SENATE RULES COMMITTEE
Office of Senate Floor Analyses
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SB 22
THIRD READING
Bill No:
Author:
Amended:
Vote:
SB 22
Roth (D)
1/25/16
21
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Residency training
SOURCE: Author
DIGEST: This bill establishes the Medical Residency Training Advisory Panel
(Advisory Panel) within the Office of Statewide Health Planning and
Development’s (OSHPD) Health Professions Education Foundation, consisting of
13 members, as specified. Specifies the duties of the Advisory Panel and OSHPD
for the purpose of establishing and funding new residency positions in medically
underserved areas of the state.
Senate Floor Amendments of 1/25/16 make technical changes to the structure of
the program created under this bill.
Senate Floor Amendments of 6/4/15 provide funding for the purposes of this bill in
the annual budget.
ANALYSIS:
Existing law:
1) Establishes the Health Professions Education Foundation (HPEF) within
OSHPD. Requires HPEF to solicit and receive funds from foundations and
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other private and public sources and to provide financial assistance in the form
of scholarships or loans to students in the health professions who are from
underrepresented groups.
2) Establishes, under HPEF, scholarship, loan, and loan repayment programs for
registered nurses, vocational nurses, geriatric nurse practitioners, clinical nurse
specialists, and mental health professionals who agree to practice for specified
periods of time in underserved areas and in designated practice settings, as
specified.
This bill:
1) Establishes the Medical Residency Training Advisory Panel within HPEF,
consisting of a total of 13 members, as specified. Requires seven members to
be appointed by the Governor, one member appointed by the Speaker of the
Assembly, one member by the Senate Committee on Rules, two members of the
Medical Board of California (MBC) by the MBC, and two members of the
Osteopathic Medical Board of California (OMBC) by the OMBC.
2) Requires the Advisory Panel members to include representatives of public and
private hospitals, community clinics, public and private health insurance
providers, the pharmaceutical industry, associations of health care practitioners,
and other appropriate members of health or related professions, as specified.
Specifies the terms of and requirements placed upon the members.
3) Makes the Advisory Panel subject to the Nonprofit Public Benefit Corporation
Law, except that if there is a conflict this bill prevails.
4) Requires the Advisory Panel to:
a) Solicit and accept funds from business, industry, foundations, and other
private or public sources for the purpose of establishing and funding new
residency positions in areas of the state.
b) Encourage public and private sector institutions, including hospitals,
colleges, universities, community clinics, and other health agencies and
organizations to identify and provide locations for the establishment of new
residency positions in areas of the state .
c) Solicit proposals for medical residency programs, as specified, and provide
HPEF a copy of all proposals it receives.
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d) Upon the sufficient solicitation of funds and at the Advisory Panel’s
discretion, recommend to HPEF the establishment of new residency
positions, as specified.
e) Only approve and recommend to HPEF proposals that would establish
residency positions that will serve in specified medical service areas.
f) Upon HPEF approval of a recommendation, deposit into the fund created in
#7 below necessary moneys required to establish and fund the residency
position.
g) Recommend to the director of OSHPD that a portion of the funds solicited
from the private sector be used for the administrative requirements of the
Advisory Panel and HPEF.
h) Prepare and submit an annual report to the Legislature documenting the
amount of money solicited, the amount of money deposited into the fund
created in #7 below, the recommendations for the location and fields of
practice of residency positions, total expenditures for the year, and
prospective fundraising goals.
5) Requires HPEF to:
a) Provide technical and staff support to Advisory Panel in meeting all of its
responsibilities.
b) Upon receipt of a recommendation by the Advisory Panel, approve the
recommendation if it fulfills the specified requirements.
c) Upon sufficient funds being available, send an approval to OSHPD for
implementation.
6) Requires OSHPD to:
a) Establish a uniform process by which the Panel may solicit proposals from
public and private sector institutions, including hospitals, colleges,
universities, community clinics, and other health agencies and organizations
that train primary care residents. Requires that the proposals contain all
necessary and pertinent information, including, but not limited to, specified
information.
b) Enter into contracts with public and private sector institutions, including
hospitals, colleges, universities, community clinics, and other health
agencies and organizations in order to fund and establish residency positions
at, or in association with, these institutions.
c) Ensure that the residency position has been, or will be, approved by the
Accreditation Council for Graduate Medical Education.
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d) Provide specified information to the Advisory Panel and HPEF as requested
and as specified.
e) Monitor the residencies established pursuant to this bill.
f) Prepare and submit an annual report to the Advisory Panel, HPEF, and the
Legislature documenting the amount of money contributed to the fund by the
Panel, the amount of money expended from the fund, the purposes of those
expenditures, the number and location of residency positions established and
funded, and recommendations for the location of future residency positions.
