BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 635|
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THIRD READING
Bill No: SB 635
Author: Hernandez (D)
Amended: 5/31/11
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 3/23/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 8-0, 5/26/11
AYES: Kehoe, Walters, Alquist, Lieu, Pavley, Price,
Runner, Steinberg
NO VOTE RECORDED: Emmerson
SUBJECT : Health care: workforce training
SOURCE : Author
DIGEST : This bill requires funds deposited into the
Managed Care Administrative Fines and Penalties Fund in
excess of $1,000,000 be transferred each year to the Office
of Statewide Health Planning and Development for the
purpose of the Song-Brown Health Care Workforce Training
Act of 1973.
ANALYSIS :
Existing federal law :
1. Establishes the National Health Services Corps program,
CONTINUED
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which administers scholarship and loan repayment
programs to primary care clinicians in exchange for
serving in Health Professional Shortage Areas throughout
the U.S. In California, the program is administered by
the Office of Statewide Health Planning and Development
(OSHPD) as the California State Loan Repayment Program.
2. Prohibits, under the Patient Protection and Affordable
Care Act, any preexisting condition exclusion from being
imposed by group health plans and extends this
protection to individual health insurance coverage,
effective for new and grandfathered group plans
beginning on or after January 1, 2014. (For enrollees
under 19 years of age, this prohibition became effective
beginning on or after September 23, 2010).
Existing state law :
1. Establishes the Song-Brown Health Care Workforce
Training Act of 1973 (Song-Brown), administered by OSHPD
to provide financial support to family practice
residency programs, nurse practitioner and physician
assistant programs, and registered nurse education
programs to increase the number of students and
residents receiving education and training in family
practice and nursing. (The Song-Brown Act also
encourages universities and primary care health
professionals to provide healthcare in medically
underserved areas).
2. Creates the Steven M. Thompson Physician Corps Loan
Repayment Program, which provides for the repayment of
educational loans for physicians and surgeons who
practice in medically underserved areas of the state, as
defined.
3. Creates the Medically Underserved Account for Physicians
within the Health Professions Education Fund, managed by
the Health Professions Education Foundation and OSHPD,
for the primary purpose of funding this program, and
provides that funds placed in the account for these
purposes are continuously appropriated.
4. Provides for the licensure and regulation of health care
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service plans by the Department of Managed Health Care
(DMHC) under the Knox-Keene Health Care Service Plan Act
of 1975. (Subjects health care service plans to various
fines and administrative penalties for failing to comply
with specified provisions of the act).
5. Requires health care service plans to pay specified
assessments each fiscal year as a reimbursement of their
share of the costs and expenses reasonably incurred in
the administration of the act.
6. Establishes the California Major Risk Medical Insurance
Program (MRMIP), which is administered by the Managed
Risk Medical Insurance Board to provide major risk
medical coverage to eligible persons who have been
rejected for coverage by at least one private health
plan.
7. Creates the Major Risk Medical Insurance Fund for
purposes of MRMIP.
8. Requires fines and administrative penalties assessed
against health care service plans by DMHC be deposited
into the Managed Care Administrative Fines and Penalties
Fund (Fund).
9. Requires, beginning September 1, 2009, that those fines
and penalties collected up to $1,000,000 be deposited
into the Stephen M. Thompson Physician Corp Loan
Repayment Program. (Any amount over the first
$1,000,000, including accrued interest, is required to
be transferred to the Major Risk Medical Insurance Fund
to be used, upon appropriation by the Legislature, for
MRMIP).
10.Requires that the Director of the Department of finance
notify the Joint Legislative Budget Committee of the
program's inoperative status and the new disposition of
these funds.
11.Specifies that the funds be transferred into a separate
account within the California Health Data and Planning
fund.
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This bill requires that any amount of funds over $1 million
deposited into the Managed Care Administrative Fines and
Penalties Fund that currently are transferred to the Major
Risk Medical Insurance Fund for use in the Major Risk
Medical Insurance Program be redirected to the OSHPD for
use in the Song-Brown Health Care Workforce Training Act to
support health care workforce development.
