Bill Text: HI SB2090 | 2012 | Regular Session | Introduced

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Bill Title: Hawaii Health Corps Program; Physician Shortage; Appropriation

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2012-01-25 - (S) Re-Referred to HTH/EDU, WAM. [SB2090 Detail]

Download: Hawaii-2012-SB2090-Introduced.html

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THE SENATE	S.B. NO.	2090
TWENTY-SIXTH LEGISLATURE, 2012
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to health care.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that changes in demographics, the delivery of health care services, and the escalating costs of education have resulted in severe shortages of health care professionals.  A poor distribution of health care professionals has resulted in a surplus of these professionals in some areas of the State and a shortage in other parts of the State, particularly in the more rural areas.  The rural shortage areas often require more services as the health care needs are greater due to socio-economic or geographic circumstances.  The salary potential for shortage areas is often not as favorable when compared to non-shortage areas resulting in many health care practitioners being financially unable to serve in those shortage areas.

     The legislature also finds that to successfully address the health care shortage areas within the State, the following programs need to be implemented:

     (1)  Loan repayment program:  Such a program should be structured to obtain federal matching funds that would be used to repay eligible student loans in exchange for a service commitment by physicians and dentists practicing in health professional shortage areas; and

     (2)  Recruitment program:  Such a program would not receive federal matching funds.  Incentives would be awarded to public or private nonprofit organizations, communities, or recruitment health professionals practicing in areas designated by the department of business, economic development, and tourism that are experiencing a shortage of health care professionals.  Unlike the loan repayment program, this program will be open to all health care professionals, including but not limited to physicians, dentists, mid-level practitioners, pharmacists, allied health professionals, and specialists such as orthopedic surgeons, for whom there is an acknowledged need in some areas of the State.  The incentives could also be used to provide financial support for the spouses and families of recruitment health professionals as doing so is critical in recruiting and retaining health care professionals in these areas.  Finally, unlike the loan repayment program, recruitment health professionals would be able to practice in geographic areas not covered under the loan repayment program.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"CHAPTER

HAWAII HEALTH CORPS PROGRAM

PART I.  GENERAL PROVISIONS

     §   -1  Definitions.  As used in this chapter, unless the context clearly requires otherwise:

     "Applicant" means an individual who has submitted a completed application for the loan repayment program or the recruitment program and meets the application requirements established by the department for the respective program.

     "Approved site" means, for the purposes of the loan repayment program, a provider site that is a public or nonprofit private entity located in a health professional shortage area and approved by the department.

     "Dentist" means an individual licensed to practice dentistry in the State under chapter 448.

     "Department" means the department of business, economic development, and tourism.

     "Eligible education" means education and training programs approved by the department that lead to eligibility for licensure as a repayment health professional.

     "Eligible expenses" means reasonable expenses associated with the costs of acquiring an eligible education such as tuition, books, equipment, fees, room and board, and other expenses determined by the department.

     "Hawaii health corps program" means the loan repayment program and recruitment program, collectively, established under this chapter.

     "Health professional shortage area" means an area in the State, designated by the department of health, where there are shortages of health professionals.  In making health professional shortage area designations in the State, the department of health may be guided by applicable federal standards.

     "Incentives" means the cash or in-kind award made to a recruitment recipient and includes awards made to a spouse or the family of a recruitment health professional.

     "Loan repayment program" means the loan repayment program administered by the department under this chapter.

     "Physician" means an individual licensed to practice medicine in the State pursuant to chapter 453.

     "Qualifying educational loan" means a government or commercial loan for eligible expenses.

     "Recruitment health professional" means an individual who is a health professional, including allopathic and osteopathic physicians (family practitioners, internists, pediatricians, obstetricians and gynecologists, and general psychiatrists), nurse practitioners, certified nurse-midwives, physician assistants, dentists, registered clinical dental hygienists, clinical or counseling psychologists, social workers, psychiatric nurse specialists, mental health counselors, licensed professional counselors, marriage and family therapists, and health care specialists.

     "Recruitment health professional shortage area" means a health professional shortage area or other area determined by the department of health to be experiencing a shortage of recruitment health professionals.

     "Recruitment program" means the health professional recruitment and retention program that is administered by the department under this chapter.

