SECTIONS 128200-128241 - California Statutes

HEALTH AND SAFETY CODE

SECTION 128200-128241

128200. (a) This article shall be known and may be cited as the
Song-Brown Health Care Workforce Training Act.
(b) The Legislature hereby finds and declares that physicians
engaged in family practice 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.
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 practice 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 practice, and has broad clinical
experience in the field of family practice.
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.
Community hospitals in general and rural community hospitals in
particular, as well as other health care delivery systems, are
encouraged to develop family practice 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.
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.
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 specialty of family
practice 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, 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).

128205. 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 practice residency for three years
after graduation from an accredited medical school.
(b) "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
which pertains to the family practice training program for which
state contract funds are sought. This definition shall include
agreements that may be entered into subsequent to October 2, 1973, as
well as those relevant agreements that are in existence prior to
October 2, 1973.
(c) "Commission" means the California Healthcare Workforce Policy
Commission.
(d) "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.
(e) "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.
(f) "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.

128207. Any reference in any code to the Health Manpower Policy
Commission is deemed a reference to the California Healthcare
Workforce Policy Commission.

128210. There is hereby created a state medical contract program
with accredited medical schools, 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
specialty of family practice or in nursing and to maximize the
delivery of primary care family physician services to specific areas
of California where there is a recognized unmet priority need for
those services.

128215. 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 physicians.
(4) One representative who is a practicing osteopathic physician
or surgeon and who is board certified in either general or family
practice.
(5) One representative of undergraduate medical students in a
family practice program or residence in family practice 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 Chief of the Health Professions Development Program in the
Office of Statewide Health Planning and Development, or the chief's
designee, shall serve as executive secretary for the commission.

128220. 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.

128224. The commission shall identify specific areas of the state
where unmet priority needs for dentists, physicians, and registered
nurses exist.

128225. 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) Establish standards for family practice training programs and
family practice residency programs, postgraduate osteopathic medical
programs in family practice, and primary care physician assistants
programs and programs that train primary care nurse practitioners,
including appropriate provisions to encourage 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 family practice residency programs shall provide
that all the residency programs contracted for pursuant to this
article and Article 2 (commencing with Section 128250) shall both
meet the Residency Review Committee on Family Practice's "Essentials"
for Residency Training in Family Practice and be approved by the
Residency Review Committee on Family Practice. Standards for
postgraduate osteopathic medical programs in family practice, 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 practice 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).
For purposes of this subdivision, "family practice" 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 family practice programs or departments and family practice
residencies and programs for the training of primary care physician
assistants and primary care nurse practitioners that are submitted to
the Health Professions Development Program 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
Health Professions Development Program 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 family practice 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 practice 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 practice 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) 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 family
practice residents or family physicians and primary care physician
assistants or primary care nurse practitioners or registered nurses,
undergraduate medical education programs in family practice, 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 family practice residency, primary care physician
assistant programs, primary care nurse practitioner programs, or
registered nurse programs.
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 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).

128230. When making recommendations to the Director of the Office
of Statewide Health Planning and Development concerning the funding
of family practice programs or departments, family practice
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.

128235. 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 family practice, primary care physician
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, programs that train primary care physician
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
specialty of family practice. 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).

128240. 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.

128240.1. 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.

128241. 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.