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AB-1918 California Reproductive Health Service Corps.(2021-2022)



Current Version: 09/27/22 - Chaptered

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AB1918:v93#DOCUMENT

Assembly Bill No. 1918
CHAPTER 561

An act to add Article 6 (commencing with Section 128560) to Chapter 5 of Part 3 of Division 107 of, and to repeal Section 128565 of, the Health and Safety Code, relating to health care education.

[ Approved by Governor  September 27, 2022. Filed with Secretary of State  September 27, 2022. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 1918, Petrie-Norris. California Reproductive Health Service Corps.
Existing law establishes a variety of health care workforce training programs and health professions education programs within the Department of Health Care Access and Information to, among other things, 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 and ensure an adequate supply of appropriately trained professional and vocational nurses. Existing law establishes the Health Professions Education Fund to support those programs by providing scholarships and loans to students from underrepresented groups who are accepted to or enrolled in schools of medicine, dentistry, nursing, or other health professions.
This bill would establish the California Reproductive Health Service Corps within the department for the purposes of recruiting, training, and retaining a diverse workforce of reproductive health care professionals who will be part of reproductive health care teams to work in underserved areas. The bill would require the corps to administer and oversee scholarships and stipends for scholars who are new reproductive health students, and loan repayment for scholars who have acquired debt from attending a reproductive health professional school in the past, in exchange for a 3-year term of obligated service in California at a corps-approved site. The bill would require the corps to prioritize the selection of scholars from historically excluded populations and underserved areas, and would require scholars to agree to complete abortion training as part of their health care education and to provide, or participate on a team that provides, reproductive health services and to commit to working at a corps-approved site in a specified area with a specified population.
This bill would require the department to conduct an evaluation 5 years after implementation to assess the impact and effectiveness of the corps, and would require the department to report its findings to the Legislature on or before January 1, 2029.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) It is the intent of the Legislature to ensure the growth of a network of clinicians and health care staff trained in abortion and sexual and reproductive health care. These clinicians and staff should reflect California’s diverse racial, ethnic, linguistic, socioeconomic, and geographic diversity and be equipped to meet the reproductive health needs of all people in California.
(b) There are significant economic barriers to entering the health care workforce, as prospective students must take on significant amounts of debt to complete their education. Therefore, it is the intent of the Legislature to create a California Reproductive Health Service Corps program to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.
(c) While some educational programs for physicians, nurse practitioners, certified nurse-midwives, and physician assistants do provide didactic instruction in abortion care and miscarriage management, hands-on training to develop proficiency is limited. It is further the intent of the Legislature to ensure a diverse pool of health care providers are trained to provide a full range of sexual and reproductive health services, with emphasis on abortion care, by creating and funding a grant program for abortion training and for providers serving medically underserved populations.

SEC. 2.

 Article 6 (commencing with Section 128560) is added to Chapter 5 of Part 3 of Division 107 of the Health and Safety Code, to read:
Article  6. California Reproductive Health Service Corps

128560.
 For purposes of this article:
(a) “Corps” means the California Reproductive Health Service Corps established pursuant to Section 128561.
(b) “Reproductive health” means health services relating to abortion care, sexual health counseling, contraception, sexually transmitted infections, reproductive tract infections, HIV, gynecology, perinatal care, midwifery care, gender affirming care, and gender-based violence prevention.
(c) “Reproductive health care professionals” means medical doctors, licensed midwives, certified nurse-midwives, nurse practitioners, registered nurses, physician’s assistants, doulas, licensed vocational nurses, community health workers, and medical assistants.
(d) “Scholar” means a person in the corps who is a student who has been accepted in a school or a program on a part-time or full-time basis that graduates reproductive health care professionals or who is an existing reproductive health professional who desires more training and professional development in abortion care to provide this service.

128561.
 For the purposes of recruiting, training, and retaining a diverse workforce of reproductive health care professionals who will be part of reproductive health care teams to work in underserved areas, the California Reproductive Health Service Corps is hereby established in the department under the supervision of the director. The director shall ensure that adequate staff are provided to effectively administer the corps.

