requires OSHPD to establish a health care
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
3
workforce clearinghouse to serve as the central source of
health care workforce and educational data in the state.
This bill requires the clearinghouse to be responsible for
the collection, analysis, and distribution of information
on educational and employment trends for health care
occupations in the state and requires related activities to
be funded by appropriations made from the California Health
Data and Planning Fund.
This bill requires OSHPD to work with the Employment
Development Department's (EDD) Labor Market Information
Division, state licensing boards, and state higher
education entities to collect data regarding the current
supply, geographical distribution, and diversity of health
care workers, the current and forecasted demand for health
care workers, and the educational capacity to produce
trained, certified, and licensed health care workers.
This bill requires OSHPD to prepare an annual report to the
Legislature that identifies education and employment trends
in the health care profession, reports on the current
supply and demand for health care workers in California and
gaps in the educational pipeline producing workers in
specific occupations and geographic areas, and recommends
state policy needed to address issues of workforce shortage
and distribution.
This bill states that it is the intent of the Legislature
that colleges and universities that operate RN programs
should not require students who have already earned a
baccalaureate degree, to complete general education
requirements, but rather should require these students to
complete only the coursework necessary to prepare them for
licensing as RNs.
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
4
FISCAL IMPACT
Unknown. The author states that the provisions related to
the health care workforce clearinghouse will require an
estimated $5 million over three years for start-up and $1
million per year beginning in 2009-10 for ongoing costs.
BACKGROUND AND DISCUSSION
Need for the bill
The author states that this bill is a combination of
clean-up and follow-up to SB 1309 (Scott - Chapter 837,
Statutes of 2006) as follows:
Employees of state facilities : SB 1309 established a new
"Employees of State Facilities" program under SNAPLE to
provide up to $20,000 loan assumption grants ($5,000 per
year for four years) for RNs to work in 24-hour state
facilities. The author states that this new program was
intended as a recruitment tool for new employees by
providing a "signing bonus." The author states that when
SB 1309 was signed, he committed to clarify in clean-up
legislation that current RNs at 24-hour state facilities
are not eligible to enter into a loan assumption agreement
under this program.
Letter to the Journal regarding intent language : The
author submitted a letter of clarification to the Journal
regarding intent language contained in SB 1309. In his
letter, the author stated that, while not specifically
referenced in the measure, it was his intent that future
state budgets fund Baccalaureate of Science degree nursing
student enrollment growth at UC and CSU from within the
general enrollment growth funding that is traditionally
provided to those institutions as part of the annual budget
process. This bill makes changes to that intent language
in line with this clarification.
Statewide health workforce database : The author states
that language to create this database was contained in SB
1309 but was stricken by the Assembly Appropriations
Committee. The author states that since that time, OSHPD
has indicated their support for the establishment of the
database and has suggested using the California Health
Planning and Data Fund, which funds OSHPD operations and is
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
5
supported entirely by fees paid by hospitals.
Technical clean-up : The author states that other
provisions of this bill, including changing the word
"instruction" to "employment" are clarifying in nature and
consistent with the intent of SB 1309.
California nursing shortage
California is experiencing a severe nursing shortage, as is
the case nationwide. According to EDD, California has an
annual shortage of 9,900 RNs and this number is expected to
increase over the next five to ten years. The Health
Resources and Services Administration's National Center for
Health Workforce Analysis projects that California will
need an estimated 47,600 RNs by 2010, and 116,600 by 2020.
Several factors contribute to the nursing shortage,
including an aging and growing population, retiring RNs,
lack of educational capacity in nursing programs, and lack
of qualified nursing instructors.
California nursing programs
Approximately 70 percent of RNs are prepared at the
community college level in California through an Associate
Degree in Nursing programs. These two-year programs
generally require one to two semesters of prerequisites
prior to admission. Approximately 26 percent of RNs
receive their preparation as part of a four-year BSN
program and about 4 percent are prepared through
Entry-Levels Master's (ELM) programs. ELM programs are
designed for individuals who already have a bachelor's
degree in a subject other than nursing. These students
received their RN in about 18 months and a Master's Degree
in Nursing in another 18 months.
According to the 2006 Annual Report of the California Nurse
Education Initiative, California currently graduates
approximately 6,000 nursing students a year. However, the
Board of Registered Nursing reports that nearly 60 percent
of qualified applicants are turned away from nursing
programs each year due to barriers such as a lack of
clinical education sites, limited classroom space, and a
lack of qualified faculty.
Workforce shortages and need
There have been ongoing efforts among advocates and
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
6
policymakers to increase the number of providers who are
able to meet the health care needs of patients in
California. One area in particular is related to the
racial and ethnic diversity of the state's workforce. For
example, by the year 2020, it is estimated that
California's population will grow to nearly 49 million,
more than half of which will be non-white. While African
Americans, Latinos, and Native Americans as a group
constitute nearly 25 percent of the U.S. population, these
three groups account for less than nine percent of nurses,
six percent of physicians, and five percent of dentists.