     "Recruitment recipient" means either a recruitment health professional or a public or private nonprofit organization or community that employs a recruitment health professional.

     "Repayment health professional" means a primary care physician, family care practitioner, internist, pediatrician, obstetrician, physician assistant, advance practice registered nurse, naturopathic physician, general psychologist, or general practice dentist.

     "Repayment participant" means a repayment health professional who has received a loan repayment award under this chapter and has commenced practice in a health professional shortage area.

PART II.  LOAN REPAYMENT PROGRAM

     §   -11  Loan repayment program.  There is established the loan repayment program within the department.  The loan repayment program shall be administered in a manner that is consistent with the provisions of title 42 United States Code section 254q-1, as the same may be amended from time to time.

     §   -12  Administration.  The loan repayment program shall be administered by the department.  The department shall:

     (1)  Accept applications from interested persons;

     (2)  Develop criteria for the selection of repayment participants;

     (3)  Select repayment health professionals to participate in the loan repayment program; provided that the department shall not select more than twenty individuals in one year and have no more than one hundred individuals participating in the loan repayment program at any one time, subject to available funding and the need for repayment health professionals in health professional shortage areas;

     (4)  Collect and manage repayments from repayment participants who do not meet their service obligations under this chapter, including enforcing the remedies for breach of the service obligation;

     (5)  Publicize and market the loan repayment program, particularly to maximize participation among repayment health professionals in health professional shortage areas;

     (6)  Solicit and accept grants and donations from public and private sources for the loan repayment program;

     (7)  Develop criteria for and enter into a contract with the repayment participant that obligates the repayment participant to complete the service obligation and to comply fully with the terms and conditions of the loan repayment program;

     (8)  Administer the recruitment program separately from the loan repayment program;

     (9)  Establish a group, which shall be advisory only, comprising representatives from government and the health profession, including providers, community health centers, and professional organizations, to:

          (A)  Assist the department in developing criteria to select participants;

         (B)  Determine areas having the greatest need for health professionals; and

         (C)  Advise on other matters related to the administration of the loan repayment program.

          The same members may serve on the advisory group for the loan repayment program and the recruitment program; and

    (10)  Take any and all other actions necessary to administer the loan repayment program.

     §   -13  Eligibility.  To be eligible to participate in the loan repayment program, an individual shall:

     (1)  Submit an application to the department;

     (2)  Have a signed employment agreement or contract with an approved site;

     (3)  Provide copies of loan documentation;

     (4)  Be a United States citizen or a naturalized citizen of the United States;

     (5)  Not have any other outstanding contractual obligations for health professional services to the federal government, to a state government, or other entity or organization unless that service obligation will be completely satisfied before the contract for the service obligation under the loan repayment program is signed;

     (6)  Not have a judgment lien against the individual's property for a debt to the United States;

     (7)  Not have a history of failing to comply with, or inability to comply with, service or payment obligations;

     (8)  Not have defaulted on any federal payment obligation, even if the creditor considers the obligation to be in good standing;

     (9)  Not have breached a prior service obligation to the federal, state, or local government or other entity or organization, even if the obligation was subsequently satisfied;

    (10)  Not have had any federal debt written off as uncollectible (pursuant to title 31 United States Code section 3711(a)) or had any federal service or payment obligation waived;

    (11)  Perform the service obligation at an approved site;

    (12)  Provide full-time clinical services at an approved site;

    (13)  Charge for the individual's professional services at the usual and customary prevailing rates in the area where the services are provided; except that if a person is unable to pay the charge, the person may be charged at a reduced rate or not charged any fee;

    (14)  Agree not to discriminate on the basis of the patient's ability to pay or on the basis that the payment for care will be made pursuant to medicare, medicaid, or the state children's health insurance program;

    (15)  Agree to accept assignment under medicare under title XVIII of the Social Security Act, enter into an appropriate agreement with the state agency that administers the state plan for medicaid under title XIX of the Social Security Act, and enter into an appropriate agreement with the state children's health insurance program to provide service to children under title XXI of the Social Security Act;

    (16)  Agree to pay the amount specified by the department if the service obligation is not completed for any reason;

    (17)  Be a licensed and qualified repayment health professional in the State and maintain licensure and qualifications during the service obligation period;

    (18)  Obtain and maintain any other licensure required of repayment health professionals in the State; and

    (19)  Meet any other requirements that may be established by the department.

