SB 22: Residency training: funding.
- Session Year: 2015-2016
- House: Senate
- Latest Version Date: 2016-02-29
The Song-Brown Health Care Workforce Training Act creates a state medical contract program to increase the number of students and residents receiving quality education and training in specified primary care specialties or in nursing, and to maximize the delivery of primary care and family physician services to specific areas of California where there is a recognized unmet priority need for those services. The act requires the Director of Statewide Health Planning and Development to, among other things, contract with accredited medical schools, teaching health centers, training programs, hospitals, and other health care delivery systems for those purposes, based on recommendations of the California Healthcare Workforce Policy Commission and in conformity with the contract criteria and program standards established by the commission.
This bill would appropriate $300,000,000 from the General Fund to the director for the purpose of funding new and existing graduate medical education physician residency positions, and supporting training faculty, pursuant to the act, for expenditure as specified. The bill would also make related findings and declarations.
Existing law, the Song-Brown Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law requires the Office of Statewide Health Planning and Development to establish the Health Professions Education Foundation to solicit and receive funds for the purpose of providing financial assistance in the form of scholarships or loans to medical students from underrepresented groups. Under existing law, the foundation also administers other programs for the advancement of health professions, including the Registered Nurse Education Program.
This bill would establish the Medical Residency Training Advisory Panel, consisting of a total of 13 members to be appointed as specified, within the Health Professions Education Foundation.
The bill would create the Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the panel to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in specified areas of the state, including medically underserved areas. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the foundation to provide technical support and financial management for the panel and to approve and send panel recommendations for new residency programs to the Office of Statewide Health Planning and Development for implementation if specified requirements are met, including sufficient funding. The bill would require the office to enter into contracts with public and private sector institutions and other health agencies and organizations in order to fund and establish recommended residency positions. The bill would authorize the Governor to include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated for this purpose. The bill, if the Legislature appropriates money for this purpose, would require the office to hold the funds and distribute them into the fund, upon request of the panel, in an amount matching the amount deposited into the fund, as specified. The bill would require money that was appropriated, but that has not been distributed to the fund at the end of each fiscal year, to be returned to the General Fund.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Existing law, the Song-Brown Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
Existing law requires the Office of Statewide Health Planning and Development to establish the Health Professions Education Foundation to solicit and receive funds for the purpose of providing financial assistance in the form of scholarships or loans to medical students from underrepresented groups. Under existing law, the foundation also administers other programs for the advancement of health professions, including the Registered Nurse Education Program.
This bill would require the Office of Statewide Health Planning and Development to establish a nonprofit public benefit corporation, to be known as the California Medical Residency Training Foundation, to be governed by a board of trustees establish the Medical Residency Training Advisory Panel, consisting of a total of 13 members, members to be appointed as specified specified, within the Health Professions Education Foundation.
The bill would create the Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the foundation panel to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in specified areas of the state, including medically underserved areas. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the Office of Statewide Health Planning and Development, among other responsibilities, foundation to provide technical support and financial management for the foundation, and panel and to approve and send panel recommendations for new residency programs to the Office of Statewide Health Planning and Development for implementation if specified requirements are met, including sufficient funding. The bill would require the office to enter into contracts with public and private sector institutions and other health agencies and organizations in order to fund and establish recommended residency positions. The bill would authorize the Governor to include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated for this purpose. The bill, if the Legislature appropriates money for this purpose, would require the office to hold the funds and distribute them into the fund, upon request of the foundation, panel, in an amount matching the amount deposited into the fund by the foundation. fund, as specified. The bill would require money that was appropriated, but that has not been distributed to the fund at the end of each fiscal year, to be returned to the General Fund.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Existing law, the Song-Brown Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
This bill would require the Office of Statewide Health Planning and Development to establish a nonprofit public benefit corporation, to be known as the California Medical Residency Training Foundation, to be governed by a board of trustees consisting of a total of 13 members, to be appointed as specified.
The bill would create the Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the foundation to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in specified areas of the state, including medically underserved areas. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the Office of Statewide Health Planning and Development, among other responsibilities, to provide technical support and financial management for the foundation, and to enter into contracts with public and private sector institutions and other health agencies and organizations in order to fund and establish residency positions. The bill would authorize the Governor to include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated for this purpose. The bill, if the Legislature appropriates money for this purpose, would require the office to hold the funds and distribute them into the fund, upon request of the foundation, in an amount matching the amount deposited into the fund by the foundation. The bill would require money that was appropriated, but that has not been distributed to the fund at the end of each fiscal year, to be returned to the General Fund.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Existing law, the Song-Brown Family Physician Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of the Office of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
This bill would require the Office of Statewide Health Planning and Development to establish a nonprofit public benefit corporation, to be known as the California Medical Residency Training Foundation, to be governed by a board of trustees consisting of a total of 13 members, to be appointed as specified.
The bill would create the California Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the foundation to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in specified areas of the state, including medically underserved areas of the state, as specified. areas. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the Office of Statewide Health Planning and Development to, among other things, Development, among other responsibilities, to provide technical support and financial management for the foundation, establish criteria for ranking geographical areas with the highest need for primary care residencies, and give preference to funding residencies in those areas, as specified. The bill would require the Legislature to, for each fiscal year, authorize in the budget an amount, as determined in the budgetary process, to match the contributions deposited into the fund by the foundation in that fiscal year. and to enter into contracts with public and private sector institutions and other health agencies and organizations in order to fund and establish residency positions.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Existing law, the Song-Brown Family Physician Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of the Office of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
This bill would require the Office of Statewide Health Planning and Development to establish a nonprofit public benefit corporation, to be known as the California Medical Residency Training Foundation, to be governed by a board of trustees consisting of a total of 13 members, 9 members appointed by the Governor, one member appointed by the Speaker of the Assembly, one member appointed by the Senate Committee on Rules, and 2 members of the Medical Board of California appointed by the Medical Board of California. to be appointed as specified.
The bill would create the California Medical Residency Training Fund in the State Treasury, a continuously appropriated fund, and would require the foundation to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs in medically underserved areas of the state, as specified. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the Office of Statewide Health Planning and Development to, among other things, provide technical support and financial management for the foundation, establish criteria for ranking geographical areas with the highest need for primary care residencies, and give preference to funding residencies in those areas, as specified. The bill would require the Legislature to, for each fiscal year, authorize in the budget an amount, as determined in the budgetary process, to match the contributions deposited into the fund by the foundation in that fiscal year.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Existing law, the Song-Brown Family Physician Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of the Office of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
This bill would require the Office of Statewide Health Planning and Development to establish a nonprofit public benefit corporation, to be known as the California Medical Residency Training Foundation, to be governed by a board of trustees consisting of a total of 13 members, 9 members appointed by the Governor, one member appointed by the Speaker of the Assembly, one member appointed by the Senate Committee on Rules, and 2 members of the Medical Board of California appointed by the Medical Board of California.
The bill would create the Graduate California Medical Education Trust Residency Training Fund in the State Treasury, to consist of funds from public-private partnerships created to fund grants to a continuously appropriated fund, and would require the foundation to solicit and accept funds from business, industry, foundations, and other private or public sources for the purpose of establishing and funding new graduate medical residency training programs and any interest that accrues on those moneys, and would require that moneys in the fund be used, upon appropriation by the Legislature, for those purposes, as specified. in medically underserved areas of the state, as specified. By creating a continuously appropriated fund, the bill would make an appropriation. The bill would require the Office of Statewide Health Planning and Development, in consultation with the California Healthcare Workforce Policy Commission, to develop criteria, upon receipt of private donations of sufficient moneys to develop the criteria, for distribution of available funds. Development to, among other things, provide technical support and financial management for the foundation, establish criteria for ranking geographical areas with the highest need for primary care residencies, and give preference to funding residencies in those areas, as specified.
Existing law, the Song-Brown Family Physician Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in the specialty of family practice and as primary care physicians assistants and primary care nurse practitioners. Existing law establishes, for this purpose, a state medical contract program with accredited medical schools, programs that train primary care physicians assistants, programs that train primary care nurse practitioners, registered nurses, hospitals, and other health care delivery systems.
Existing law establishes the California Healthcare Workforce Policy Commission and requires the commission, among other things, to identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist, establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners, and review and make recommendations to the Director of the Office of Statewide Health Planning and Development concerning the funding of those programs that are submitted to the Healthcare Workforce Development Division for participation in the state medical contract program.
The bill would create the Graduate Medical Education Trust Fund in the State Treasury, to consist of funds from public-private partnerships created to fund grants to graduate medical residency training programs and any interest that accrues on those moneys, and would require that moneys in the fund be used, upon appropriation by the Legislature, for those purposes, as specified. The bill would require the Office of Statewide Health Planning and Development, in consultation with the California Healthcare Workforce Policy Commission, to develop criteria, upon receipt of private donations of sufficient moneys to develop the criteria, for distribution of available funds.
The Legislature finds and declares as follows:
(a)More than $40 million of funding for the training of Californias primary care physicians is expiring in 2016.
(b)Each year in California, only 368 slots are available to the thousands of medical students seeking to train in family medicine. If the funding is not replaced, 158 of those slots will be lost, creating a terrible deficit of primary care physicians in Californias underserved communities.
(c)Only 36 percent of Californias active patient care physicians practice primary care. Twenty-three of Californias 58 counties fall below the minimum required primary care physician to population ratio.
(d)As of 2010, California needed an estimated additional 8,243 primary care physicians by 2030 to prevent projected shortages in the state, which is about 412 new primary care physicians per year.
(e)More than 32 percent of Californias practicing primary care physicians are 60 years of age or older only four other states have a larger percentage of soon-to-retire physicians.
(f)States with higher ratios of primary care physicians to population have better health outcomes, including decreased mortality from cancer, heart disease, and stroke.
(g)The Song-Brown program provides an existing state infrastructure to support an increase in the number of primary care providers serving Californias underserved populations. By investing in Song-Brown, California will realize an immediate return on investment as each primary care resident provides an average of 600 additional patient visits per physician per year during training alone.
