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AB-443 Office of Statewide Health Planning and Development: international medical graduates.(2021-2022)

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Date Published: 03/11/2021 09:00 PM
AB443:v98#DOCUMENT

Amended  IN  Assembly  March 11, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 443


Introduced by Assembly Member Carrillo

February 04, 2021


An act to add Section 2028 2065.5 to the Business and Professions Code, and to add Article 2 (commencing with Section 127850) to Chapter 1 of Part 3 of Division 107 of the Health and Safety Code, relating to healing arts. health professions.


LEGISLATIVE COUNSEL'S DIGEST


AB 443, as amended, Carrillo. International Office of Statewide Health Planning and Development: international medical graduates.
Existing law establishes in the California Health and Human Services Agency the Office of Statewide Health Planning and Development, under the control of an executive officer known as the Director of Statewide Health Planning and Development, and makes the office responsible for administering various programs with respect to the health care professions.
This bill would require the office to establish an international medical graduates assistance program to address barriers to practice and facilitate pathways to assist immigrant international medical graduates to integrate into the California health care delivery system, with the goal of increasing access to primary care in rural and underserved areas of the state. The bill would require the office to enter into an agreement with another state agency as the office determines to be appropriate, based on prescribed criteria, to operate as the managing agency of the program. The bill would require the agreement to include a requirement that, by June 30, 2022, the managing agency shall provide dedicated staffing for the planning and management of the program and that the governing body of the managing agency shall be the entity responsible for the supervision of programmatic operations. The bill would also require the agreement to provide that the office shall oversee the managing agency’s planning, management, and operation of the program.
The bill would require the governing body of the managing agency, in administering the program, to take prescribed actions, including providing overall coordination for the planning, development, and implementation of a comprehensive system for integrating qualified immigrant international medical graduates into the California health care delivery system, developing a system for the assessment and certification of the clinical readiness of eligible immigrant international medical graduates to serve in a residency program, and studying, in consultation with the Medical Board of California and other stakeholders as determined by the governing body, changes necessary in health professional licensure and regulation to ensure full utilization of immigrant international medical graduates in the California health care delivery system. The bill would also require the governing body of the managing agency to prepare and post on its internet website, commencing June 30, 2022, and annually thereafter, a report with related information.
The bill would authorize the director to develop initial clinical readiness assessments for practice of one or more primary care specialties and would require the director to add additional assessments as they determine resources are available. The bill would authorize the director, in collaboration with the managing agency, to enter into an agreement with another state agency or an independent entity to conduct assessments.
The bill would require the Secretary of California Health and Human Services to issue a California certificate of clinical readiness for residency to an individual who passes the assessment. The bill would authorize the secretary to impose an unspecified certificate fee to cover the administrative costs to the agency. The bill would require fee revenues to be deposited in the International Medical Graduates Clinical Readiness Fund, which the bill would establish. Moneys in the fund would be available to the agency only for the purpose of reimbursing its administrative costs, subject to appropriation by the Legislature.
Existing law, the Medical Practice Act, establishes the Medical Board of California and sets forth its powers and duties relating to the licensure and regulation of physicians and surgeons. Existing law establishes the University of California at Los Angeles David Geffen School of Medicine’s International Medical Graduate Program to allow selected international medical graduates in a preresidency training program at the University of California, Los Angeles David Geffen School of Medicine, Department of Family Medicine to receive hands-on clinical instruction, as prescribed.
This bill would make findings and declarations regarding the state’s need for Spanish-speaking physicians to meet the needs of Spanish-speaking limited English proficient patients. The bill would declare the intent of the Legislature to expand the existing pool of international medical graduates in California. require the office, in consultation with the board and other stakeholders as determined by the office, to develop requirements for qualification for an international medical graduate integration license for the practice of medicine to be issued by the board. The bill would require the board to consult with the office and other stakeholders in the development of those requirements. The bill would require an international medical graduate integration license to exempt a qualified immigrant international medical graduate from residency requirements for the practice of medicine under the act. The bill would authorize the board to issue an international medical graduate integration license if it determines an applicant is qualified for such a license and the practice of the applicant will be primary care in a rural or underserved area.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 (a) The Legislature finds and declares the following:
(1) Bilingual international medical graduates can help meet the needs of medically underserved regions with limited English proficient populations.
(2) There is an increasing number of undergraduate students born in the United States who attend medical school in foreign Spanish-speaking countries, and are considered international medical graduates.
(3) Spanish-speaking physicians, including Spanish-speaking international medical graduates, are highly underrepresented in California’s physician workforce.
(4) California needs Spanish-speaking physicians to meet the needs of Spanish-speaking limited English proficient patients more than any other linguistically underrepresented language group.
(5) The current supply is limited and insufficient to address the expected demand from the limited English proficient Spanish-speaking population.
(b) It is the intent of the Legislature to expand the existing pool of international medical graduates in California.

SEC. 2.

 Section 2065.5 is added to the Business and Professions Code, to read:

2065.5.
 (a) The Legislature finds and declares that this section is necessary to integrate qualified international medical graduates into the health care delivery system without the time and expense of residency, and is consistent with health equity priorities of the state.
(b) As used in this section, “immigrant international medical graduate” has the same meaning as defined in Section 127850 of the Health and Safety Code.
(c) The board, in accordance with Section 127852 of the Health and Safety Code, shall consult with the Office of Statewide Health Planning and Development and other stakeholders as determined by that office in the development of requirements for qualification for an international medical graduate integration license for the practice of medicine, to be issued by the board.
(d) The international medical graduate integration license shall exempt a qualified immigrant international medical graduate from residency requirements for the practice of medicine under this chapter.
(e) The board may issue an international medical graduate integration license if it determines the following:
(1) The applicant is qualified for an international medical graduate integration license pursuant to the requirements developed in accordance with subdivision (c).
(2) The practice of the applicant will be primary care in a rural or underserved area.

