BILL ANALYSIS
SB 761
Page 1
Date of Hearing: July 7, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
SB 761 (Aanestad) - As Amended: May 6, 2009
SENATE VOTE : 39-0
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 (HWPPs), as specified.
Prohibits OSHPD from granting continuing approval to a project
in the absence of specified information. Specifically, this
bill :
1)Requires OSHPD to submit a report to the Legislature by June
30, 2010 and annually thereafter, on all HWPPs approved or
renewed pursuant to the Health Manpower Pilot Projects (HMPP)
Program provisions.
2)Requires the report to include:
a) An assessment of the outcomes; and,
b) The extent to which the HWPP has sufficient funding to
perform the agreed to activities.
3)Requires OSHPD to deny continuing approval if all the
information that the HWPP agreed to provide in its application
has not been reported.
EXISTING LAW :
1)Establishes the HMPP Program within OSHD.
2)Permits OSHPD to designate experimental HWPPs in specified
fields.
3)Requires OSHPD to establish standards, guidelines, and
instructions after one or more public hearings.
4)Requires OSHPD to periodically visit and evaluate each
approved HWPP and specifies the criteria.
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5)Requires all data collected by OSHPD and the HWPPs to be
public information, subject to patient confidentiality.
Requires OSHPD to make raw data available on request to
interested parties.
6)Requires OSHPD to provide a reasonable opportunity for
interested parties to submit dissenting views or challenges on
reports to the Legislature and to professional licensing
boards and to publish the comments as part of its annual, or
any special, reports.
FISCAL EFFECT : According to Senate Appropriations, pursuant to
Rule 28.8, negligible costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, accountability
and transparency are critical to the function of the
Legislature and this bill allows legislative oversight and
offers consumer protection and accountability to taxpayers.
The author also states that given the limitation of resources
to address health workforce shortages in the state, pilot
projects under this program should meet standards of safety,
effectiveness, and fiscal responsibility.
2)BACKGROUND . According to OSHPD, the HMPP Program was enacted
in 1972 to establish a procedure for expanded roles of health
care personnel. The program allows organizations to test,
demonstrate, and evaluate new or expanded roles for health
care professionals, or new health care delivery alternatives
before changes in licensing laws are made by the Legislature.
Legislative intent indicates that the purpose of the
legislation is to provide oversight and regulation of
exemptions from the healing arts practice acts.
Extensive regulations have been adopted detailing every aspect
of the pilot projects including the application contents and
process, standards, training, curriculum, evaluation, informed
consent, funding, monitoring, records, site visits, and the
process for continuing approval.
Since the inception there have been 171 applications. OSHPD
has approved 78 that completed their pilot project, approved
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28 that were discontinued due to statutory changes while in
progress or where there was a decline in interested trainees.
An additional 65 were denied or withdrawn. Approved pilot
projects have included expanded roles for nurses (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.
HWPPs are responsible for their own funding. The one
remaining project (HWPP #171) relies totally on private funds
from the John Merck Fund, Educational Foundation of America,
Packard Foundation and an anonymous foundation.
3)PRIOR LEGISLATION .
a) SB 1850 (Committee on Health), Chapter 259, Statutes of
2006, changed "manpower" to "workforce".
b) AB 2874 (Epple), Chapter 711, Statutes of 1992 and AB
3564, (Wright), Chapter 713, Statutes of 1992 delete the
reporting requirement for the HMPP.
c) SB 167 (McCorqudale), Chapter 857, Statutes of 1987,
expand the types of facilities that could qualify for
sponsorship and allowed for an increase in the number of
projects.
d) AB 1986 (Hart), Chapter 1038, Statutes of 1978,
formalizes administrative procedures for reviewing HWPPs.
e) AB 1141 (Duffy), Chapter 342, Statutes of 1975, requires
program staff to seek review of appropriate healing arts
boards. AB 1141 also establishes a limit of two training
cycles and a maximum of 24 months preceptorship or
employment/utilization phase and allow extensions if it
would contribute substantially to the availability of
high-quality health services.
f) AB 717 (Duffy), Chapter 843, Statutes of 1977, adds
additional categories of personnel that could participate
in HWPPs.
g) AB 1503 (Duffy), Chapter 1350, Statutes of 1972,
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authorizes the HMPP Program to approve locally conceived
and implemented demonstration projects to prepare and
utilize health care personnel in new or expanded roles.
4)ISSUES .
a) Need for bill . There is currently only one pilot
project and it is privately funded by foundation donations.
There is an abstract of the application on the OSPHD Web
site. (HWPP #171). Existing law requires all data
collected by OSHPD and the HWPPs to become public
information, subject to patient confidentiality. In 1992,
the requirement of a report to the legislature was repealed
(along with other state department reporting requirements
deemed unnecessary) in order to prioritize state staff
activities in a time of fiscal crisis. Is this bill
prudent given the current situation of state staff
reductions and furloughs and given that information
regarding this project is currently publicly available?
b) What is sufficient funding ? The bill requires OSHPD to
make a subjective assessment of whether there is
"sufficient funding." This is vague and ambiguous.
c) What is the purpose of the continuing approval
requirement ? This bill prohibits continuing approval
unless all the information agreed to in the application has
been provided. The author has supplied no examples of
noncompliance or cited a justification. The regulations
already require continuing approval to be contingent upon
review of written information and also delineate a process
for modifications. Is this intended to require a denial
of a continuation for minor or technical variations?
d) Erroneous Cross-Reference. This bill cites Chapter 6
(commencing with Section 920011 of Division 7 of Title 22
of the California Code of Regulations.) The Sections
pertaining to this program are actually Section 92001
through 92701.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
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Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097