Background
Current workforce shortages . Statewide shortages of health
providers currently exist in several major health
professions, such as nursing, primary care providers, and
allied health. (Allied health professions are clinical
health care professions distinct from medicine, dentistry,
and nursing.) Health care workforce needs are projected to
increase dramatically due to the aging of the population
and the state's increasing diversity. In February of 2009,
the Senate Health Committee held a hearing on California's
health care workforce. The background paper, prepared by
the Senate Office of Research (SOR), stated that the health
care worker shortage is defined in many ways, citing the
following:
The state will face a shortage of up to 17,000
physicians by 2015.
The Center for California Health Workforce Studies
researchers indicate that the registered nurse
shortage is between 7,000 and 21,000. This shortage is
expected to grow due to both the aging of the general
population and the nursing workforce.
It is projected that California will need a 26.1
percent growth in the number of pharmacists from 2006
to 2016.
Fifty percent of the public health workforce and
seventy percent of community clinic administrators
will retire in the next five to ten years.
Seventy-six percent of clinics report a staffing
shortage of allied health workers.
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In addition to the shortages of certain health
professionals, SOR stated that California's health
professions workforce does not reflect the state's
demographic racial and ethnic composition and language
proficiency. According to research conducted by the Public
Health Institute and UC Berkeley's School of Public Health,
California's emerging populations are underrepresented in
all health professions and in the health professions
pipeline. A report by the Institute of Medicine links
poorer health outcomes for minorities to the shortage of
minority health care providers. One reason for this is
that persons of color are less likely than whites to
receive needed services due to cultural or linguistic
barriers between the health care provider and the patient.
Song-Brown Act . The Song-Brown Health Care Workforce
Training Act was established in 1973 to address the
shortage of physicians engaged in family practice in
California by providing financial support to family
practice residency, nurse practitioner, physician
assistant, and registered nurse education programs
throughout California. It also encourages universities and
primary care health professionals to provide health care in
medically underserved areas. The Song-Brown program
currently funds 27 California family practice residency
programs, 16 physician assistant/nurse practitioner
programs, and 34 registered nurse education programs.
Total funding proposed for the Song-Brown program in the
Governor's 2011-12 Budget is $7.1 million.
The Song-Brown Act also established the California
Healthcare Workforce Policy Commission (Commission)
consisting of 15 members appointed by the Governor and
Legislature to aid the Song-Brown program by establishing
standards for family practice training and residency
programs, postgraduate osteopathic medical programs in
family practice, primary care physician assistant and nurse
practitioner programs, and registered nurse training
programs. The Commission reviews and makes recommendations
to OSHPD on the awarding of funds for loan assumption as
well.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14
Fund
Redirection of General$2,000 - $3000 annually, commencing
General
Fund revenue January 1, 2014, and ongoing
MRMIP cost pressure$2,000 - $3,000 annually, commencing
General
January 1, 2014, and ongoing
Increase in Song-Brown$2,000 - $3,000 annually, commencing
Special*
Program funds January 1, 2014, and ongoing
*Fund into which the monies would be deposited is
unspecified.
SUPPORT : (Verified 3/23/11) (prior version)
California Academy of Family Physicians
California Academy of Physician Assistants
California Hospital Association
ARGUMENTS IN SUPPORT : The California Academy of Family
Physicians urges support for the bill and believes that to
ensure adequate health care access; California must begin
to address the shortage of primary care physicians. They
assert that this bill will do so without compromising other
important health programs. The California Hospital
Association believes that Song-Brown is critically
important, and this bill will provide much needed
additional financial support to the program as demand
increases and public education funding decreases. The
California Academy of Physician Assistants claims it has a
long history of addressing barriers to health care access
and has played a pivotal role in helping to deliver high
quality medical care in all clinical settings and supports
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the new opportunities for physician assistants that could
result from this bill.
CTW:do 5/31/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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