(h)Californias long-term workforce will also grow significantly as the vast majority of physicians who train in a region stay there to practice. California leads all fifty states in the percentage of residency program graduates who stay in the state in which they are trained.
SEC. 2.Notwithstanding Section 13340 of the Government Code, there is hereby continuously appropriated from the General Fund the sum of three hundred million dollars ($300,000,000) to the Director of Statewide Health Planning and Development, for the purpose of funding new and existing graduate medical education physician residency positions, and supporting training faculty, pursuant to the Song-Brown Health Care Workforce Training Act (Article 1 (commencing with Section 128200) of Chapter 4 of Part 3 of Division 107 of the Health and Safety Code). The moneys shall be expended as follows:
(a)The sum of one hundred million dollars ($100,000,000) shall be expended in the 201617 fiscal year.
(b)The sum of one hundred million dollars ($100,000,000) shall be expended in the 201718 fiscal year.
(c)The sum of one hundred million dollars ($100,000,000) shall be expended in the 201819 fiscal year.
SECTION 1.Article 7 (commencing with Section 128590) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:7.California Medical Residency Training Program128590.As used in this article:
(a)Director means the Director of Statewide Health Planning and Development.
(b)Foundation means the Health Professions Education Foundation.
(c)Fund means the Medical Residency Training Fund.
(d)Office means the Office of Statewide Health Planning and Development.
(e)Panel means the Medical Residency Training Advisory Panel, established pursuant to Section 128591.
(f)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and related specialties and subspecialties as the office deems appropriate.
(g)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)There is established within the foundation the Medical Residency Training Advisory Panel.
(2)The panel shall consist of 13 members. Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, two members of the Medical Board of California shall be appointed by the Medical Board of California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the panel appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall consist of representatives of designated and nondesignated public hospitals, 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this article, as determined by the appointing power.
(b)The Governor shall appoint the president of the panel from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California.
(c)(1)Of the members of the panel first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and one member shall be appointed to serve a three-year term.
(2)Each member of the panel first appointed by the Speaker of the Assembly and the Senate Committee on Rules shall be appointed to serve a three-year term.
(3)Each member of the panel appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(4)Upon the expiration of the initial appointments to the panel by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(d)(1)Members of the panel appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the panel.
(2)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California and the Osteopathic Medical Board of California, respectively, for any actual and necessary expenses incurred in connection with their duties as members of the panel.
(e)Notwithstanding any law relating to incompatible activities, no member of the panel shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California or the Osteopathic Medical Board of California.
(f)The panel shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this article and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this article shall prevail.
128592.The panel shall do all of the following:
(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 described in subdivision (c).
(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 described in subdivision (c). The panel shall solicit proposals for medical residency programs, as described in subdivision (c), and shall provide to the foundation a copy of all proposals it receives.
(c)Upon the sufficient solicitation of funds and at the panels discretion, recommend to the foundation the establishment of new residency positions. A recommendation shall include all pertinent information required to enter into the necessary contracts to establish the residency positions. The panel shall only approve and recommend to the foundation proposals that would establish residency positions that will serve in any of the following medical service areas:
(1)A service area that is designated as a primary care shortage area by the office.
(2)A service area that is designated as a health professional shortage area for primary care, by either population or geographic designation, by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(3)A service area that is designated as a medically underserved area or medically underserved population by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(d)Upon foundation approval of a recommendation, deposit into the fund necessary moneys required to establish and fund the residency position.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the panel and the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited, the amount of money deposited by the panel into the fund, the recommendations for the location and fields of practice of residency positions, total expenditures for the year, and prospective fundraising goals.
128593.The foundation shall do all of the following:
(a)Provide technical and staff support to the panel in meeting all of its responsibilities.
(b)Upon receipt of a recommendation made by the panel pursuant to subdivision (c) of Section 128592, approve the recommendation if the recommendation fulfills the requirements of subdivision (c) of Section 128592 and the recommendation fulfills the goals of this article. Upon sufficient funds being available, an approval shall be sent to the office for implementation pursuant to Section 128594.
128594.The office shall do all of the following:
(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. The office shall require that the proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(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.
(d)Provide all of the following information to the panel and the foundation as requested:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)Other information relevant to assist the panel and the foundation in making recommendations on possible locations for new residency positions.
(e)Monitor the residencies established pursuant to this article.
(f)(1)Prepare and submit an annual report to the panel, the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128595.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the panel and the foundation as established by this article, and for any other purpose authorized by this article.
(c)The level of expenditure by the office for the administrative support of the panel and the foundation is subject to review and approval annually through the state budget process.
(d)In addition to funds raised by the panel, the office and the foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this article. The office shall manage this fund prudently in accordance with applicable laws.
128596.Any regulations the office adopts to implement this article shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128597.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this article if the donor has requested anonymity.
128598.(a)The Governor may include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated to the office to be used as provided in this article.
(b)If the Legislature appropriates money for purposes of this article, the money shall be appropriated to the office, which shall hold the money for distribution to the fund.
(c)Funds appropriated to the office shall be paid into the fund, upon request of the panel, in an amount matching the amount deposited into the fund by the panel or by the foundation and office pursuant to subdivision (d) of Section 128595 for the purposes of this article. Any money that was appropriated to the office and that has not been distributed to the fund at the end of each fiscal year shall be returned to the General Fund.
SEC. 2.The Legislature finds and declares that Section 1 of this act, which adds Article 7 (commencing with Section 128590) to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, imposes a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individual privacy of donations made by a donor to fund new medical residency positions in underserved areas of the state outweighs the interest in the public disclosure of that information.
As used in this chapter:
(a)Board means the Board of Trustees of the California Medical Residency Training Foundation.
(b)Commission means the California Healthcare Workforce Policy Commission.
(c)Director means the Director of Statewide Health Planning and Development.
(d)Foundation means the California Medical Residency Training Foundation.
(e)Fund means the Medical Residency Training Fund.
(f)Office means the Office of Statewide Health Planning and Development.
(g)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and related specialties and subspecialties as the office deems appropriate.
(h)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)The office shall establish a nonprofit public benefit corporation to be known as the California Medical Residency Training Foundation.
(2)The foundation shall be governed by a board of trustees consisting of a total of 13 members. Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, two members of the Medical Board of California shall be appointed by the Medical Board of California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the foundation board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall consist of representatives of designated and nondesignated public hospitals, 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
(5)The chairperson of the commission shall also be a nonvoting, ex officio member of the board.
(b)The Governor shall appoint the president of the board from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California.
(c)Of the members of the board first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and one member shall be appointed to serve a three-year term.
(d)Of the members of the board first appointed by the Speaker of the Assembly and the Senate Committee on Rules, each member shall be appointed to serve a three-year term.
(e)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(f)Upon the expiration of the initial appointments to the board by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(g)The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the foundation.
(h)(1)Members of the board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules, and members of the council shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with his or her duties as a member of the board or the council.
(2)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California and the Osteopathic Medical Board of California, respectively, for any actual and necessary expenses incurred in connection with his or her duties as a member of the foundation board.
(i)Notwithstanding any law relating to incompatible activities, no member of the foundation board shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California or the Osteopathic Medical Board of California.
(j)The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this chapter and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this chapter shall prevail.
128592.The foundation shall do the following:
(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 described in subdivision (c).
(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 described in subdivision (c). The foundation shall solicit proposals for medical residency programs, as described in subdivision (c), and provide the office a copy of all proposals it receives.
(c)Upon the sufficient solicitation of funds and at the foundations discretion, approve proposals and recommend to the office the establishment of new residency positions. A recommendation shall include all pertinent information necessary for the office to enter into the necessary contracts to establish the residency positions. The foundation shall only approve and recommend to the office proposals that would establish residency positions that will serve in any of the following medical service areas:
(1)A service area that is designated as a primary care shortage area by the office.
(2)A service area that is designated as a health professional shortage area for primary care, by either population or geographic designation, by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(3)A service area that is designated as a medically underserved area or medically underserved population by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(d)Upon office approval of a recommendation, deposit into the fund necessary moneys as required to establish and fund the residency position.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited, the amount of money deposited from the foundation into the fund, the recommendations for the location and fields of practice of residency positions, total expenditures for the year, and prospective fundraising goals.
128593.The office shall do all of the following:
(a)Provide technical and staff support to the foundation in meeting all of its responsibilities.
(b)Provide financial management for the foundation.
(c) Upon receipt of a recommendation made by the foundation pursuant to subdivision (c) of Section 128592, approve the recommendation if the recommendation fulfills the requirements of subdivision (c) of Section 128592 and the recommendation fulfills the goals of this chapter. Upon sufficient funds being available, an approval shall signal the offices intent to establish the residency position.
(d)Establish a uniform process by which the foundation 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. The office shall require that these proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(e)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.
(f)Ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
(g)Provide all of the following information to the board:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)Other information that the office or board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
(h)Monitor the residencies established pursuant to this chapter.
(i)(1)Prepare and submit an annual report to the foundation and the Legislature documenting the amount of money contributed to the fund by the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128594.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the foundation, and for any other purpose authorized by this chapter.
(c)The level of expenditure by the office for the administrative support of the foundation is subject to review and approval annually through the state budget process.
(d)The office and foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this chapter. The office shall manage this fund prudently in accordance with applicable laws.
128595.Any regulations the office adopts to implement this chapter shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128596.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this chapter if the donor has requested anonymity.
128597.(a)The Governor may include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated to the office to be used as provided in this chapter.
(b)If the Legislature appropriates money for purposes of this chapter, the money shall be appropriated to the office, which shall hold the money for distribution to the fund.
(c)Funds appropriated to the office shall be paid into the fund, upon request of the foundation, in an amount matching the amount deposited into the fund by the foundation for the purposes of this chapter. Any money that was appropriated to the office and that has not been distributed to the fund at the end of each fiscal year shall be returned to the General Fund.
SECTION 1.Article 7 (commencing with Section 128590) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:7.California Medical Residency Training Program128590.As used in this article:
(a)Director means the Director of Statewide Health Planning and Development.