7) Establishes the Medical Residency Training Fund (Fund) within the State
Treasury. Specifies that the primary purpose of the Fund is to allocate funding
for new residency positions throughout the state and requires money in the
Fund to also be used to pay for the cost of administering the goals of the
Advisory Panel, and for any other purpose authorized by this bill.
8) Makes the level of expenditure by OSHPD for the administrative support of
HPEF subject to review and approval annually through the state budget process.
9) Permits OSHPD and HPEF to solicit and accept public and private donations
for deposit in the Fund, and makes all money in the Fund continuously
appropriated to OSHPD for the purposes of this bill. Requires OSHPD to
manage this fund prudently in accordance with applicable laws.
10) Requires any regulations adopted to implement this to be emergency
regulations, as specified.
11) Permits OSHPD to exempt from public disclosure any document in its
possession that pertains to a donation made pursuant to this bill if the donor
has requested anonymity.
12) Permits the Governor to include in the annual budget proposal an amount, as
he or she deems reasonable, to be appropriated to OSHPD, as specified.
13) Requires the money, if the Legislature appropriates it for the purposes of this
bill, to be appropriated to OSHPD. Requires OSHPD to hold the money for
distribution to the Fund created under this bill.
14) Requires appropriated funds to be paid into the Fund, upon request of HPEF in
an amount matching the amount deposited into the Fund for the purposes of
this bill.
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15) Requires any appropriated funds that has not been distributed to the Fund at the
end of each fiscal year to be returned to the General Fund.
Comments
1) Author’s statement. According to the author, California has a critical shortage
of primary care physicians. In order to maintain our current rate of utilizations,
we must train 8,000 more primary care physicians by 2030. Our statewide
shortage is further aggravated by misdistribution. Only 16 of California’s 58
counties meet the recommended 60-80 primary care physicians per 1,000
people. With an increasing Medi-Cal population, these already underserved
areas will see their services stretched even thinner. SB 22 will create a
voluntary public-private partnership to fund additional primary care physician
residency positions to be placed in these underserved areas of California. By
providing a state match of up to $20 million for private contributions, SB 22
creates a fund to provide additional residency positions while allowing a state
sanctioned but privately run non-profit organization have a say in the
distribution of the positions within these areas. By working closely with private
and public stakeholders, this bill aims to create a consensus based solution to
meet the need for more doctors in California as access to healthcare continues
to grow.
2) Primary Care in California. California ranks 23rd in the number of primary
care physicians per resident. An August 2014 report by the California
HealthCare Foundation states that California has only 35 to 49 primary care
physicians per 100,000 Medi-Cal enrollees. Federal guidelines call for the state
to have 60 to 80 doctors per 100,000 patients. The supply of primary care
physicians also varies substantially across California’s counties. The number of
primary care physicians actively practicing in California counties is, in too
many cases, at the bottom range of, or below, the state’s need. According to
2011 Health Resources and Services Administration data, 29 of California’s 58
counties fall at the lower end, or below, the needed supply range for primary
care physicians. In other words, half of Californians live in a community where
they do not have adequate access to the health care services they need.
3) The Affordable Care Act (ACA). Under the ACA, about five million
Californians have enrolled in either private insurance or Medi-Cal. There are
now 12 million Medi-Cal enrollees, about one third of California’s population.
The newly insured will increase demand for health care from an already
strained system. Furthermore, the ACA will change how care is delivered. It
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provides incentives for expanded and improved primary care, which may affect
demand for some health care professionals more than others, and encourages
the creation of team-based models of service delivery. Research indicates that
health care reform will place higher skill demands on all members of the health
care workforce as systems try to improve quality while limiting costs. The scale
of change with health care reform is unlike anything that California has
previously faced. Studies have found that persons with health insurance use
more health care services than uninsured persons, particularly in primary care
and preventive services. This was found in Massachusetts, which experienced a
substantial increase in demand for primary care services as a result of its 2006
health reform.
4) Current workforce development programs. The state operates a number of
programs designed to increase the number of health care professionals
practicing in medically underserved areas:
a) HPEF offers six scholarships and seven loan repayment programs in several
allied health professions, including nursing, mental health, dentistry, and
medicine. Scholarship programs provide financial assistance to healthcare
students who are attending a California accredited college or university and
agree to practice in California’s underserved communities upon graduation.