     §   -14  Preference and selection.  (a)  In selecting repayment participants, the department shall give preference in the following order of priority:

     (1)  Graduates of the University of Hawaii John A. Burns school of medicine;

     (2)  Graduates of out-of-state medical schools who are legal residents of Hawaii and are engaged in medical residency or practicing medicine in Hawaii; and

     (3)  Graduates of out-of-state medical schools who are graduates of high schools located in Hawaii and are engaged in medical residency or practicing medicine in Hawaii.

     (b)  The criteria used to select repayment participants for the loan repayment program shall be determined by the department.  The criteria may include:

     (1)  The need for primary care physicians and dentists in the health professional shortage areas;

     (2)  The willingness of an applicant to work full-time in the health professional shortage area; or

     (3)  The likelihood of the applicant continuing to practice in the health professional shortage area after the service obligation has been completed.

     §   -15  Eligible expenses.  The department shall repay only qualifying educational loans.

     §   -16  Amount of the award.  Subject to the availability of funding and need for repayment health professionals in health professional shortage areas, the amount of the award shall be determined by the department but shall not exceed the maximum amounts permitted to be awarded to repayment participants under title 42 United States Code section 254q-1, as the same may be amended from time to time.

     §   -17  Service obligation.  A repayment participant shall agree to serve full-time at an approved site for a minimum of two years with the possibility of extending the service obligation for one-year terms for a total service obligation not to exceed five years.  Periods of internship, preceptorship, clinical training, or other postgraduate training shall not be counted toward the service obligation.

     §   -18  Cancellation of service obligation.  The department may cancel a contract with a repayment participant only upon the death of the repayment participant.

     §   -19  Waiver of service obligation.  The department may permanently waive the service obligation upon the documentation by the repayment participant that a medical condition or a personal situation makes compliance with the service obligation permanently impossible, as determined by the department.

     §   -20  Suspension.  The department may temporarily suspend the repayment participant's service obligation upon the documentation by the repayment participant of a medical condition or personal situation that makes compliance with the service obligation temporarily impossible, as determined by the department.

     §   -21  Default.  A repayment participant who fails to complete the service obligation shall pay as a penalty the sum of the following:

     (1)  The amount paid to or on behalf of a repayment participant for any period of obligated service not served;

     (2)  The amount equal to the number of months of obligated service not served multiplied by $7,500; and

     (3)  Interest on the above amount at the maximum prevailing interest rate determined by the Treasurer of the United States from the day of the default; provided that the amount the State is entitled to collect shall not be less than $31,000.

     §   -22  Rules.  The department may adopt rules under chapter 91 necessary to effectuate this part.

PART III.  RECRUITMENT PROGRAM

     §   -31  Recruitment program; established.  There is established the recruitment program within the department.

     §   -32  Administration.  The recruitment program shall be administered by the department.  The department shall:

     (1)  Maintain listings of communities and areas within the State with a need for recruitment health professionals;

     (2)  Maintain listings of recruitment health professionals interested in working in the areas designated by the department to be experiencing a shortage of health care professionals;

     (3)  Act as an intermediary between communities and public or private nonprofit organizations and recruitment health professionals desiring to practice in recruitment health professional shortage areas;

     (4)  Develop funding models for the recruitment program that provide for security and flexibility for recruitment health professionals;

     (5)  Develop incentive payment structures and packages that support recruitment health professionals, their spouses, and families, including but not limited to professional liability insurance relief, cost of living allowances, income guarantee payments, housing allowances, vehicle, vehicle allowance, continuing medical education, telemedicine capability, waiver of fees, or providing employment opportunities for the spouses of recruitment health professionals;

     (6)  Work with other agencies to minimize or remove regulatory barriers to relocating or practicing in health professional shortage areas;

     (7)  Select recruitment recipients using criteria established by the department;

     (8)  Publicize and market the recruitment program;

     (9)  Solicit and accept grants and donations from public and private sources for the recruitment program;

    (10)  Administer the recruitment program separately from the loan repayment program, except to the extent provided in this chapter;

    (11)  Enter into a contract with a recruitment recipient that obligates the recruitment health professional to provide the services of the recruitment health professional in the recruitment health professional shortage area for the length of the service obligation;

    (12)  Establish a group, which shall be advisory only, comprising representatives from government and the health profession, including providers, community health centers, and professional organizations, to:

         (A)  Assist the department in developing criteria to select recruitment health professionals;

         (B)  Identify areas having the greatest need for health professionals; and

         (C)  Advise on other matters related to the administration of the recruitment program.