Non-white individuals make up less than ten percent of
baccalaureate nursing faculty, 8.6 percent of dental school
faculty, and only 4.2 percent of medical school faculty.
A number of studies have shown a strong correlation between
greater diversity among health professionals and enhanced
access to care for racial and ethnic minority patients,
expanded patient choice and satisfaction, better
patient-provider communication, and better educational
experiences for all students in the medical school setting.
In the Nation's Compelling Interest, a 2003 publication by
the Institute of Medicine, states that racial and ethnic
minority health care professionals are significantly more
likely than their white peers to serve minority and
medically underserved communities, thereby helping to
improve problems of access to care for populations of
color.
Related legislation
SB 764 (Migden) requires the OSHPD to report five year
projections on the primary care physician workforce in the
state to the Legislature by June 1, 2009. This bill will
be heard in the Senate Health Committee on April 18, 2006.
Previous legislation
AB 394 (Kuehl - Chapter 945, Statutes of 1999) required the
Department of Health Services to adopt regulations that
establish licensed nurse-to-patient ratios for all health
facilities, as specified, and limits the nursing-related
duties performed by unlicensed assistive personnel.
AB 655 (Scott - Chapter 954, Statutes of 1999) required a
multi-system study of the need for trained nurses in
California.
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
7
SB 664 (Poochigian - Chapter 443, Statutes of 2001)
required the California Postsecondary Education Commission
to study community college districts' admissions procedures
and attrition rates for two-year associate degree nursing
programs.
AB 652 (Horton - Chapter 459, Statutes of 2001) established
the Health Professions Education and Outreach for Medically
Underserved Communities and Populations Act. Appropriates
$2 million from the state General Fund to UC for outreach
programs designed to increase the number of
underrepresented and/or disadvantaged students in UC health
professional schools.
AB 1241 (Parra - Chapter 396, Statutes of 2003) required
OSHPD to establish an Associate Degree Nursing Scholarship
Pilot Program, funded from the Health Professions Education
Foundation, to provide scholarships to associate degree
nursing students in counties determined to have high need.
SB 63 (Committee on Budget and Fiscal Review - Chapter 73,
Statues of 2005) establishes the SNAPLE program, which was
modeled after the existing teacher Assumption Program of
Loans for Education (APLE) program, to encourage
individuals to complete their graduate education and serve
as nursing faculty at an accredited California college or
university.
Arguments in support
The California Hospital Association (CHA) writes that,
while there has been increasing attention and funds devoted
to enhancing the nurse workforce, California continues to
rank last in the nation in the number of RNs per capita.
CHA contends that SB 139 addresses enrollment expansion at
CSUs for nursing degrees and the funding for these
programs. CHA also writes that this bill creates a much
needed clearinghouse that would establish a central source
of health care workforce and educational pipeline data on
which to base future funding for nursing and health care
occupations. The Latino Coalition for a Healthy California
writes that California is at a crossroad where demographic
shifts are already causing gaps between workforce supply
and demand and states that this bill will provide a fuller
picture of the state's health profession capacity so that
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
8
policymakers will have the data needed to make informed
decisions.
COMMENTS AND QUESTIONS
1. Technical amendments
This bill requires two technical changes, which the author
has agreed to take in Senate Education Committee when it is
heard there on April 25, 2007:
On page 7, line 3:
The Office of Statewide Health Planning and
Development
is responsible for establishing shall establish a
health care workforce clearinghouse to serve as the
central source of health care workforce and
educational pipeline data in the state. The
clearinghouse shall be
responsible for the collection, analysis, and
distribution of
information on the educational and employment trends
for health care
occupations in the state. The activities of the
clearinghouse shall
be funded by appropriations made from the California
Health Data and
Planning Fund in accordance with subdivision (h) of
Section 127280.
2. Clarifying amendment
This bill also requires an amendment to clarify that the
prohibition on currently employed nurses participating in
SNAPLE-SF if effective when this bill becomes operative.
On page 3, line 26:
(b) (1) The applicant has been admitted to, or is
enrolled in, an
accredited program of professional preparation for
licensing as a
registered nurse in California. However, a person who
is
currently employed as a registered nurse in a
state-operated 24-hour
facility is not eligible to enter into an agreement
for loan
STAFF ANALYSIS OF SENATE BILL 139 (Scott) Page
9
assumption under this article upon the operative date
of this section.
POSITIONS
Support: California Hospital Association
Latino Coalition for a Healthy California
Oppose: None received.
-- END --