128562.
 The corps shall do all of the following:
(a) (1) Administer and oversee scholarships and stipends for new reproductive health students, loan repayment for graduates who have acquired debt from attending a reproductive health professional school in the past, and other types of direct financial support for scholars, in exchange for a three-year term of obligated service in California at a corps-approved site.
(2) Pay a learning institution, teaching facility, or approved clinical training site directly on behalf of scholar, including for tuition, fees, facility costs, teaching costs, and preceptor time.
(3) Provide an annual payment for education-related costs and a monthly stipend to cover living expenses directly to a scholar. The corps shall consider family size and numbers of dependents when determining stipend amounts.
(4) Offer existing reproductive health professionals an option for loan forgiveness for each year of service.
(5) Offer scholars stipends or reimbursement for childcare, eldercare, housing, health care coverage with coverage for mental health services, and transportation to eliminate known obstacles of educational completion for scholars.
(6) Notwithstanding paragraphs (2) to (5), inclusive, scholarships, stipends, and obligated service shall be independently assessed for doula education due to the diverse pathways for education.
(b) (1) Identify and create opportunities for scholars to receive supplemental trainings in comprehensive sexual and reproductive health care, including miscarriage management, aspiration abortion, and medication abortion, through partnerships with and financial support for California-based external partners providing and enabling clinical abortion training.
(2) Identify and create a postgraduate practice integration and retention program by funding organizations providing technical assistance and support to scholars, placement sites, or both to support incorporation of abortion services at service site or into a scholar’s practice.
(3) The Legislature finds that external contracts are critically important to the success of the corps to supplement the lack of training in abortion currently available at medical, nursing, or health care professional schools and to support service integration and retention posttraining. Supplemental programs are needed for scholars to be adequately trained before graduation.

128563.
 (a) The corps shall prioritize the selection of scholars from historically excluded populations and underserved areas, who reflect the patient populations they serve, to ensure greater inclusion and improved diverse representation in the reproductive health services workforce.
(b) Scholars from historically excluded populations shall meet one of the following criteria:
(1) Were or currently are homeless.
(2) Were or currently are in the foster care system.
(3) Were eligible for the National School Lunch Program for two or more years as a child.
(4) Do not have or have not had parents or legal guardians who completed a bachelor’s degree.
(5) Were or currently are eligible for federal Pell Grants.
(6) Received support from the California Special Supplemental Nutrition Program for Women, Infants, and Children as a parent or child.
(7) Reside or grew up in one of the following areas:
(A) A rural area, as designated by the Rural Health Grants Eligibility Analyzer of the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services.
(B) A health professional shortage area, as designated by the HRSA.
(8) Is an individual with a disability, meaning a person with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990 (42 U.S.C. Sec. 12101 et seq.), as amended.

128564.
 (a) A scholar shall do all of the following:
(1) Agree to complete abortion training as part of their health care education and to provide, or participate on a team that provides, reproductive health services with the inclusion of medical abortion or procedural abortion and miscarriage management.
(2) Commit to working for three years at a corps-approved site in one of the following areas or with one of the following populations:
(A) A health professional shortage area, as designated by the HRSA.
(B) A medically underserved area or with a medically underserved population, as mapped by the HRSA.
(C) A Maternity Care Health Professional Target Area, as designated by HRSA, or a maternity care desert, as designated by the March of Dimes.
(D) A rural area, as designated by the federal Centers for Medicare and Medicaid Services.
(E) A California county identified to have no abortion services.
(F) An area where the majority of patients are covered under the Medi-Cal program.
(3) Agree, in writing, that if the scholar fails to complete the period of obligated service at a corps-approved site, they will be in breach of contract.
(b) Notwithstanding paragraph (2) of subdivision (a), a scholar or a site may petition the corps for approval of a site based on the reproductive health needs of specific communities or populations or the area’s specific linguistic needs.
(c) With the authorization of the corps, a scholar may transfer to a new site to complete their obligated service. The corps shall define the criteria for transfer eligibility. Under certain defined conditions, the corps shall assist the scholar to find a new approved site.
(d) When a scholar is employed at a corps-approved site, the scholar shall be subject to the personnel system of that entity.

128565.
 (a) The department shall conduct an evaluation five years after implementation to assess the impact and effectiveness of the corps. The evaluation shall include all of the following:
(1) The number of health care providers from underrepresented racial, ethnic, socioeconomic, and geographic backgrounds that have completed the corps program.
(2) The number of scholars and corps graduates who are practicing in underserved areas.
(3) The geographic areas served by scholars and corps graduates and geographic placement gaps that persist.
(4) The provider types utilizing the corps.
(5) The number of scholars and corps graduates who have integrated abortion care into their practices.
(6) The number of applicants to the corps.
(7) The number of awardees who do not meet their service requirement, by provider type.
(b) The department shall report its findings to the Legislature on or before January 1, 2029. The report shall be submitted in compliance with Section 9795 of the Government Code.
(c) This section shall remain in effect only until January 1, 2031, and as of that date is repealed.

SEC. 3.

 The provisions of this act are severable. If any provision of this act or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.