               The same members may serve on the advisory group for the loan repayment program and the recruitment program; and

    (13)  Take any and all other actions necessary to administer the recruitment program.

     §   -33  Eligibility.  (a)  The recruitment program shall accept applications from recruitment health professionals, or public or nonprofit private entities or communities intending to employ or currently employing a recruitment health professional.

     (b)  To be eligible to participate in the recruitment program, the recruitment recipient shall:

     (1)  In the case of a public or nonprofit private entity or community, employ or intend to employ and provide the services of a recruitment health professional for the length of the service obligation in the recruitment health professional shortage area; or

     (2)  In the case of a recruitment health professional, provide the full-time services of a recruitment health professional in a recruitment health professional shortage area.

     (c)  In addition to the requirements set forth in subsection (b), to be eligible to participate in the recruitment program, a recruitment health professional shall also:

     (1)  Be a United States citizen or a naturalized citizen of the United States;

     (2)  Charge for the recruitment health professional's professional services at the usual and customary prevailing rates in the area where the services are provided, except that if a person is unable to pay the charge, the person may be charged at a reduced rate or not charged any fee;

     (3)  Agree not to discriminate on the basis of the patient's ability to pay or on the basis that the payment for the care will be made pursuant to medicare, medicaid, or the state children's health insurance program;

     (4)  Agree to accept assignment under medicare under title XVIII of the Social Security Act, enter into an appropriate agreement with the state agency that administers the state plan for medicaid under title XIX of the Social Security Act, and enter into an appropriate agreement with the state children's health insurance program to provide service to children under title XXI of the Social Security Act;

     (5)  Agree to pay the amount specified by the department if the service obligation is not completed for any reason;

     (6)  Be a licensed and qualified recruitment health professional in the State and maintain the licensure and qualifications during the service obligation period;

     (7)  Obtain and maintain any other licensure required of recruitment health professionals in the State; and

     (8)  Meet any other requirements that may be established by the department.

     §   -34  Preference and selection.  (a)  In selecting recruitment recipients, the department shall give preference in the following order of priority:

     (1)  Graduates of the University of Hawaii John A. Burns school of medicine;

     (2)  Graduates of a Hawaii residency program; or

     (3)  Residents of the State of Hawaii who have obtained residency through a minimum of three of the following seven criteria:

         (A)  Legal residence of the applicant for at least twelve months;

         (B)  Legal residence of the applicant's parents;

         (C)  The applicant's place of birth;

         (D)  Location of the high school from which the applicant graduated;

         (E)  The applicant is native Hawaiian;

         (F)  Location of the college or university that the applicant attended; or

         (G)  The applicant's parent or legal guardian is a University of Hawaii John A. Burns school of medicine graduate, graduate of a Hawaii residency program, or is a University of Hawaii John A. Burns school of medicine faculty member.

     (b)  The department shall give second priority preference to recruitment health professionals who are graduates of out-of-state schools or residency programs.

     (c)  The department shall develop criteria for selecting recruitment recipients.  The criteria may include:

     (1)  The need for recruitment health professionals in the recruitment health professional shortage areas;

     (2)  The willingness of an applicant to work full-time in the recruitment health professional shortage areas; or

     (3)  The likelihood of the applicant continuing to practice in the recruitment health professional shortage area after the service obligation has been completed.

     §   -35  Award of incentives.  (a)  Incentives shall only be awarded to recruitment recipients.

     (b)  Subject to available funding and need for recruitment health professionals in the recruitment health professional shortage area, the amount of the incentives awarded to each recruitment recipient shall be determined by the department, but shall not exceed $17,500 per recruitment recipient per year.

     §   -36  Service obligation.  The recruitment recipient, in the case of a public or nonprofit private entity or community, shall obligate the recruitment health professional to practice full-time in a recruitment health professional shortage area for a minimum of two years with the possibility of extending the service obligation for one-year terms for a total service obligation not to exceed five years.  Periods of internship, preceptorship, clinical training, or other post-graduate training shall not be counted toward the service obligation.