SEC. 3.

 Article 2 (commencing with Section 127850) is added to Chapter 1 of Part 3 of Division 107 of the Health and Safety Code, to read:
Article  2. International Medical Graduates Assistance Program

127850.
 As used in this article:
(a) “Immigrant international medical graduate” means an international medical graduate who meets all of the following requirements:
(1) Was born outside the United States.
(2) Now resides permanently in the United States.
(3) Did not enter the United States on a J-1 or similar nonimmigrant visa following acceptance into a United States medical residency or fellowship program.
(b) “International medical graduate” means a physician who received a basic medical degree or qualification from a medical school located outside the United States and Canada.
(c) “Rural community” means a rural community included in the list established pursuant to Section 124425.
(d) “Underserved community” means a California area or population included in the list of designated primary medical care health professional shortage areas, medically underserved areas, or medically underserved populations maintained and updated by the United States Department of Health and Human Services.

127851.
 (a) The office shall establish an international medical graduates assistance program to address barriers to practice and facilitate pathways to assist immigrant international medical graduates to integrate into the California health care delivery system, with the goal of increasing access to primary care in rural and underserved areas of the state.
(b) (1) The office shall enter into an agreement with another state agency as the office determines to be appropriate to operate as the managing agency of the program in accordance with this article. The office shall base the determination of the appropriate managing agency on criteria that shall include, but is not limited to, experience in health profession licensing, education and health equity, managing cross-sector, regional, or statewide education workforce partnerships, health professional education, and diversity in medical education.
(2) The agreement shall include that, by June 30, 2022, the managing agency shall provide dedicated staffing for the planning and management of the program and that the governing body of the managing agency shall be the entity responsible for the supervision of programmatic operations. The agreement shall provide that the office shall oversee the managing agency’s planning, management, and operation of the program.

127852.
 (a) In administering the international medical graduates assistance program pursuant to this article, the governing body of the managing agency shall do the following:
(1) Provide overall coordination for the planning, development, and implementation of a comprehensive system for integrating qualified immigrant international medical graduates into the California health care delivery system, particularly those willing to serve in rural or underserved communities of the state.
(2) Develop and maintain, in partnership with community organizations working with international medical graduates, a voluntary roster of immigrant international medical graduates interested in entering the California health workforce to assist in planning and program administration.
(3) Work with graduate clinical medical training programs to address barriers faced by immigrant international medical graduates in securing residency positions in California, including the requirement that applicants for residency positions be recent graduates of medical school.
(4) Subject to paragraph (1) of subdivision (b), develop a system for the assessment and certification of the clinical readiness of eligible immigrant international medical graduates to serve in a residency program. The system shall include assessment methods, an operating plan, and a budget.
(5) Explore and facilitate more streamlined pathways for immigrant international medical graduates to serve in nonphysician professions in the California workforce.
(6) Prepare and post on its internet website a report, commencing June 30, 2022, and annually thereafter, with information on the following:
(A) The aggregate number and distribution, by geography and specialty, of immigrant international medical graduates in California.
(B) Progress in addressing barriers as described in paragraph (3).
(C) Recommendations on necessary changes identified pursuant to paragraph (6).
(b) (1) The director may develop initial clinical readiness assessments as described in paragraph (4) of subdivision (a) for practice of one or more primary care specialties and shall add additional assessments as they determine resources are available. In order to be assessed for clinical readiness for residency, an eligible international medical graduate shall have obtained a certification from the Educational Commission for Foreign Medical Graduates.
(2) The director, in collaboration with the managing agency, may enter into an agreement with another state agency or an independent entity to conduct assessments in accordance with paragraph (1) of this section and paragraph (4) of subdivision (a).
(c) (1) The secretary shall issue a California certificate of clinical readiness for residency to an individual who passes the assessment. The secretary may impose a certificate fee of ____ ($____) to cover the administrative costs to the agency.
(2) Fee revenues pursuant to paragraph (a) shall be deposited in the International Medical Graduates Clinical Readiness Fund, which is hereby established in the State Treasury. Moneys in the fund shall be available to the agency only for the purpose of reimbursing the costs of administering this article, upon appropriation by the Legislature.
(d) The office, in consultation with the Medical Board of California and other stakeholders as determined by the office, shall develop requirements for qualification for an international medical graduate integration license for the practice of medicine to be issued by the board pursuant to Section 2065.5 of the Business and Professions Code.
(e) Nothing in this section alters the authority of the Medical Board of California to regulate the practice of medicine.

SECTION 1.Section 2028 is added to the Business and Professions Code, to read:
2028.

(a)The Legislature finds and declares the following:

(1)Bilingual international medical graduates can help meet the needs of medically underserved regions with limited English proficient populations.

(2)There is an increasing number of undergraduate students born in the United States who attend medical school in foreign Spanish-speaking countries, and are considered international medical graduates.

(3)Spanish-speaking physicians, including Spanish-speaking international medical graduates, are highly underrepresented in California’s physician workforce.

(4)California needs Spanish-speaking physicians to meet the needs of Spanish-speaking limited English proficient patients more than any other linguistically underrepresented language group.

(5)The current supply is limited and insufficient to address the expected demand from the limited English proficient Spanish-speaking population.

(b)It is the intent of the Legislature to expand the existing pool of international medical graduates in California.