(b)Foundation means the Health Professions Education Foundation.
(c)Fund means the Medical Residency Training Fund.
(d)Office means the Office of Statewide Health Planning and Development.
(e)Panel means the Medical Residency Training Advisory Panel, established pursuant to Section 128591.
(f)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and related specialties and subspecialties as the office deems appropriate.
(g)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)There is established within the foundation the Medical Residency Training Advisory Panel.
(2)The panel shall consist of 13 members. Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, two members of the Medical Board of California shall be appointed by the Medical Board of California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the panel appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall consist of representatives of designated and nondesignated public hospitals, 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this article, as determined by the appointing power.
(b)The Governor shall appoint the president of the panel from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California.
(c)(1)Of the members of the panel first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and one member shall be appointed to serve a three-year term.
(2)Each member of the panel first appointed by the Speaker of the Assembly and the Senate Committee on Rules shall be appointed to serve a three-year term.
(3)Each member of the panel appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(4)Upon the expiration of the initial appointments to the panel by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(d)(1)Members of the panel appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the panel.
(2)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California and the Osteopathic Medical Board of California, respectively, for any actual and necessary expenses incurred in connection with their duties as members of the panel.
(e)Notwithstanding any law relating to incompatible activities, no member of the panel shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California or the Osteopathic Medical Board of California.
(f)The panel shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this article and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this article shall prevail.
128592.The panel shall do all of the following:
(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 described in subdivision (c).
(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 described in subdivision (c). The panel shall solicit proposals for medical residency programs, as described in subdivision (c), and shall provide to the foundation a copy of all proposals it receives.
(c)Upon the sufficient solicitation of funds and at the panels discretion, recommend to the foundation the establishment of new residency positions. A recommendation shall include all pertinent information required to enter into the necessary contracts to establish the residency positions. The panel shall only approve and recommend to the foundation proposals that would establish residency positions that will serve in any of the following medical service areas:
(1)A service area that is designated as a primary care shortage area by the office.
(2)A service area that is designated as a health professional shortage area for primary care, by either population or geographic designation, by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(3)A service area that is designated as a medically underserved area or medically underserved population by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(d)Upon foundation approval of a recommendation, deposit into the fund necessary moneys required to establish and fund the residency position.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the panel and the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited, the amount of money deposited by the panel into the fund, the recommendations for the location and fields of practice of residency positions, total expenditures for the year, and prospective fundraising goals.
128593.The foundation shall do all of the following:
(a)Provide technical and staff support to the panel in meeting all of its responsibilities.
(b)Upon receipt of a recommendation made by the panel pursuant to subdivision (c) of Section 128592, approve the recommendation if the recommendation fulfills the requirements of subdivision (c) of Section 128592 and the recommendation fulfills the goals of this article. Upon sufficient funds being available, an approval shall be sent to the office for implementation pursuant to Section 128594.
128594.The office shall do all of the following:
(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. The office shall require that the proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(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.
(d)Provide all of the following information to the panel and the foundation as requested:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)Other information relevant to assist the panel and the foundation in making recommendations on possible locations for new residency positions.
(e)Monitor the residencies established pursuant to this article.
(f)(1)Prepare and submit an annual report to the panel, the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128595.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the panel and the foundation as established by this article, and for any other purpose authorized by this article.
(c)The level of expenditure by the office for the administrative support of the panel and the foundation is subject to review and approval annually through the state budget process.
(d)In addition to funds raised by the panel, the office and the foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this article. The office shall manage this fund prudently in accordance with applicable laws.
128596.Any regulations the office adopts to implement this article shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128597.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this article if the donor has requested anonymity.
128598.(a)The Governor may include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated to the office to be used as provided in this article.
(b)If the Legislature appropriates money for purposes of this article, the money shall be appropriated to the office, which shall hold the money for distribution to the fund.
(c)Funds appropriated to the office shall be paid into the fund, upon request of the panel, in an amount matching the amount deposited into the fund by the panel or by the foundation and office pursuant to subdivision (d) of Section 128595 for the purposes of this article. Any money that was appropriated to the office and that has not been distributed to the fund at the end of each fiscal year shall be returned to the General Fund.
SEC. 2.The Legislature finds and declares that Section 1 of this act, which adds Chapter 6 Article 7 (commencing with Section 128590) to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, imposes a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individual privacy of donations made by a donor to fund new medical residency positions in underserved areas of the state outweighs the interest in the public disclosure of that information.
As used in this chapter:
(a)Board means the Board of Trustees of the California Medical Residency Training Foundation.
(b)Commission means the California Healthcare Workforce Policy Commission.
(c)Director means the Director of Statewide Health Planning and Development.
(d)Foundation means the California Medical Residency Training Foundation.
(e)Fund means the Medical Residency Training Fund.
(f)Office means the Office of Statewide Health Planning and Development.
(g)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and related specialties and subspecialties as the office deems appropriate.
(h)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)The office shall establish a nonprofit public benefit corporation to be known as the California Medical Residency Training Foundation.
(2)The foundation shall be governed by a board of trustees consisting of a total of 13 members. Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, two members of the Medical Board of California shall be appointed by the Medical Board of California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the foundation board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall consist of representatives of designated and nondesignated public hospitals, 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
(5)The chairperson of the commission shall also be a nonvoting, ex officio member of the board.
(b)The Governor shall appoint the president of the board from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California.
(c)Of the members of the board first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and one member shall be appointed to serve a three-year term.
(d)Of the members of the board first appointed by the Speaker of the Assembly and the Senate Committee on Rules, each member shall be appointed to serve a three-year term.
(e)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(f)Upon the expiration of the initial appointments to the board by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(g)The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the foundation.
(h)(1)Members of the board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules, and members of the council shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with his or her duties as a member of the board or the council.
(2)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California and the Osteopathic Medical Board of California, respectively, for any actual and necessary expenses incurred in connection with his or her duties as a member of the foundation board.
(i)Notwithstanding any law relating to incompatible activities, no member of the foundation board shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California or the Osteopathic Medical Board of California.
(j)The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this chapter and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this chapter shall prevail.
128592.The foundation shall do the following:
(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 described in subdivision (c).
(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 described in subdivision (c). The foundation shall solicit proposals for medical residency programs, as described in subdivision (c), and provide the office a copy of all proposals it receives.
(c)Upon the sufficient solicitation of funds and at the foundations discretion, approve proposals and recommend to the office the establishment of new residency positions. A recommendation shall include all pertinent information necessary for the office to enter into the necessary contracts to establish the residency positions. The foundation shall only approve and recommend to the office proposals that would establish residency positions that will serve in any of the following medical service areas:
(1)A service area that is designated as a primary care shortage area by the office.
(2)A service area that is designated as a health professional shortage area for primary care, by either population or geographic designation, by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(3)A service area that is designated as a medically underserved area or medically underserved population by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(d)Upon office approval of a recommendation, deposit into the fund necessary moneys as required to establish and fund the residency position.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited, the amount of money deposited from the foundation into the fund, the recommendations for the location and fields of practice of residency positions, total expenditures for the year, and prospective fundraising goals.
128593.The office shall do all of the following:
(a)Provide technical and staff support to the foundation in meeting all of its responsibilities.
(b)Provide financial management for the foundation.
(c) Upon receipt of a recommendation made by the foundation pursuant to subdivision (c) of Section 128592, approve the recommendation if the recommendation fulfills the requirements of subdivision (c) of Section 128592 and the recommendation fulfills the goals of this chapter. Upon sufficient funds being available, an approval shall signal the offices intent to establish the residency position.
(d)Establish a uniform process by which the foundation 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. The office shall require that these proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(e)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.
(f)Ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
(g)Provide all of the following information to the board:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)Other information that the office or board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
(h)Monitor the residencies established pursuant to this chapter.
(i)(1)Prepare and submit an annual report to the foundation and the Legislature documenting the amount of money contributed to the fund by the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128594.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the foundation, and for any other purpose authorized by this chapter.
(c)The level of expenditure by the office for the administrative support of the foundation is subject to review and approval annually through the State Budget state budget process.
(d)The office and foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this chapter. The office shall manage this fund prudently in accordance with applicable laws.
128595.Any regulations the office adopts to implement this chapter shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128596.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this chapter if the donor has requested anonymity.
128597.(a)The Governor may include in the annual budget proposal an amount, as he or she deems reasonable, to be appropriated to the office to be used as provided in this chapter.
(b)If the Legislature appropriates money for purposes of this chapter, the money shall be appropriated to the office, which shall hold the money for distribution to the fund.
(c)Funds appropriated to the office shall be paid into the fund, upon request of the foundation, in an amount matching the amount deposited into the fund by the foundation for the purposes of this chapter. Any money that was appropriated to the office and that has not been distributed to the fund at the end of each fiscal year shall be returned to the General Fund.
SEC. 2.The Legislature finds and declares that Section 1 of this act, which adds Chapter 6 (commencing with Section 128590) to Part 3 of Division 107 of the Health and Safety Code, imposes a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individual privacy of donations made by a donor to fund new residency positions in underserved areas of the state outweighs the interest in the public disclosure of that information.
As used in this chapter:
(a)Board means the Board of Trustees of the California Medical Residency Training Foundation.
(b)Commission means the California Healthcare Workforce Policy Commission.
(c)Director means the Director of the Office of Statewide Health Planning and Development.
(d)Foundation means the California Medical Residency Training Foundation.
(e)Fund means the Medical Residency Training Fund.
(f)Office means the Office of Statewide Health Planning and Development.
(g)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry. psychiatry, and related specialties and subspecialties as the office deems appropriate.
(h)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)The office shall establish a nonprofit public benefit corporation to be known as the California Medical Residency Training Foundation.
(2)The foundation shall be governed by a board of trustees consisting of a total of 13 members. Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, two members of the Medical Board of California shall be appointed by the Medical Board of California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the foundation board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules shall consist of representatives of designated and nondesignated public and hospitals, 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
(5)The chairperson of the commission shall also be a nonvoting, ex officio member of the board.
