BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 761
S
AUTHOR: Aanestad
B
AMENDED: April 22, 2009
HEARING DATE: April 29, 2009
7
CONSULTANT:
6
Moreno/cjt
1
SUBJECT
Health manpower: pilot projects
SUMMARY
Requires the Office of Statewide Health Planning and
Development (OSHPD), no later than June 30, 2010, to submit
an annual report to the Legislature on all approved or
renewed health workforce pilot projects, including, but not
limited to, assessment of outcomes, budget impact, and
sources of funding.
CHANGES TO EXISTING LAW
Existing law:
Permits OSHPD to approve experimental health workforce
pilot projects in specified fields, and gives priority to
pilot projects in rural and central city areas.
Existing law requires all data collected by OSHPD and the
manpower pilot projects to be public information, with due
regard for the confidentiality of individual patient
information. Project evaluation is required to be
conducted by OSHPD, and the law requires raw data from
individual projects and the data that is the basis of
OSHPD's evaluation is required to be made available on
request. OSHPD is required to provide a reasonable
opportunity for interested parties to submit dissenting
Continued---
STAFF ANALYSIS OF SENATE BILL SB 761 (Aanestad)Page 2
views or challenges in reports to the Legislature and
professional licensing boards.
This bill:
Requires OSHPD, no later than June 30, 2010, to submit an
annual report to the Legislature on all approved or renewed
health workforce pilot projects, including, but not limited
to, assessment of outcomes, budget impact, and sources of
funding.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
According to the author, accountability and transparency
are critical to the function of the Legislature. Given the
limitation of resources to address healthcare workforce
shortages in the state, pilot projects under the health
workforce pilot project program administered by the Office
of Statewide Health Planning and Development should meet
standards of safety, effectiveness, and fiscal
responsibility. An annual report that addresses these
standards and allows Legislative oversight offers consumer
protection and accountability to taxpayers. The author
states that the OSHPD Healthcare Workforce Pilot Project
Program should be subject to oversight by the Legislature,
particularly given its potential impact on public health
and patient safety.
Background
According to a February 2009 paper prepared by the Senate
Office of Research (SOR), statewide shortages of health
providers currently exist in several major health
professions, such as nursing, primary care, and allied
health. Furthermore, healthcare workforce needs are
projected to increase dramatically due to population aging,
growth, and diversity. Inability to meet health workforce
needs will have serious adverse health access, quality, and
cost consequences. The SOR report pointed out that, for
professions regulated by the state, scope of practice is
restricted by law and closely guarded by the professions.
Practitioners often assert that they are uniquely qualified
STAFF ANALYSIS OF SENATE BILL SB 761 (Aanestad)Page 3
to perform the range of tasks permitted by their license
(to protect the patient's safety) and do not support
delegating tasks to associates who may not be as highly
trained. Changes to scope of practice can provide
opportunities for additional resources for certain
professions. However, policy changes must strike a balance
between public protection and ensuring a fair market place.
Health Manpower Pilot Projects Act
The Health Manpower Pilot Projects Act of 1972 was intended
to address the need to improve the effectiveness of the
state's health care delivery system, particularly as it
related to the development of health care professionals.
According to a 2003 OSHPD report, the law was in response
to an issue policymakers had been grappling with since the
early 1960s: the functioning of licensed nurses in roles
that exceeded the scope of the California Nurse Practice
Act of 1939. The health workforce pilot project program
permits expanded roles for health care occupations to be
designed, demonstrated, and tested by health facilities,
state agencies, and educational institutions. In addition,
new categories of health occupations and professions can be
developed to fill gaps in the health care delivery system.
According to OSHPD, pilot projects are conducted in three
phases: didactic, clinical, and employment/utilization
(E/U). The didactic phase consists of a specified
curriculum of classroom training designed to teach the
participants the necessary skills to achieve the project's
objectives. In the clinical phase, the participant applies
these skills under the direct supervision of the project
instructor. In the E/U phase, the participants utilize and
test the new skills in the work setting with continued
periodic monitoring. There have been 171 applications to
the program. OSHPD has approved 78 applications that
completed their pilot project, approved 28 applications
that were discontinued due to statute changes while in
progress or there was a decline in interested trainees, and
65 denied or withdrawn applications. Approved pilot
projects have related to expanded roles for nurses
(including nurse practitioners, nurse midwives, and nurse
anesthetists), pharmaceutical prescribing and dispensing
projects, expanded roles for "medical auxiliaries"
(emergency medical technicians and physician assistants),
maternal-child health projects, and mental health projects.
STAFF ANALYSIS OF SENATE BILL SB 761 (Aanestad)Page 4
Oversight of projects
In order to receive approval from OSHPD, pilot projects
under the program submit an extensive application.
Applications are reviewed by OSHPD for feasibility and
completeness and are made available for review by
appropriate health care professional boards, agencies,
associations, and technical consultants for review. A
public meeting is held at which abstracts of the
application are distributed for review, comments from
consultants, reviewers, healing arts boards, professional
associations, and other interested parties are heard and
addressed.
After a project receives approval, OSHPD oversight
continues through site visits. Invitations to attend site
visits are extended by OSHPD to "an interdisciplinary team
composed of representatives of the healing arts boards,
professional organizations, and other state regulatory
bodies," most of whom are identified through the
application review process. Site visits include a
determination that patient safeguards are in place and
validation that the project is in compliance with the
approved or amended application. Ongoing project oversight
and review includes the submission of reports, project
updates, and other written information requested by OSHPD
(and required under the program regulations and authorizing
statute). Project approval is reviewed and must be renewed
annually. Through this renewal process, the project
sponsor submits reports, project updates, data summaries,
and other written information as requested by OSHPD. All
of these materials are public information.
COMMENTS
1.The need for information identified in this bill is
unclear. The state does not fund any pilot projects
under this program. Each applicant is responsible for
funding their project(s). The current pilot project
(#171) is funded by the John Merck Fund, the Education
Foundation of America, the David and Lucile Packard
Foundation, and an anonymous foundation. OSHPD's
administration of the program is funded through hospital
fees deposited into the Health Data and Planning Fund,
which were projected at $25 million for fiscal year
STAFF ANALYSIS OF SENATE BILL SB 761 (Aanestad)Page 5
2008-09. OSHPD dedicates approximately 0.3 positions and
$20,000 for program oversight. This bill requires an
"assessment of...budget impact and sources of funding."
However, this information is already made available to
the public. In line with the author's intent and because
it is unclear how budget impact could be assessed by
OSHPD, this bill should be amended as follows:
On page 2, line 5:
128196. Not later than June 30, 2010, and annually
thereafter, the office shall submit to the Legislature a
report relating to all health workforce pilot projects
approved or renewed pursuant to this article that
includes, but is not limited to, assessment of outcomes ,
budget impact, and sources of funding .
POSITIONS
Support: None received
Oppose: None received
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