Loan repayment programs are offered to working health professionals to
assist in repayment of their education debt in exchange for a service
obligation. Service obligations are typically one to three years, and vary
depending on the program and awards range from $4,000 to $105,000
depending on profession and length of service obligation. HPEF has
increased access to care in the state’s underserved areas via 6,693 awards
totaling more than $60 million to health practitioner awardees serving in 57
of the state’s 58 counties.
b) California State Loan Repayment Program (SLRP) provides educational
loan repayment assistance to primary health care professionals who provide
health care services in federally designated the Health Professional Shortage
Areas (HPSAs). Eligible health professionals include physicians specializing
in primary care fields, nurse practitioners, certified nurse-midwives, general
practice dentists, registered dental hygienists, clinical or counseling
psychologists, clinical social workers, licensed counselors, pharmacists,
physician assistants, psychiatric nurse specialists, and marriage and family
therapists. Eligible health professionals must be employed by or have
accepted employment at a SLRP Certified Eligible Site (which includes rural
health clinics, community health clinics, county facilities, and federally
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qualified health centers) and must commit to providing full-time or half-time
primary care services in a HPSA for a minimum of two years. Health
professionals may receive up to $50,000 in exchange for a two year fulltime service obligation and/or $25,000 for a two year half-time service
obligation; individuals can receive up to $150,000 over six years at full-time
and $75,00 for half-time. SLRP award amounts are matched by the site(s) in
which the health professional is practicing, on a dollar-for-dollar basis, in
addition to salary.
c) The Song-Brown Program provides financial support to family medicine and
primary care residency (Internal Medicine, OB/GYN and Pediatric)
programs, family nurse practitioner programs, primary care physician
assistant training programs, and registered nurse education programs.
Funding is provided to institutions that provide clinical training and
education in underserved areas, and healthcare to the state’s underserved
population.
d) Mini Grants Program provides grants to organizations supporting
underrepresented and economically disadvantaged students in pursuit of
careers in health care. Organizations receive grants of up to $15,000 to
engage in health career conferences, workshops, and/or career exploration
activities. Since 2005, over $2.2 million has been awarded to support
organizations engaging in these activities serving nearly 56,000 students
statewide. In 2014 and 2015, OSHPD awarded 46 Mini Grants to
organizations for a sum of $603,706. This will help support 16,555 students
from demographically underrepresented groups to pursue healthcare careers.
e) California Student/Resident Experiences and Rotations in Community
Health provides grants to organizations that support student and resident
rotations from primary care and mental health disciplines in community
clinics, health centers, and public mental health system sites which expose
students, residents and practitioners to underserved communities.
Organizations awarded receive funding to administer the program and to
provide students, residents, and preceptors and mentors a small stipend for
completing the program. In addition to completing a rotation in an
underserved area, participants are also required to complete a community
project. From 2009 to 2012, 150 students and residents were supported via
an American Recovery and Reinvestment Act grant. In 2014 to 2015, via
funding from the Mental Health Services Act (MHSA) Workforce Education
and Training and The California Endowment, OSHPD granted 12 awards to
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organizations for a sum of $317,000 which will help support 92 participants
statewide.
f) MHSA Workforce Education and Training (WET) Program is funded by
Proposition 63 and seeks to remedy the shortage of mental health
practitioners in the public mental health system (PMHS) via: career
awareness; PMHS rotations; retention grants; stipends; loan repayments;
grants to expand capacity of education and residency programs; grants to
increase and retain consumer and family member employment; and grants to
support regional partnerships.
FISCAL EFFECT: Appropriation: Yes Fiscal Com.:
Yes
Local: No
According to the Senate Appropriations Committee, as amended 6/2/15:
1) One-time administrative costs of about $1 million to create the Advisory Panel
and develop criteria for making grants (General Fund). In the long-run,
donations may support some or all of the activities of the proposed program. In
the near term, however, state funds will likely be needed to create the program.
2) Ongoing costs of about $800,000 per year to administer the program, support
the Advisory Panel, and review and approve grants and contracts (private
funds).
3) Unknown costs to make grants to medical residency programs (private funds).
This bill will require the Advisory Panel to solicit donations from public and
private sources in order to fund new medical residency positions. The amount
of funding available under the program will depend on the success of those
fundraising efforts.
SUPPORT: (Verified 1/26/16)
AARP
Association of California Healthcare Districts
California Academy of Physician Assistants
California Chapter of the American College of Emergency Physicians
California Physical Therapy Association
California Primary Care Association
Community Clinic Association of Los Angeles County
OPPOSITION: (Verified 1/26/16)
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None received
Prepared by: Melanie Moreno / HEALTH /
1/26/16 16:39:31
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