(b)The Governor shall appoint the president of the board from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California.
(c)Of the members of the board first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and three members one member shall be appointed to serve a three-year term.
(d)Of the members of the board first appointed by the Speaker of the Assembly and the Senate Committee on Rules, each member shall be appointed to serve a four-year three-year term.
(e)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(f)Upon the expiration of the initial appointments to the board by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(g)The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the foundation.
(h)(1)Members of the board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules, and members of the council shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with his or her duties as a member of the board or the council.
(2)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California and the Osteopathic Medical Board of California, respectively, for any actual and necessary expenses incurred in connection with his or her duties as a member of the foundation board.
(i)Notwithstanding any law relating to incompatible activities, no member of the foundation board shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California. California or the Osteopathic Medical Board of California.
(j)The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this chapter and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this chapter shall prevail.
128592.The foundation shall do the following:
(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 medically underserved areas of the state. state described in subdivision (c).
(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 the medically underserved areas of the state. state described in subdivision (c). The foundation shall solicit proposals for medical residency programs, as described in subdivision (c), and provide the office a copy of all proposals it receives.
(c)Make recommendations to the director on the establishment of new residency positions, including the locations, fields of practice, and levels of funding in order to fulfill the goals of this chapter.
(d)Recommend to the director the disbursement of moneys deposited in the California Medical Residency Training Fund to establish and fund residency positions.
(c)Upon the sufficient solicitation of funds and at the foundations discretion, approve proposals and recommend to the office the establishment of new residency positions. A recommendation shall include all pertinent information necessary for the office to enter into the necessary contracts to establish the residency positions. The foundation shall only approve and recommend to the office proposals that would establish residency positions that will serve the following medical service areas:
(1)A service area that is designated as a primary care shortage area by the office.
(2)A service area that is designated as a health professional shortage area for primary care, by either population or geographic designation, by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(3)A service area that is designated as a medically underserved area or medically underserved population by the Health Resources and Services Administration of the United States Department of Health and Human Services.
(d)Upon office approval of a recommendation, deposit into the fund necessary moneys as required to establish and fund the residency position.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited from the private sector, solicited, the amount of money deposited from the foundation into the fund, the recommendations for the location and fields of practice of future residency positions, total expenditures for the year, and the prospective fundraising goals.
128593.The office shall do all of the following:
(a)Provide technical and staff support to the foundation in meeting all of its responsibilities.
(b)Provide financial management for the foundation.
(c)Establish, with the recommendation of the board, criteria for ranking the geographical areas of the state that have the highest need for primary care residencies, and give preference to proposals that would establish residency positions in these areas. These criteria shall be based on both of the following:
(1)The size of an areas population that is enrolled in, or eligible for, Medi-Cal.
(2)The shortage of primary care physicians in the area.
(c) Upon receipt of a recommendation made by the foundation pursuant to subdivision (c) of Section 128592, approve the recommendation if the recommendation fulfills the requirements of subdivision (c) of Section 128592 and the recommendation fulfills the goals of this chapter. Upon sufficient funds being available, an approval shall signal the offices intent to establish the residency position.
(d)Solicit proposals for new residency positions from public and private sector institutions, including hospitals, colleges, universities, community clinics, and other health agencies and organizations that train primary care residents. The office shall establish Establish a uniform process that requires that by which the foundation 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. The office shall require that these proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(e)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. The director shall seek the recommendations of the commission and foundation as to which proposals best fulfill this chapters objective.
(f)Prior to the first distribution of funds for any new residency position, ensure Ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
(g)Provide all of the following information to the board:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)The proposals received from institutions that train primary care physicians pursuant to subdivision (d).
(4)
(3)Other information that the office or board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
(h)Monitor the residencies established pursuant to this chapter.
(i)(1)Prepare and submit an annual report to the foundation and the Legislature documenting the amount of money contributed to the fund by the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128594.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the foundation, and for any other purpose authorized by this chapter.
(c)The level of expenditure by the office for the administrative support of the foundation is subject to review and approval annually through the State Budget process.
(d)The office and foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this chapter. The office shall manage this fund prudently in accordance with applicable laws.
128595.Any regulations the office adopts to implement this chapter shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128596.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this chapter if the donor has requested anonymity.
128597.For each fiscal year, the Legislature shall authorize in the budget an amount, as determined in the budgetary process, to match the contributions deposited into the Medical Residency Training Fund by the foundation in that fiscal year. The matching funds may come from the General Fund or any other fund or source approved in the budgetary process.
SEC. 2.The Legislature finds and declares that Section 1 of this act, which adds Chapter 6 (commencing with Section 128590) to Part 3 of Division 107 of the Health and Safety Code, imposes a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individual privacy of donations made by a donor to fund new residency positions in medically underserved areas of the state outweighs the interest in the public disclosure of that information.
As used in this chapter:
(a)Board means the Board of Trustees of the California Medical Residency Training Foundation.
(b)Commission means the California Healthcare Workforce Policy Commission.
(c)Director means the Director of the Office of Statewide Health Planning and Development.
(d)Foundation means the California Medical Residency Training Foundation.
(e)Fund means the Medical Residency Training Fund.
(f)Office means the Office of Statewide Health Planning and Development.
(g)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry.
(h)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)The office shall establish a nonprofit public benefit corporation to be known as the California Medical Residency Training Foundation.
(2)The foundation shall be governed by a board of trustees consisting of a total of 13 members. Nine Seven members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, and two members of the Medical Board of California shall be appointed by the Medical Board of California. California, and two members of the Osteopathic Medical Board of California shall be appointed by the Osteopathic Medical Board of California.
(3)The members of the foundation board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules may include shall consist of 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
(5)The chairperson of the commission shall also be a nonvoting, ex officio member of the board.
(b)The Governor shall appoint the president of the board from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, and the Medical Board of California. California, and the Osteopathic Medical Board of California.
(c)Of the members of the board first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and three members shall be appointed to serve a three-year term.
(d)Of the members of the board first appointed by the Speaker of the Assembly and the Senate Committee on Rules, each member shall be appointed to serve a four-year term.
(e)The members appointed by the Medical Board of California and the Osteopathic Medical Board of California shall be appointed to serve a four-year term.
(f)Upon the expiration of the initial appointments to the board by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, and the Medical Board of California, and the Osteopathic Medical Board of California, each member shall be appointed to serve a four-year term.
(g)The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the foundation.
(h)(1)Members of the board and members of the council shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with his or her duties as a member of the board or the council.
(2)The members appointed by the Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California for any actual and necessary expenses incurred in connection with his or her duties as a member of the foundation board.
(i)Notwithstanding any law relating to incompatible activities, no member of the foundation board shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California.
(j)The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this chapter and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this chapter shall prevail.
128592.The foundation shall do the following:
(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 medically underserved 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 the medically underserved areas of the state.
(c)Make recommendations to the director on the establishment of new residency positions, including the locations, fields of practice, and levels of funding in order to fulfill the goals of this chapter.
(d)Recommend to the director the disbursement of moneys deposited in the California Medical Residency Training Fund to establish and fund residency positions.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited from the private sector, the amount of money deposited from the foundation into the fund, the recommendations for the location and fields of practice of future residency positions, and the prospective fundraising goals.
128593.The office shall do all of the following:
(a)Provide technical and staff support to the foundation in meeting all of its responsibilities.
(b)Provide financial management for the foundation.
(c)Establish, with the recommendation of the board, criteria for ranking the geographical areas of the state that have the highest need for primary care residencies, and give preference to proposals that would establish residency positions in these areas. These criteria shall be based on both of the following:
(1)The size of an areas population that is enrolled in, or eligible for, Medi-Cal.
(2)The shortage of primary care physicians in the area.
(d)Solicit proposals for new residency positions from public and private sector institutions, including hospitals, colleges, universities, community clinics, and other health agencies and organizations that train primary care residents. The office shall establish a uniform process that requires that these proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(e)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. The director shall seek the recommendations of the commission and foundation as to which proposals best fulfill this chapters objective.
(f)Prior to the first distribution of funds for any new residency position, ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
(g)Provide all of the following information to the board:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)The proposals received from institutions that train primary care physicians pursuant to subdivision (d).
(4)Other information that the office or board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
(h)Monitor the residencies established pursuant to this chapter.
(i)(1)Prepare and submit an annual report to the foundation and the Legislature documenting the amount of money contributed to the fund by the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128594.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the foundation, and for any other purpose authorized by this chapter.
(c)The level of expenditure by the office for the administrative support of the foundation is subject to review and approval annually through the State Budget process.
(d)The office and foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this chapter. The office shall manage this fund prudently in accordance with applicable laws.
128595.Any regulations the office adopts to implement this chapter shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
128596.Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this chapter if the donor has requested anonymity.
128597.For each fiscal year, the Legislature shall authorize in the budget an amount, as determined in the budgetary process, to match the contributions deposited into the Medical Residency Training Fund by the foundation in that fiscal year. The matching funds may come from the General Fund or any other fund or source approved in the budgetary process.
SEC. 2.The Legislature finds and declares that Section 1 of this act, which adds Chapter 6 (commencing with Section 128590) to Part 3 of Division 107 of the Health and Safety Code, imposes a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individual privacy of donations made by a donor to fund new residency positions in medically underserved areas of the state outweighs the interest in the public disclosure of that information.
As used in this chapter:
(a)Board means the Board of Trustees of the California Medical Residency Training Foundation.
(b)Commission means the California Healthcare Workforce Policy Commission.
(c)Director means the Director of the Office of Statewide Health Planning and Development.
(d)Foundation means the California Medical Residency Training Foundation.
(e)Fund means the Medical Residency Training Fund.
(f)Office means the Office of Statewide Health Planning and Development.
(g)Primary care means the medical practice areas of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry.
(h)Residency position means a graduate medical education residency position in the field of primary care.
128591.(a)(1)The office shall establish a nonprofit public benefit corporation to be known as the California Medical Residency Training Foundation.
