Article 1. Song-brown Health Care Workforce Training Act of California Health And Safety Code >> Division 107. >> Part 3. >> Chapter 4. >> Article 1.
(a) This article shall be known and may be cited as the
Song-Brown Health Care Workforce Training Act.
(b) (1) The Legislature hereby finds and declares that
physicians engaged in family medicine are in very short supply in
California. The current emphasis placed on specialization in medical
education has resulted in a shortage of physicians trained to provide
comprehensive primary health care to families. The Legislature
hereby declares that it regards the furtherance of a greater supply
of competent family physicians to be a public purpose of great
importance and further declares the establishment of the program
pursuant to this article to be a desirable, necessary, and economical
method of increasing the number of family physicians to provide
needed medical services to the people of California. The Legislature
further declares that it is to the benefit of the state to assist in
increasing the number of competent family physicians graduated by
colleges and universities of this state to provide primary health
care services to families within the state.
(2) The Legislature finds that the shortage of family physicians
can be improved by the placing of a higher priority by public and
private medical schools, hospitals, and other health care delivery
systems in this state, on the recruitment and improved training of
medical students and residents to meet the need for family
physicians. To help accomplish this goal, each medical school in
California is encouraged to organize a strong family medicine program
or department. It is the intent of the Legislature that the programs
or departments be headed by a physician who possesses specialty
certification in the field of family medicine, and has broad clinical
experience in the field of family medicine.
(3) The Legislature further finds that encouraging the training of
primary care physician's assistants and primary care nurse
practitioners will assist in making primary health care services more
accessible to the citizenry, and will, in conjunction with the
training of family physicians, lead to an improved health care
delivery system in California.
(4) Community hospitals in general and rural community hospitals
in particular, as well as other health care delivery systems, are
encouraged to develop family medicine residencies in affiliation or
association with accredited medical schools, to help meet the need
for family physicians in geographical areas of the state with
recognized family primary health care needs. Utilization of expanded
resources beyond university-based teaching hospitals should be
emphasized, including facilities in rural areas wherever possible.
(5) The Legislature also finds and declares that nurses are in
very short supply in California. The Legislature hereby declares that
it regards the furtherance of a greater supply of nurses to be a
public purpose of great importance and further declares the expansion
of the program pursuant to this article to include nurses to be a
desirable, necessary, and economical method of increasing the number
of nurses to provide needed nursing services to the people of
California.
(6) It is the intent of the Legislature to provide for a program
designed primarily to increase the number of students and residents
receiving quality education and training in the primary care
specialties of family medicine, internal medicine, obstetrics and
gynecology, and pediatrics and as primary care physician's
assistants, primary care nurse practitioners, and registered nurses
and to maximize the delivery of primary care family physician
services to specific areas of California where there is a recognized
unmet priority need. This program is intended to be implemented
through contracts with accredited medical schools, teaching health
centers, programs that train primary care physician's assistants,
programs that train primary care nurse practitioners, programs that
train registered nurses, hospitals, and other health care delivery
systems based on per-student or per-resident capitation formulas. It
is further intended by the Legislature that the programs will be
professionally and administratively accountable so that the maximum
cost-effectiveness will be achieved in meeting the professional
training standards and criteria set forth in this article and Article
2 (commencing with Section 128250).
As used in this article, and Article 2 (commencing with
Section 128250), the following terms mean:
(a) "Family physician" means a primary care physician who is
prepared to and renders continued comprehensive and preventative
health care services to families and who has received specialized
training in an approved family medicine residency for three years
after graduation from an accredited medical school.
(b) "Primary care physician" means a physician who is prepared to
and renders continued comprehensive and preventative health care
services, and has received specialized training in the areas of
internal medicine, obstetrics and gynecology, or pediatrics.
(c) "Associated" and "affiliated" mean that relationship that
exists by virtue of a formal written agreement between a hospital or
other health care delivery system and an approved medical school that
pertains to the primary care or family medicine training program for
which state contract funds are sought.
(d) "Commission" means the California Healthcare Workforce Policy
Commission.
(e) "Programs that train primary care physician's assistants"
means a program that has been approved for the training of primary
care physician assistants pursuant to Section 3513 of the Business
and Professions Code.
(f) "Programs that train primary care nurse practitioners" means a
program that is operated by a California school of medicine or
nursing, or that is authorized by the Regents of the University of
California or by the Trustees of the California State University, or
that is approved by the Board of Registered Nursing.
(g) "Programs that train registered nurses" means a program that
is operated by a California school of nursing and approved by the
Board of Registered Nursing, or that is authorized by the Regents of
the University of California, the Trustees of the California State
University, or the Board of Governors of the California Community
Colleges, and that is approved by the Board of Registered Nursing.