     §   -37  Recruitment health professional shortage areas.  The recruitment recipients shall be located in and shall provide services of a recruitment health professional in a recruitment health professional shortage area.

     §   -38  Waiver of service obligation.  The department may permanently waive the service obligation upon documentation by the recruitment health professional that a medical condition or a personal situation makes compliance with the service obligation permanently impossible, as determined by the department.

     §   -39  Suspension.  The department may temporarily suspend the service obligation upon documentation by the recruitment health professional of a medical condition or personal situation that makes compliance with the service obligation temporarily impossible, as determined by the department.

     §   -40  Default.  A recruitment recipient who fails to complete the service obligation shall pay as a penalty the sum of the following:

     (1)  The amount paid to or on behalf of a repayment participant for any period of obligated service not served;

     (2)  The amount equal to the number of months of obligated service not served multiplied by $7,500; and

     (3)  Interest on the above amount at the maximum prevailing interest rate determined by the Treasurer of the United States from the day of the default; provided that the amount the State is entitled to collect shall not be less than $31,000.

     §   -41  Rules.  The department may adopt rules under chapter 91 necessary to effectuate this part.

PART IV.  FIRST RESPONDERS

     §   -51  First responders.  In the event of a declared emergency in the State by the governor, at the request of the governor or director of health, all repayment participants and all recruitment health professionals participating in the recruitment program shall commit to serve as first responders.

PART V.  COORDINATION OF PROGRAMS

     §   -61  Coordination.  Notwithstanding that the loan repayment program and recruitment program shall be administered separately, the department shall determine the need for repayment health professionals and recruitment health professionals in areas of the State experiencing a shortage of health care professionals and select participants for the respective programs.

     §   ‑62  Hawaii health corps special fund.  (a)  There is established within the state treasury a special fund to be known as the Hawaii health corps special fund to be administered and expended by the department.

     (b)  Moneys deposited into the fund shall include appropriations made by the legislature from general funds, private contributions, stipend repayments, interest earned or accrued on moneys deposited in the fund, and other income from the fund, which shall be separately accounted for.

     (c)  The fund shall be used for the Hawaii health corps program pursuant to this chapter.

     §   -63  Coordination of funds.  Funds appropriated by the legislature for the purposes of this chapter or received from private sources may be allocated by the department between the loan repayment program and recruitment program based on the need for the funds and need for either repayment health professionals or recruitment health professionals within the State."

     SECTION 3.  (a)  The department of business, economic development, and tourism shall implement the Hawaii health corps program no later than July 1, 2013.

     (b)  For the purposes of efficiency in the implementation of this new program, the department of business, economic development, and tourism shall award a minimum of thirty stipends of $30,000 per recipient in the first year of the program, an additional thirty stipends of $30,000 per recipient in the second year of the program, and an additional thirty stipends of $30,000 per recipient in the third year of the program.  Thereafter, the department shall award annually a maximum of one hundred stipends.

     (c)  The director of business, economic development, and tourism shall report to the legislature on the status of the Hawaii health corps program no later than twenty days prior to the convening of each regular session of the legislature beginning with the regular session of 2013.

     SECTION 4.  If any part of this Act is found to be in conflict with federal requirements that are a prescribed condition for the allocation of federal funds to the State, the conflicting part of this Act is inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding does not affect the operation of the remainder of this Act in its application to the agencies concerned.  The rules under this Act shall meet federal requirements that are a necessary condition to the receipt of federal funds by the State.

     SECTION 5.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2012-2013 for deposit into the Hawaii health corps special fund.

     SECTION 6.  There is appropriated out of the Hawaii health corps special fund of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2012-2013 to provide stipends to qualifying recipients for the implementation of the Hawaii health corps program.

     The sum appropriated shall be expended by the department of business, economic development, and tourism for the purposes of this Act.

     SECTION 7.  This Act shall take effect on July 1, 2012.

 

INTRODUCED BY:	_____________________________

 

 

Report Title:

Hawaii Health Corps Program; Physician Shortage; Appropriation

 

Description:

Creates the Hawaii health corps program, by which student loans will be repaid or incentives given to health care professionals to work in areas that have been designated as underserviced.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.