(2)The foundation shall be governed by a board of trustees consisting of a total of 13 members. Nine members shall be appointed by the Governor, one member shall be appointed by the Speaker of the Assembly, one member shall be appointed by the Senate Committee on Rules, and two members of the Medical Board of California shall be appointed by the Medical Board of California.
(3)The members of the foundation board appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules may 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.
(4)All persons considered for appointment shall have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
(5)The chairperson of the commission shall also be a nonvoting, ex officio member of the board.
(b)The Governor shall appoint the president of the board from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, and the Medical Board of California.
(c)Of the members of the board first appointed by the Governor, three members shall be appointed to serve a one-year term, three members shall be appointed to serve a two-year term, and three members shall be appointed to serve a three-year term.
(d)Of the members of the board first appointed by the Speaker of the Assembly and the Senate Committee on Rules, each member shall be appointed to serve a four-year term.
(e)The members appointed by the Medical Board of California shall be appointed to serve a four-year term.
(f)Upon the expiration of the initial appointments to the board by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, and the Medical Board of California, each member shall be appointed to serve a four-year term.
(g)The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the foundation.
(h)(1)Members of the board and members of the council shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with his or her duties as a member of the board or the council.
(2)The members appointed by the Medical Board of California shall serve without compensation, but shall be reimbursed by the Medical Board of California for any actual and necessary expenses incurred in connection with his or her duties as a member of the foundation board.
(i)Notwithstanding any law relating to incompatible activities, no member of the foundation board shall be considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the Medical Board of California.
(j)The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this chapter and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this chapter shall prevail.
128592.The foundation shall do the following:
(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 medically underserved 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 the medically underserved areas of the state.
(c)Make recommendations to the director on the establishment of new residency positions, including the locations, fields of practice, and levels of funding in order to fulfill the goals of this chapter.
(d)Recommend to the director the disbursement of moneys deposited in the California Medical Residency Training Fund to establish and fund residency positions.
(e)Recommend to the director that a portion of the funds solicited from the private sector be used for the administrative requirements of the foundation.
(f)Prepare and submit an annual report to the Legislature documenting the amount of money solicited from the private sector, the amount of money deposited from the foundation into the fund, the recommendations for the location and fields of practice of future residency positions, and the prospective fundraising goals.
128593.The office shall do all of the following:
(a)Provide technical and staff support to the foundation in meeting all of its responsibilities.
(b)Provide financial management for the foundation.
(c)Establish, with the recommendation of the board, criteria for ranking the geographical areas of the state that have the highest need for primary care residencies, and give preference to proposals that would establish residency positions in these areas. These criteria shall be based on both of the following:
(1)The size of an areas population that is enrolled in, or eligible for, Medi-Cal.
(2)The shortage of primary care physicians in the area.
(d)Solicit proposals for new residency positions from public and private sector institutions, including hospitals, colleges, universities, community clinics, and other health agencies and organizations that train primary care residents. The office shall establish a uniform process that requires that these proposals contain all necessary and pertinent information, including, but not limited to, all of the following:
(1)The location of the proposed residency position.
(2)The medical practice area of the proposed residency position.
(3)Information that demonstrates the areas need for the proposed residency position and for additional primary care practitioners.
(4)The amount of funding required to establish and operate the residency position.
(e)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. The director shall seek the recommendations of the commission and foundation as to which proposals best fulfill this chapters objective.
(f)Prior to the first distribution of funds for any new residency position, ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
(g)Provide all of the following information to the board:
(1)The areas of the state that are deficient in primary care services.
(2)The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population.
(3)The proposals received from institutions that train primary care physicians pursuant to subdivision (d).
(4)Other information that the office or board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
(h)Monitor the residencies established pursuant to this chapter.
(i)(1)Prepare and submit an annual report to the foundation and the Legislature documenting the amount of money contributed to the fund by the foundation, 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.
(2)The report pursuant to paragraph (1) shall be made to the Legislature pursuant to Section 9795 of the Government Code.
128594.(a)The Medical Residency Training Fund is hereby created within the State Treasury.
(b)The primary purpose of the fund is to allocate funding for new residency positions throughout the state. Money in the fund shall also be used to pay for the cost of administering the goals of the foundation, and for any other purpose authorized by this chapter.
(c)The level of expenditure by the office for the administrative support of the foundation is subject to review and approval annually through the State Budget process.
(d)The office and foundation may solicit and accept public and private donations to be deposited into the fund. All money in the fund is continuously appropriated to the office for the purposes of this chapter. The office shall manage this fund prudently in accordance with applicable laws.
128595.Any regulations the office adopts to implement this chapter shall be adopted as emergency regulations in accordance with Section 11346.1 of the Government Code, except that the regulations shall be exempt from the requirements of subdivisions (e), (f), and (g) of that section. The regulations shall be deemed to be emergency regulations for the purposes of Section 11346.1 of the Government Code.
SECTION 1.Article 4 (commencing with Section 128310) is added to Chapter 4 of Part 3 of Division 107 of the Health and Safety Code, to read:4.Medical Residency Training Program Grants128310.(a)The Graduate Medical Education Trust Fund is hereby created in the State Treasury.
(b)Moneys in the fund, upon appropriation by the Legislature, shall be used solely for the purpose of funding grants to graduate medical education residency programs in California.
(c)Notwithstanding Section 16305.7 of the Government Code, all interest earned on the moneys that have been deposited into the fund shall be retained in the fund and used for purposes consistent with the fund.
(d)The fund shall consist of all of the following:
(1)Funds from public-private partnerships created for the purpose of funding grants to graduate medical education residency programs in California.
(2)Any interest that accrues on amounts in the fund.
(e)(1)The Office of Statewide Health Planning and Development, in consultation with the California Healthcare Workforce Policy Commission, shall develop criteria for distribution of available moneys in the fund.
(2)The office shall develop criteria only upon receipt of donations sufficient to cover the costs of developing the criteria.
(f)In developing the criteria, the office shall give priority to programs that meet the following specifications:
(1)Are located in medically underserved areas, as defined in Section 128552.
(2)Have a proven record of placing graduates in those medically underserved areas.
(3)Place an emphasis on training primary care providers.
(4)Place an emphasis on training physician specialties that are most needed in the community in which the program is located.
(g)Moneys appropriated from the fund may also be used to fund existing graduate medical education residency slots as well as new graduate medical education residency slots.
(h)Whenever applicable, the office shall utilize moneys appropriated from the fund to provide a match for available federal funds for graduate medical education.
(a)The Graduate Medical Education Trust Fund is hereby created in the State Treasury.
(b)Moneys in the fund, upon appropriation by the Legislature, shall be used solely for the purpose of funding grants to graduate medical education residency programs in California.
(c)Notwithstanding Section 16305.7 of the Government Code, all interest earned on the moneys that have been deposited into the fund shall be retained in the fund and used for purposes consistent with the fund.
(d)The fund shall consist of all of the following:
(1)Funds from public-private partnerships created for the purpose of funding grants to graduate medical education residency programs in California.
(2)Any interest that accrues on amounts in the fund.
(e)(1)The Office of Statewide Health Planning and Development, in consultation with the California Healthcare Workforce Policy Commission, shall develop criteria for distribution of available moneys in the fund.
(2)The office shall develop criteria only upon receipt of donations sufficient to cover the costs of developing the criteria.
(f)In developing the criteria, the office shall give priority to programs that meet the following specifications:
(1)Are located in medically underserved areas, as defined in Section 128552.
(2)Have a proven record of placing graduates in those medically underserved areas.
(3)Place an emphasis on training primary care providers.
(4)Place an emphasis on training physician specialties that are most needed in the community in which the program is located.
(g)Moneys appropriated from the fund may also be used to fund existing graduate medical education residency slots as well as new graduate medical education residency slots.
(h)Whenever applicable, the office shall utilize moneys appropriated from the fund to provide a match for available federal funds for graduate medical education.
|
Date
|
Status
|
|---|---|
| Jun 1, 2015 | From committee: Do pass as amended. (Ayes 7. Noes 0.) (May 28). |
| Feb 29, 2016 | Referred to Com. on RLS. |
| Feb 29, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Jan 27, 2016 | Read third time. Passed. (Ayes 39. Noes 0. Page 2964.) Ordered to the Assembly. |
| Jan 27, 2016 | In Assembly. Read first time. Held at Desk. |
| Jan 26, 2016 | Read second time. Ordered to third reading. |
| Jan 25, 2016 | Read second time and amended. Ordered to second reading. |
| Jan 25, 2016 | Ordered to second reading. |
| Jan 25, 2016 | From inactive file. |
| Jun 4, 2015 | Read third time and amended. |
| Jun 4, 2015 | Ordered to inactive file on request of Senator Roth. |
| Jun 2, 2015 | Read second time and amended. Ordered to third reading. |
| Dec 1, 2014 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
| Jun 1, 2015 | From committee: Do pass as amended. (Ayes 7. Noes 0. Page 1146.) (May 28). |
| May 23, 2015 | Set for hearing May 28. |
| May 11, 2015 | May 11 hearing: Placed on APPR. suspense file. |
| May 5, 2015 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR. |
| May 1, 2015 | Set for hearing May 11. |
| Apr 30, 2015 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (April 29). Re-referred to Com. on APPR. |
| Apr 30, 2015 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0. Page 859.) (April 29). Re-referred to Com. on APPR. |
| Apr 21, 2015 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Mar 18, 2015 | Set for hearing April 29. |
| Jan 15, 2015 | Referred to Com. on HEALTH. |
| Dec 2, 2014 | From printer. May be acted upon on or after January 1. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jan 27, 2016 | Senate 3rd Reading SB22 Roth | Senate Floor |
Passed |
|
| May 28, 2015 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| May 11, 2015 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 29, 2015 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| AARP | ** Support | Jan 27, 2016 |
| Association of California Healthcare Districts | ** Support | Jan 27, 2016 |
| Association Of California Healthcare Districts (Achd) | * Indeterminate | Apr 29, 2015 |
| California Academy of Physician Assistants | ** Support | Jan 27, 2016 |
| California Chapter of the American College of Emergency Physicians | ** Support | Jan 27, 2016 |
| California Physical Therapy Association | ** Support | Jan 27, 2016 |
| California Primary Care Association | ** Support | Jan 27, 2016 |
| Community Clinic Association of Los Angeles County | ** Support | Jan 27, 2016 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 22
: 6
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
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.