(h) "Teaching health center" means a community-based ambulatory
patient care center that operates a primary care residency program.
Community-based ambulatory patient care settings include, but are not
limited to, federally qualified health centers, community mental
health centers, rural health clinics, health centers operated by the
Indian Health Service, an Indian tribe or tribal organization, or an
urban Indian organization, and entities receiving funds under Title X
of the federal Public Health Service Act (Public Law 91-572).
Any reference in any code to the Health Manpower Policy
Commission is deemed a reference to the California Healthcare
Workforce Policy Commission.
There is hereby created a state medical contract program
with accredited medical schools, teaching health centers, programs
that train primary care physician's assistants, programs that train
primary care nurse practitioners, programs that train registered
nurses, hospitals, and other health care delivery systems to increase
the number of students and residents receiving quality education and
training in the primary care specialties of family medicine,
internal medicine, obstetrics and gynecology, and pediatrics, 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.
There is hereby created a California Healthcare Workforce
Policy Commission. The commission shall be composed of 15 members who
shall serve at the pleasure of their appointing authorities:
(a) Nine members appointed by the Governor, as follows:
(1) One representative of the University of California medical
schools, from a nominee or nominees submitted by the University of
California.
(2) One representative of the private medical or osteopathic
schools accredited in California from individuals nominated by each
of these schools.
(3) One representative of practicing family medicine physicians.
(4) One representative who is a practicing osteopathic physician
or surgeon and who is board certified in either general or family
medicine.
(5) One representative of undergraduate medical students in a
family medicine program or residence in family medicine training.
(6) One representative of trainees in a primary care physician's
assistant program or a practicing physician's assistant.
(7) One representative of trainees in a primary care nurse
practitioners program or a practicing nurse practitioner.
(8) One representative of the Office of Statewide Health Planning
and Development, from nominees submitted by the office director.
(9) One representative of practicing registered nurses.
(b) Two consumer representatives of the public who are not elected
or appointed public officials, one appointed by the Speaker of the
Assembly and one appointed by the Chairperson of the Senate Committee
on Rules.
(c) Two representatives of practicing registered nurses, one
appointed by the Speaker of the Assembly and one appointed by the
Chairperson of the Senate Committee on Rules.
(d) Two representatives of students in a registered nurse training
program, one appointed by the Speaker of the Assembly and one
appointed by the Chairperson of the Senate Committee on Rules.
(e) The Deputy Director of the Healthcare Workforce Development
Division in the Office of Statewide Health Planning and Development,
or the deputy director's designee, shall serve as executive secretary
for the commission.
The members of the commission, other than state employees,
shall receive compensation of twenty-five dollars ($25) for each day'
s attendance at a commission meeting, in addition to actual and
necessary travel expenses incurred in the course of attendance at a
commission meeting.
The commission shall identify specific areas of the state
where unmet priority needs for dentists, physicians, and registered
nurses exist.
The commission shall do all of the following:
(a) Identify specific areas of the state where unmet priority
needs for primary care family physicians and registered nurses exist.
(b) (1) Establish standards for primary care and family medicine
training programs, primary care and family medicine residency
programs, postgraduate osteopathic medical programs in primary care
or family medicine, and primary care physician assistants programs
and programs that train primary care nurse practitioners, including
appropriate provisions to encourage primary care physicians, family
physicians, osteopathic family physicians, primary care physician's
assistants, and primary care nurse practitioners who receive training
in accordance with this article and Article 2 (commencing with
Section 128250) to provide needed services in areas of unmet need
within the state. Standards for primary care and family medicine
residency programs shall provide that all of the residency programs
contracted for pursuant to this article and Article 2 (commencing
with Section 128250) shall be approved by the Accreditation Council
for Graduate Medical Education's Residency Review Committee for
Family Medicine, Internal Medicine, Pediatrics, or Obstetrics and
Gynecology. Standards for postgraduate osteopathic medical programs
in primary care and family medicine, as approved by the American
Osteopathic Association Committee on Postdoctoral Training for
interns and residents, shall be established to meet the requirements
of this subdivision in order to ensure that those programs are
comparable to the other programs specified in this subdivision. Every
program shall include a component of training designed for medically
underserved multicultural communities, lower socioeconomic
neighborhoods, or rural communities, and shall be organized to
prepare program graduates for service in those neighborhoods and
communities. Medical schools receiving funds under this article and
Article 2 (commencing with Section 128250) shall have programs or
departments that recognize family medicine as a major independent
specialty. Existence of a written agreement of affiliation or
association between a hospital and an accredited medical school shall
be regarded by the commission as a favorable factor in considering
recommendations to the director for allocation of funds appropriated
to the state medical contract program established under this article
and Article 2 (commencing with Section 128250). Teaching health
centers receiving funds under this article shall have programs or
departments that recognize family medicine as a major independent
specialty.