Existing law:
- Establishes the Health Professions Education Foundation (HPEF) within OSHPD. Requires HPEF to solicit and receive funds from foundations and 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.
- 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:
- 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.
- 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.
- Makes the Advisory Panel subject to the Nonprofit Public Benefit Corporation Law, except that if there is a conflict this bill prevails.
- Requires the Advisory Panel to:
- 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.
- 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 .
- Solicit proposals for medical residency programs, as specified, and provide HPEF a copy of all proposals it receives.
- Upon the sufficient solicitation of funds and at the Advisory Panel’s discretion, recommend to HPEF the establishment of new residency positions, as specified.
- Only approve and recommend to HPEF proposals that would establish residency positions that will serve in specified medical service areas.
- Upon HPEF approval of a recommendation, deposit into the fund created in #7 below necessary moneys required to establish and fund the residency position.
- 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.
- 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.
- Requires HPEF to:
- Provide technical and staff support to Advisory Panel in meeting all of its responsibilities.
- Upon receipt of a recommendation by the Advisory Panel, approve the recommendation if it fulfills the specified requirements.
- Upon sufficient funds being available, send an approval to OSHPD for implementation.
- Requires OSHPD to:
- 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.
- 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.
- Ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education.
- Provide specified information to the Advisory Panel and HPEF as requested and as specified.
- Monitor the residencies established pursuant to this bill.
- 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.
- 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.
- Makes the level of expenditure by OSHPD for the administrative support of HPEF subject to review and approval annually through the state budget process.
- 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.
- Requires any regulations adopted to implement this to be emergency regulations, as specified.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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 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.
- 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:
- 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.
- 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 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 full-time 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.
- 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.
- 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.
- 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 organizations for a sum of $317,000 which will help support 92 participants statewide.
- 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: Fiscal Com.: Local:
According to the Senate Appropriations Committee, as amended 6/2/15:
- 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.
- 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).
- 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.
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)
None received
1/26/16 16:39:31
SB 22
Page 11
|
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 |
THIRD READING
Bill No: SB 22
Amended: 6/2/15
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
DIGEST: This bill requires the Office of Statewide Health Planning and Development (OSHPD) to establish a non-profit public benefit corporation to be known as the California Medical Residency Training Foundation (Foundation), as specified. This bill requires the Foundation to be governed by a board of trustees, as specified. This bill specifies the duties of the Foundation and OSHPD for the purposes of establishing and funding new residency positions in underserved areas of the state.
Existing law:
Establishes the California Healthcare Workforce Policy Commission (Commission) and requires the Commission to, among other things, identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist; establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners; and review and make recommendations to OSHPD about funding of those programs.
Establishes the Health Professions Education Foundation (HPEF) within OSHPD. Requires the HPEF to solicit and receive funds from Foundations and 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. Establishes, under the 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.
Establishes, under HPEF, the Steven M. Thompson Physician Corps Loan Repayment Program, which provides for the repayment of educational loans for licensed physicians and surgeons who practice in medically underserved areas of the state, as defined.
Establishes within OSHPD the Health Professions Education Fund to receive funds for scholarships and loans to students from underrepresented groups who are enrolled in or accepted to schools of medicine, dentistry, nursing, and other health professions.
Establishes the Song-Brown Health Care Workforce Training Act of 1973, 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.
This bill:
Requires OSHPD to establish a non-profit public benefit corporation to be known as the Foundation, which is required to be governed by a board of trustees consisting of a total of 13 members.
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). Permits the board members appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules to include representatives of designated and nondesignated 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. Specifies terms of appointees.
Permits the OSHPD director, after consultation with the president of the board, to appoint a council of advisers comprised of up to nine members, to advise the director and the board on technical matters and programmatic issues related to the Foundation.
Requires board and council members appointed by the Governor, Assembly, and Senate to serve without compensation, but to be reimbursed for any actual and necessary expenses incurred in connection with their duties as a board or council member. Requires members appointed by the MBC and OMBC to be reimbursed by those entities for any actual and necessary expenses, as specified.
Prohibits any board member from being considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the MBC and OMBC.
Makes the Foundation subject to the Nonprofit Public Benefit Corporation Law, except that if there is a conflict with this bill and that law, this bill prevails.
Requires the Foundation to:
Solicit and accept funds from business, industry, Foundations, and other private or public sources for the purpose of establishing and funding new residency positions described in c) below;
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 described in c) below. Requires the Foundation to solicit proposals for medical residency programs and provide OSHPD a copy of all proposals it receives;
Approve proposals and recommend to OSHPD the establishment of new residency positions upon the sufficient solicitation of funds and at the Foundation’s discretion. Requires a recommendation to include all pertinent information necessary for OSHPD to enter into the necessary contracts to establish the residency positions. Requires the Foundation to only approve and recommend proposals that would establish residency positions that will serve a service area that is designated as:
A primary care shortage area;
A health professional shortage area (HPSA) for primary care, by either population or geographic designation by HRSA;
A medically underserved area or medically underserved population by HRSA.
Deposit into the Fund necessary moneys are required to establish and fund the residency program, upon approval of a recommendation;
Recommend to the OSHPD director that a portion of the funds solicited from the private sector be used for the administrative requirements of the Foundation; and
Prepare and submit an annual report to the Legislature documenting the amount of money solicited, the amount of money deposited from the Foundation into the Fund, the recommendations for the location and fields of practice of future residency positions, total expenditures for the year, and the prospective fundraising goals.
Requires OSHPD to:
Provide technical and staff support to the Foundation in meeting all of its responsibilities.
Provide financial management for the Foundation.
Approve the recommendation, upon receipt from the Foundation, if it fulfills the requirements of this bill. Requires an approval to signal OSHPD’s intent to establish the residency position upon sufficient funds being available.
Establish a uniform process by which the Foundation 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.
Require that these proposals contain all necessary and pertinent information, including, but not limited to, the location of the proposed residency position; the medical practice area of the proposed residency position; information that demonstrates the area’s need for the proposed residency position and for additional primary care practitioners;
amount of funding required to establish and operate the residency position;
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.
Ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education;
Provide the following information to the board:
The areas of the state that are deficient in primary care services;
The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population;
The proposals received from institutions that train primary care physicians pursuant d) above; and
Other information that OSHPD or the board finds relevant to assist the board in making its recommendations on possible locations for new residency positions.
Monitor the residencies established pursuant to this chapter; and
Prepare and submit an annual report to the Foundation and the Legislature documenting the amount of money contributed to the fund by the Foundation, 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.
Establishes the Medical Residency Training Fund within the State Treasury, as specified.
Makes the level of expenditure by OSHPD for the administrative support of the Foundation is subject to review and approval annually through the State Budget process.
Permits OSHPD and the Foundation 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 chapter. Requires OSHPD to manage this fund prudently in accordance with applicable laws.
Requires any regulations adopted to implement this to be emergency regulations, as specified.
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.
Comments
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.
Primary Care in California. California is home to the largest number of primary care physicians and nurse practitioner in the country. However, the state 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 (HRSA) 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.
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 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. A February 2, 2015 article in the San Jose Mercury News reported that the primary care physician shortage combined with the millions of newly insured has resulted in significant delays in seeing a doctor and crowded emergency rooms. According to the Mercury News article, “… many experts say the problems are so widespread they shouldn't be ignored.”
Current workforce development programs. The state currently operates a number of programs designed to increase the number of health care professionals practicing in medically underserved areas:
HPEF established in 1987 and housed within OSHPD non-profit, HPEF is a non-profit Foundation statutorily created to provide financial incentives to aspiring and practicing health professionals. 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.
California State Loan Repayment Program (SLRP) provides educational loan repayment assistance to primary health care professionals who provide health care services in federally designated 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 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 full-time 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. The SLRP is funded through a grant from the HRSA, Bureau of Clinician Recruitment and Service, National Health Service Corps and is administered by OSHPD.
Song-Brown Program. The Song-Brown Program was established to increase the number of family physicians in the state and increase the number of family medicine residency programs. Currently, Song-Brown 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.
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 to2015, via partial funding from Mental Health Services Act Workforce Education and Training, the California Endowment, and the California State Office of Rural Health, 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.
California Student/Resident Experiences and Rotations in Community Health (CalSEARCH) 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 to2015, via funding from the MHSA Workforce Education and Training and The California Endowment, OSHPD granted 12 awards to organizations for a sum of $317,000 which will help support 92 participants statewide.
MHSA Workforce Education and Training (WET) Program funded by Proposition 63, this program remedies 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.
Prior Legislation
SB 1416 (Rubio, 2012) would have created the Graduate Medical Education Trust Fund for the purpose of funding grants to graduate medical education residency programs in California, and would have required OSHPD to develop criteria for distribution of available moneys. SB 1416 was held in the Assembly Appropriations Committee
FISCAL EFFECT: Appropriation: Yes Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee:
One-time administrative costs of about $1 million to create the foundation 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.
Ongoing costs of about $800,000 per year to administer the program, support the Foundation, and review and approve grants and contracts (private funds).
Unknown costs to make grants to medical residency programs (private funds). The bill would require the Foundation 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.
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
None received
Prepared by: Melanie Moreno / HEALTH /
6/2/15 20:28:34
**** END ****
SB 22 (Roth) Page 2 of 2
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 22 (Roth) - Residency training.
|
|
Version: May 5, 2015 |
Policy Vote: HEALTH 9 - 0 |
Urgency: No |
Mandate: No |
Hearing Date: May 28, 2015 |
Consultant: Brendan McCarthy |
SUSPENSE FILE. AS AMENDED.
Bill Summary:
SB 22 would require the Office of Statewide Health Planning and Development to establish a non-profit corporation for the purpose of funding new medical residency programs in medically underserved areas.
Fiscal Impact (as approved on May 28, 2015):
One-time administrative costs of about $1 million to create the foundation 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.
Ongoing costs of about $800,000 per year to administer the program, support the Foundation, and review and approve grants and contracts (private funds).
Unknown costs to make grants to medical residency programs (private funds). The bill would require the Foundation 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.
Background:
The Office of Statewide Health Planning and Development operates several programs to support workforce training for the health care sector. Current programs provide loans, scholarships, and loan repayments to students in health professions and provide funding to support medical training programs. For example, the Song-Brown Program provides funding to family practice residency programs, physician assistant/nurse practitioner training programs, and registered nurse training programs, with a focus on medically underserved areas.
Generally, medical residency programs are paid for by federal Medicare program to subsidize (since hospitals would otherwise be financially unable to pay for the costs to train resident physicians).
Proposed Law:
SB 22 would require the Office of Statewide Health Planning and Development to establish a non-profit corporation for the purpose of funding new medical residency programs in medically underserved areas.
Specific provision of the bill would:
Require the Office of Statewide Health Planning and Development to establish the California Medical Residency Training Foundation, as a non-profit, public benefit corporation;
Specify the membership of the Foundation board of trustees;
Require the Foundation to solicit and accept funds from various sources in order to provide funding for new medical residency programs and take related actions;
Require the Office to provide administrative support to the Foundation;
Create a new special fund to support the program and continuously appropriate money in the fund;
Authorize the Office to adopt emergency regulations to implement the bill and exempt those emergency regulations from the existing requirement that emergency regulations subsequently be adopted as regular regulations;
Require the Legislature to appropriate funds in the annual budget act to match the private donations collected by the foundation, to be used for the purposes of the bill.
Related Legislation:
SB 1416 (Rubio and Hernandez, 2012) would have created a fund to be used to by the Office of Statewide Health Planning and Development to make grants to medical residency training programs. That bill was held in the Assembly Appropriations Committee.
SB 635 (Hernandez, 2012) would have required funds in excess of $1 million from fines and penalties deposited in the Managed Care Administrative Fines and Penalties Fund to be transferred each year to the Office for support of the Song-Brown Program. That bill was held in the Assembly Appropriations Committee.
Staff Comments:
While the bill allows for the use of private funds to support the program, there will be upfront costs to develop program criteria. In the absence of private funds, those costs will fall on the state. In addition, there will be ongoing administrative costs to the Office (for example, administering grants previously awarded by the Foundation). If private funds do not materialize, those costs would fall on the state.
Author’s amendments (as adopted May 28, 2015): make a variety of technical and clarifying changes.
Committee amendments (as adopted May 28, 2015): delete the requirement for legislative appropriation of funds to match private donations.
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SB 22 (Roth) Page 2 of 2
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 22 (Roth) - Residency training.
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|
Version: May 5, 2015 |
Policy Vote: HEALTH 9 - 0 |
Urgency: No |
Mandate: No |
Hearing Date: May 11, 2015 |
Consultant: Brendan McCarthy |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
SB 22 would require the Office of Statewide Health Planning and Development to establish a non-profit corporation for the purpose of funding new medical residency programs in medically underserved areas.
Fiscal Impact:
One-time administrative costs of about $1 million to create the foundation 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.
Ongoing costs of about $800,000 per year to administer the program, support the Foundation, and review and approve grants and contracts (General Fund and private funds).
Unknown costs to make grants to medical residency programs (private funds). The bill would require the Foundation 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.
Unknown General Fund costs to match private donations (General Fund). The bill would require the Legislature to appropriate funds in the annual budget act to match the contributions of private funds collected by the foundation.
Background:
The Office of Statewide Health Planning and Development operates several programs to support workforce training for the health care sector. Current programs provide loans, scholarships, and loan repayments to students in health professions and provide funding to support medical training programs. For example, the Song-Brown Program provides funding to family practice residency programs, physician assistant/nurse practitioner training programs, and registered nurse training programs, with a focus on medically underserved areas.
Generally, medical residency programs are paid for by federal Medicare program to subsidize (since hospitals would otherwise be financially unable to pay for the costs to train resident physicians).
Proposed Law:
SB 22 would require the Office of Statewide Health Planning and Development to establish a non-profit corporation for the purpose of funding new medical residency programs in medically underserved areas.
Specific provision of the bill would:
Require the Office of Statewide Health Planning and Development to establish the California Medical Residency Training Foundation, as a non-profit, public benefit corporation;
Specify the membership of the Foundation board of trustees;
Require the Foundation to solicit and accept funds from various sources in order to provide funding for new medical residency programs and take related actions;
Require the Office to provide administrative support to the Foundation;
Create a new special fund to support the program and continuously appropriate money in the fund;
Authorize the Office to adopt emergency regulations to implement the bill and exempt those emergency regulations from the existing requirement that emergency regulations subsequently be adopted as regular regulations;
Require the Legislature to appropriate funds in the annual budget act to match the private donations collected by the foundation, to be used for the purposes of the bill.
Related Legislation:
SB 1416 (Rubio and Hernandez, 2012) would have created a fund to be used to by the Office of Statewide Health Planning and Development to make grants to medical residency training programs. That bill was held in the Assembly Appropriations Committee.
SB 635 (Hernandez, 2012) would have required funds in excess of $1 million from fines and penalties deposited in the Managed Care Administrative Fines and Penalties Fund to be transferred each year to the Office for support of the Song-Brown Program. That bill was held in the Assembly Appropriations Committee.
Staff Comments:
While the bill allows for the use of private funds to support the program, there will be upfront costs to develop program criteria. In the absence of private funds, those costs will fall on the state. In addition, there will be ongoing administrative costs to the Office (for example, administering grants previously awarded by the Foundation). If private funds do not materialize, those costs would fall on the state.
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SB 22 (Roth) Page 9 of 9
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 22
AUTHOR: |
Roth |
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VERSION: |
April 21, 2015 |
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HEARING DATE: |
April 29, 2015 |
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|
CONSULTANT: |
Melanie Moreno |
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SUBJECT: Residency training.
SUMMARY:
Requires the Office of Statewide Health Planning and Development (OSHPD) to establish a non-profit public benefit corporation to be known as the California Medical Residency Training Foundation (Foundation), as specified. Requires the Foundation to be governed by a board of trustees consisting of a total of 13 members, as specified. Specifies the duties of the Foundation and OSHPD for the purposes of establishing and funding new residency positions in medically underserved areas of the state.
Existing law:
Establishes the California Healthcare Workforce Policy Commission (Commission) and requires the Commission to, among other things, identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist; establish standards for family practice training programs, family practice residency programs, primary care physician assistants programs, and programs that train primary care nurse practitioners; and review and make recommendations to OSHPD concerning the funding of those programs that are submitted to the Health Professions Development Program for participation in the state medical contract program.
Establishes the Health Professions Education Foundation (HPEF) within OSHPD. Requires the HPEF to solicit and receive funds from Foundations and 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. Provides that HPEF governed by a board consisting of 13 members appointed by the Governor, Speaker of the Assembly, and Senate Rules Committee.
Establishes, under the 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.
Establishes, under HPEF, the Steven M. Thompson Physician Corps Loan Repayment Program (STPCLRP), which provides for the repayment of educational loans for licensed physicians and surgeons who practice in medically underserved areas of the state, as defined. Requires HPEF, in administering the STPCLRP, to use and develop guidelines for applicants that give preference to applicants who are best suited to meet the cultural and linguistic needs of patients in medically underserved populations, as specified, and who agree to practice in geriatric care settings. Also allows HPEF to appoint a selection committee to provide policy direction and guidance to the STPCLRP. Requires funds for loan repayment under the STPCLRP to have a funding match from a Foundation or other private source. Establishes a Medically Underserved Account for Physicians within the Fund, the primary purpose of which is to provide funding for the STPCLRP.
Establishes within OSHPD the Health Professions Education Fund to receive funds for scholarships and loans to students from underrepresented groups who are enrolled in or accepted to schools of medicine, dentistry, nursing, and other health professions. Provides that moneys in the fund are continuously appropriated.
Establishes the Song-Brown Health Care Workforce Training Act of 1973 (Song-Brown Act), 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 health care in medically underserved areas.
This bill:
Requires OSHPD to establish a non-profit public benefit corporation to be known as the Foundation, which is required to be governed by a board of trustees consisting of a total of 13 members.
Requires nine members to be appointed by the Governor, one member appointed by the Speaker of the Assembly, one member by the Senate Committee on Rules, and two members of the Medical Board of California (MBC) by the MBC. Permits the board members appointed by the Governor, the Speaker of the Assembly, and the Senate Committee on Rules 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.
Requires all persons considered for appointment to have an interest in increasing the number of medical residencies in the state, an interest in increasing access to health care in underserved areas of California, and the ability and desire to solicit funds for the purposes of this chapter, as determined by the appointing power.
Requires the chairperson to be a non-voting, ex officio member of the board. Requires the Governor to appoint the president of the board from among those members appointed by the Governor, the Assembly, the Senate, and the MBC. Requires the initial terms to be as follows:
Governor appointees: three members to serve a one-year term, three members to serve a two-year term, and three members to serve a three-year term;
Assembly and Senate appointees: four-year terms;
MBC appointees: four-year term; and,
Upon expiration of the initial appointments: four-year terms.
Permits the OSHPD director, after consultation with the president of the board, to appoint a council of advisers comprised of up to nine members, to advise the director and the board on technical matters and programmatic issues related to the Foundation.
Requires board and council members to serve without compensation, but to be reimbursed for any actual and necessary expenses incurred in connection with their duties as a board or council member. Requires members appointed by the MBC to be reimbursed by the MBC for any actual and necessary expenses, as specified.
Prohibits any board member from being considered to be engaged in activities inconsistent and incompatible with his or her duties solely as a result of membership on the MBC.