(2) For purposes of this subdivision, "primary care" and "family
medicine" includes the general practice of medicine by osteopathic
physicians.
(c) Establish standards for registered nurse training programs.
The commission may accept those standards established by the Board of
Registered Nursing.
(d) Review and make recommendations to the Director of the Office
of Statewide Health Planning and Development concerning the funding
of primary care and family medicine programs or departments and
primary care and family medicine residencies and programs for the
training of primary care physician assistants and primary care nurse
practitioners that are submitted to the Healthcare Workforce
Development Division for participation in the contract program
established by this article and Article 2 (commencing with Section
128250). If the commission determines that a program proposal that
has been approved for funding or that is the recipient of funds under
this article and Article 2 (commencing with Section 128250) does not
meet the standards established by the commission, it shall submit to
the Director of the Office of Statewide Health Planning and
Development and the Legislature a report detailing its objections.
The commission may request the Office of Statewide Health Planning
and Development to make advance allocations for program development
costs from amounts appropriated for the purposes of this article and
Article 2 (commencing with Section 128250).
(e) Review and make recommendations to the Director of the Office
of Statewide Health Planning and Development concerning the funding
of registered nurse training programs that are submitted to the
Healthcare Workforce Development Division for participation in the
contract program established by this article. If the commission
determines that a program proposal that has been approved for funding
or that is the recipient of funds under this article does not meet
the standards established by the commission, it shall submit to the
Director of the Office of Statewide Health Planning and Development
and the Legislature a report detailing its objections. The commission
may request the Office of Statewide Health Planning and Development
to make advance allocations for program development costs from
amounts appropriated for the purposes of this article.
(f) Establish contract criteria and single per-student and
per-resident capitation formulas that shall determine the amounts to
be transferred to institutions receiving contracts for the training
of primary care and family medicine students and residents and
primary care physician's assistants and primary care nurse
practitioners and registered nurses pursuant to this article and
Article 2 (commencing with Section 128250), except as otherwise
provided in subdivision (d). Institutions applying for or in receipt
of contracts pursuant to this article and Article 2 (commencing with
Section 128250) may appeal to the director for waiver of these single
capitation formulas. The director may grant the waiver in
exceptional cases upon a clear showing by the institution that a
waiver is essential to the institution's ability to provide a program
of a quality comparable to those provided by institutions that have
not received waivers, taking into account the public interest in
program cost-effectiveness. Recipients of funds appropriated by this
article and Article 2 (commencing with Section 128250) shall, as a
minimum, maintain the level of expenditure for family medicine or
primary care physician's assistant or family care nurse practitioner
training that was provided by the recipients during the 1973-74
fiscal year. Recipients of funds appropriated for registered nurse
training pursuant to this article shall, as a minimum, maintain the
level of expenditure for registered nurse training that was provided
by recipients during the 2004-05 fiscal year. Funds appropriated
under this article and Article 2 (commencing with Section 128250)
shall be used to develop new programs or to expand existing programs,
and shall not replace funds supporting current family medicine or
registered nurse training programs. Institutions applying for or in
receipt of contracts pursuant to this article and Article 2
(commencing with Section 128250) may appeal to the director for
waiver of this maintenance of effort provision. The director may
grant the waiver if he or she determines that there is reasonable and
proper cause to grant the waiver.
(g) (1) Review and make recommendations to the Director of the
Office of Statewide Health Planning and Development concerning the
funding of special programs that may be funded on other than a
capitation rate basis. These special programs may include the
development and funding of the training of primary health care teams
of primary care and family medicine residents or primary care or
family physicians and primary care physician assistants or primary
care nurse practitioners or registered nurses, undergraduate medical
education programs in primary care or family medicine, and programs
that link training programs and medically underserved communities in
California that appear likely to result in the location and retention
of training program graduates in those communities. These special
programs also may include the development phase of new primary care
or family medicine residency, primary care physician assistant
programs, primary care nurse practitioner programs, or registered
nurse programs.
(2) The commission shall establish standards and contract
criteria for special programs recommended under this subdivision.
(h) Review and evaluate these programs regarding compliance with
this article and Article 2 (commencing with Section 128250). One
standard for evaluation shall be the number of recipients who, after
completing the program, actually go on to serve in areas of unmet
priority for primary care or family physicians in California or
registered nurses who go on to serve in areas of unmet priority for
registered nurses.
(i) Review and make recommendations to the Director of the Office
of Statewide Health Planning and Development on the awarding of funds
for the purpose of making loan assumption payments for medical
students who contractually agree to enter a primary care specialty
and practice primary care medicine for a minimum of three consecutive
years following completion of a primary care residency training
program pursuant to Article 2 (commencing with Section 128250).