Makes the Foundation subject to the Non-profit Public Benefit Corporation Law, except that if there is a conflict with this bill and that law, this bill prevails.
Requires the Foundation to:
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 medically underserved areas of the state;
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 the medically underserved areas of the state;
Make recommendations to the OSHPD director on the establishment of new residency positions, including the locations, fields of practice, and levels of funding in order to fulfill the goals of this bill;
Recommend to the OSHPD director the disbursement of moneys deposited in the California Medical Residency Training Fund to establish and fund residency positions;
Recommend to the OSHPD director that a portion of the funds solicited from the private sector be used for the administrative requirements of the Foundation; and,
Prepare and submit an annual report to the Legislature documenting the amount of money solicited from the private sector, the amount of money deposited from the Foundation into the fund, the recommendations for the location and fields of practice of future residency positions, and the prospective fundraising goals.
Requires OSHPD to:
Provide technical and staff support to the Foundation in meeting all of its responsibilities;
Provide financial management for the Foundation;
Establish, with the recommendation of the board, criteria for ranking the geographical areas of the state that have the highest need for primary care residencies, and give preference to proposals that would establish residency positions in these areas. Requires the criteria to be based the size of an area’s population that is enrolled in, or eligible for, Medi-Cal and the shortage of primary care physicians in the area;
Solicit proposals for new residency positions from public and private sector institutions, including hospitals, colleges, universities, community clinics, and other health agencies and organizations that train primary care residents;
Establish a uniform process that requires that these proposals contain all necessary and pertinent information, including, but not limited to, the location of the proposed residency position; the medical practice area of the proposed residency position; information that demonstrates the area’s need for the proposed residency position and for additional primary care practitioners; and, the amount of funding required to establish and operate the residency position;
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. Requires the OSHPD director to seek the recommendations of the Commission and Foundation as to which proposals best fulfill this bill’s objective;
Prior to the first distribution of funds for any new residency position, ensure that the residency position has been, or will be, approved by the Accreditation Council for Graduate Medical Education;
Provide the following information to the board:
The areas of the state that are deficient in primary care services;
The areas of the state that have the highest number of Medi-Cal enrollees and persons eligible to enroll in Medi-Cal, by proportion of population;
The proposals received from institutions that train primary care physicians pursuant d) above;
Other information that OSHPD or the board finds relevant to assist the board in making its recommendations on possible locations for new residency positions;
Monitor the residencies established pursuant to this chapter; and,
Prepare and submit an annual report to the Foundation and the Legislature documenting the amount of money contributed to the fund by the Foundation, 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.
Establishes the Medical Residency Training Fund is hereby created 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 Foundation, and for any other purpose authorized by this bill.
Makes the level of expenditure by OSHPD for the administrative support of the Foundation is subject to review and approval annually through the State Budget process.
Permits OSHPD and the Foundation 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 chapter. Requires OSHPD to manage this fund prudently in accordance with applicable laws.
Requires any regulations adopted to implement this to be emergency regulations, as specified.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
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 8000 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 would create 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, the bill aims to create a consensus based solution to meet the need for more doctors in California as access to healthcare continues to grow.
Primary Care in California. California is home to the largest number of primary care physicians and nurse practitioner in the country. However, the state 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 (HRSA) 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.
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 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. A February 2, 2015 article in the San Jose Mercury News reported that the primary care physician shortage combined with the millions of newly insured has resulted in significant delays in seeing a doctor and crowded emergency rooms. According to the Mercury News article, “… many experts say the problems are so widespread they shouldn't be ignored.”
Current workforce development programs. The state currently operates a number of programs designed to increase the number of health care professionals practicing in medically underserved areas:
Health Professions Education Foundation (HPEF) Established in 1987 and housed within OSHPD non-profit, HPEF is a non-profit Foundation statutorily created to provide financial incentives to aspiring and practicing health professionals. The Foundation 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. Awards range from $4,000 to $105,000 dependent 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.
California State Loan Repayment Program (SLRP) Provides educational loan repayment assistance to primary health care professionals who provide health care services in federally designated 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 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 full-time 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. The SLRP is funded through a grant from the HRSA, Bureau of Clinician Recruitment and Service, National Health Service Corps (NHSC) and is administered by OSHPD.
Song-Brown Program The Song-Brown Program was established in 1973 under Health and Safety Code Section 128200-128241 to increase the number of family physicians in the state and increase the number of family medicine residency programs. Currently, Song-Brown 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.
Mini Grants Program (Mini Grants) 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 to2015, via partial funding from Mental Health Services Act (MHSA) Workforce Education and Training, the California Endowment, and the California State Office of Rural Health, 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.
California Student/Resident Experiences and Rotations in Community Health (CalSEARCH) 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 to2015, via funding from the MHSA Workforce Education and Training and The California Endowment, OSHPD granted 12 awards to organizations for a sum of $317,000 which will help support 92 participants statewide.
MHSA Workforce Education and Training (WET) Program Funded by Proposition 63, this program remedies 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.
Prior legislation. SB 1416 (Rubio and Hernandez) of 2012 would have created the Graduate Medical Education Trust Fund for the purpose of funding grants to graduate medical education residency programs in California, and would have required OSHPD to develop criteria for distribution of available moneys. SB 1416 was held in the Assembly Appropriations Committee
SB 635 (Hernandez) would have required funds deposited in the Managed Care Administrative Fines and Penalties Fund in excess of $1 million be transferred each year to OSHPD for the purposes of the Song-Brown Program. SB 635 was held in the Assembly Appropriations Committee.
AB 589 (Perea), Chapter 339, Statutes of 2012, establishes the Steven M. Thompson Medical School Scholarship Program and would provide that the program is open to persons who agree in writing, prior to entering an accredited medical or osteopathic school, to serve in an eligible practice setting, as defined, for at least three years.
AB 2551 (Hernandez), of 2010, would have established the Health Workforce Development Fund, consisting of moneys received from federal and private sources, as specified; would have authorized the Fund to be used, upon appropriation by the Legislature, for prescribed purposes relating to health workforce development, and would have required the California Workforce Investment Board and OSHPD to report specified information to the Legislature annually, as specified. AB 2551 failed passage on the Senate Floor.
AB 657 (Hernandez) of 2009 would have required OSHPD, in collaboration with the California Workforce Investment Board, to establish the Health Professions Workforce Task Force, composed of specified members, to assist in the development of a health professions workforce master plan for the state and would have prescribed the functions and duties of the task force in that regard. AB 657 was vetoed by the Governor, who stated, in part, that the bill was unnecessary and duplicative of efforts already underway.
AB 2375 (Hernandez), of 2008, would have required OSHPD to establish the Health Professions Workforce Task Force, as specified, to assist in the development of a health professions workforce master plan. AB 2375 was held in the Senate Appropriations Committee on suspense.
AB 2439 (De La Torre), Chapter 640, Statutes of 2008, requires the Medical Board of California (MBC) to assess an additional $25 fee for the initial license and license
renewal of a physician or surgeon to support the STPCLRP. Requires up to 15 percent of the funds collected from the additional $25 fee to be dedicated to loan assistance for
physicians who agree to practice in geriatric care settings, as specified.
AB 327 (De La Torre), Chapter 293, Statutes of 2005, requires the MBC to assess an applicant a $50 fee for the issuance and renewal of a physician and surgeon's certificate. Specifies that payment of the fee is voluntary and directs the fees to the Medically Underserved Account for the STPCLRP.
AB 920 (Aghazarian), Chapter 317, Statutes of 2005, provides for the transfer of the
STPCLRP and the Physician Volunteer Program from the MBC to the California Physician Corps Program within the Foundation, effective July 1, 2006.
AB 1403 (Nunez), Chapter 367, Statutes of 2004, renames the California Physician Corps Loan Repayment Program of 2002 as the STPCLRP.
AB 982 (Firebaugh), Chapter 1131, Statutes of 2002, creates the California Physician Corps Loan Repayment Program of 2002. This program is administered by the Division of Licensing of MBC for the purpose of granting loan repayment awards to physicians and surgeons working in medically underserved communities.
Support. The Association of California Healthcare Districts writes that funding graduate medical residency programs will make it financially more feasible for students to afford higher quality education and training. In turn, this would increase the number of residents in the area who are able to provide higher quality healthcare services for those in need. The Community Clinic Association of Los Angeles County believes this is important legislation that supports the primary care workforce necessary to serve underserved communities. The AARP believes that significant legislation is needed to deal with shortages and unequal geographic distribution of health care professionals, most notably primary-care physicians and nurses.
Support in concept. The MBC supports the concept of increasing funding for residency programs and positions in California, as this would help promote MBC’s mission of increasing access to care for consumer. However, this bill does not specify which public-private partnerships would be funding the California Medical Residency Training Fund.
Support if amended. The California Medical Association writes that it is not appropriate to suggest that the various appointing authorities consider an individual or organization’s ability to fundraise as a factor in making appointments to the Foundation board and that it is not in the public interest to have corporations and other wealthy interests having “significant control over the geographic dispersion of funds,” as stated by the author’s office.
Author’s amendments. The author request the Committee approve an amendment to add the following language to the bill:
SECTION 7: Section 128596 is added to the Health and Safety Code to read:
128596. Notwithstanding any other law, the office may exempt from public disclosure any document in the possession of the office that pertains to a donation made pursuant to this chapter if the donor has requested anonymity.
SECTION 8: Section 128597 is added to the Health and Safety Code to read:
128597.
This chapter shall become operative only upon certification by the Director of the Department of Finance that sufficient private funds have been made available from private sources to implement this chapter.
Upon this chapter becoming operative, the State General Fund shall annually deposit into the Fund an amount equal to the contribution received by the Fund from the Foundation in the preceding fiscal year, not to exceed 20 million dollars annually.
SUPPORT AND OPPOSITION:
Support: AARP
Association of California Healthcare Districts
California Academy of Physician Assistants
California Physical Therapy Association
California Primary Care Association
Community Clinic Association of Los Angeles County
Oppose: None received.
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