(a) The commission shall review and make recommendations
to the Director of the Office of Statewide Health Planning and
Development concerning the provision of grants pursuant to this
section. In making recommendations, the commission shall give
priority to residency programs that demonstrate all of the following:
(1) That the grant will be used to support new primary care
physician slots.
(2) That priority in filling the position shall be given to
physicians who have graduated from a California-based medical school.
(3) That the new primary care physician residency positions have
been, or will be, approved by the Accreditation Council for Graduate
Medical Education or the American Osteopathic Association prior to
the first distribution of grant funds.
(b) The director shall do both of the following:
(1) Determine whether the residency programs recommended by the
commission meet the standards established by this section.
(2) Select and contract on behalf of the state with accredited
primary care or family medicine residency programs for the purpose of
providing grants for the support of newly created residency
positions.
(c) This section does not apply to funding appropriated in the
annual Budget Act for the Song-Brown Health Care Workforce Training
Act (Article 1 (commencing with Section 128200)).
(d) This section shall be operative only if funds are appropriated
in the Budget Act of 2014 for the purposes described in this
section.
(e) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
When making recommendations to the Director of the Office
of Statewide Health Planning and Development concerning the funding
of primary care and family medicine programs or departments, primary
care and family medicine residencies, and programs for the training
of primary care physician assistants, primary care nurse
practitioners, or registered nurses, the commission shall give
priority to programs that have demonstrated success in the following
areas:
(a) Actual placement of individuals in medically underserved
areas.
(b) Success in attracting and admitting members of minority groups
to the program.
(c) Success in attracting and admitting individuals who were
former residents of medically underserved areas.
(d) Location of the program in a medically underserved area.
(e) The degree to which the program has agreed to accept
individuals with an obligation to repay loans awarded pursuant to the
Health Professions Education Fund.
Pursuant to this article and Article 2 (commencing with
Section 128250), the Director of the Office of Statewide Health
Planning and Development shall do all of the following:
(a) Determine whether primary care and family medicine, primary
care physician's assistant training program proposals, primary care
nurse practitioner training program proposals, and registered nurse
training program proposals submitted to the California Healthcare
Workforce Policy Commission for participation in the state medical
contract program established by this article and Article 2
(commencing with Section 128250) meet the standards established by
the commission.
(b) Select and contract on behalf of the state with accredited
medical schools, teaching health centers, programs that train primary
care physician's assistants, programs that train primary care nurse
practitioners, hospitals, and other health care delivery systems for
the purpose of training undergraduate medical students and residents
in the specialties of internal medicine, obstetrics and gynecology,
pediatrics, and family medicine. Contracts shall be awarded to those
institutions that best demonstrate the ability to provide quality
education and training and to retain students and residents in
specific areas of California where there is a recognized unmet
priority need for primary care family physicians. Contracts shall be
based upon the recommendations of the commission and in conformity
with the contract criteria and program standards established by the
commission.
(c) Select and contract on behalf of the state with programs that
train registered nurses. Contracts shall be awarded to those
institutions that best demonstrate the ability to provide quality
education and training and to retain students and residents in
specific areas of California where there is a recognized unmet
priority need for registered nurses. Contracts shall be based upon
the recommendations of the commission and in conformity with the
contract criteria and program standards established by the
commission.
(d) Terminate, upon 30 days' written notice, the contract of any
institution whose program does not meet the standards established by
the commission or that otherwise does not maintain proper compliance
with this part, except as otherwise provided in contracts entered
into by the director pursuant to this article and Article 2
(commencing with Section 128250).
The Director of the Office of Statewide Health Planning and
Development shall adopt, amend, or repeal regulations as necessary
to enforce this article and Article 2 (commencing with Section
128250), which shall include criteria that training programs must
meet in order to qualify for waivers of single capitation formulas or
maintenance of effort requirements authorized by Section 128250.
Regulations for the administration of this chapter shall be adopted,
amended, or repealed as provided in Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
The department shall adopt emergency regulations, as
necessary to implement the changes made to this article by the act
that added this section during the first year of the 2005-06 Regular
Session, no later than September 30, 2005, unless notification of a
delay is made to the Chair of the Joint Legislative Budget Committee
prior to that date. The adoption of regulations implementing the
applicable provisions of this act shall be deemed to be an emergency
and necessary for the immediate preservation of the public peace,
health, safety, or general welfare. The emergency regulations
authorized by this section shall be submitted to the Office of
Administrative Law for filing with the Secretary of State and shall
remain in effect for no more than 180 days, by which time the final
regulations shall be developed.
The Office of Statewide Health Planning and Development
shall develop alternative strategies to provide long-term stability
and non-General Fund support for programs established pursuant to
this article. The office shall report on these strategies to the
legislative budget committees by February 1, 2005.