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AB-443 Physicians and surgeons: fellowship programs: special faculty permits.(2021-2022)



Current Version: 04/19/21 - Amended Assembly         Compare Versions information image


AB443:v97#DOCUMENT

Amended  IN  Assembly  April 19, 2021
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 amend Sections 2168, 2168.1, and 2168.2 of, and to add Section 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 health professions. 2112.5 to, the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


AB 443, as amended, Carrillo. Office of Statewide Health Planning and Development: international medical graduates. Physicians and surgeons: fellowship programs: special faculty permits.
Existing law, the Medical Practice Act, authorizes physicians who are not citizens and who seek postgraduate study to, after application to and approval by the Medical Board of California, be permitted to participate in a fellowship program in a specialty or subspecialty field, if the fellowship program is given in a hospital in this state which is approved by the Joint Commission and if the service is satisfactory to the board.
This bill would authorize physicians who are not citizens and who seek postgraduate study to, after application to and approval by the board, be permitted to participate in a fellowship program in a specialty or subspecialty field if certain criteria are met, including that the fellowship program is given in a federally qualified health center, as defined, in this state that receives funding from the federal Health Resources and Services Administration Health Center Program and the service is satisfactory to the board.
The Medical Practice Act also authorizes a holder of a special faculty permit to practice medicine only within the medical school itself, any affiliated institution of the medical school, or an academic medical center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or academic medical center’s educational program and for which the medical school or academic medical center has assumed direct responsibility. The act prescribes criteria that a person is required to satisfy in order to apply for a special faculty permit, including that the person is academically eminent and possesses a current valid license to practice medicine issued by another state, country, or other jurisdiction. The act provides that a person is “academically eminent” if the person either holds or has been offered a full-time appointment at the level of full professor in a tenure track position, or its equivalent, at an academic medical center, as defined, or a California medical school approved by the board or the person is clearly outstanding in a specific field of medicine or surgery and has been offered by the dean of a medical school or the dean or chief medical officer of an academic medical center a full-time academic appointment at the level of full professor or associate professor, and a great need exists to fill that position.
This bill would additionally authorize a holder of a special faculty permit to practice medicine in a federally qualified health center and any affiliated institution. The bill would also provide that a person is also academically eminent if the person is an immigrant international medical graduate, as defined, participating in a fellowship program in a specialty or subspecialty field in a rural community or underserved community.

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 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: YES   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 serving non-English or limited English-speaking patients 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:
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.

SEC. 2.

 Section 2112.5 is added to the Business and Professions Code, to read:

2112.5.
 (a) (1) Physicians who are not citizens and who seek postgraduate study, may, after application to and approval by the board, be permitted to participate in a fellowship program in a specialty or subspecialty field if both of the following are true:
(A) The fellowship program is given in a federally qualified health center in this state that receives funding from the federal Health Resources and Services Administration Health Center Program.
(B) The service is satisfactory to the board.
(2) (A) A physician described in paragraph (1) shall at all times be under the direction and supervision of a licensed, board-certified physician and surgeon.
(B) The supervisor, as part of the application process, shall submit a curriculum vitae and a protocol of the fellowship program to be completed by the foreign fellow.
(3) Approval of the program and supervisor shall be for a period of one year and may be renewed annually upon application to and approval by the board. The approval may not be renewed more than four times.
(4) The board may determine an application fee not to exceed the reasonable regulatory cost to process an application. This fee shall be paid by the applicant at the time the application is filed.
(b) Except to the extent authorized by this section, a physician permitted to participate in a fellowship program pursuant to this section shall not engage in the practice of medicine or receive compensation therefor.
(c) The time spent participating a fellowship program in a federally qualified health center pursuant to this section shall not be used to meet the requirements for licensure.
(d) A physician permitted to participate in a fellowship program pursuant to this section shall speak a language of need matching the federally qualified health center’s patient population.
(e) A United States citizen who has received a medical degree from a medical school located in a foreign country may participate in a program established pursuant to this section.
(f) For purposes of this section, “federally qualified health center” has the same meaning as defined in subdivision (l) of Section 1396d of Title 42 of the United States Code.

SEC. 3.

 Section 2168 of the Business and Professions Code is amended to read:

2168.
 (a) (1) A special faculty permit authorizes the holder to practice medicine only within the medical school itself, any affiliated institution of the medical school, or an academic medical center and any affiliated institution institution, or a federally qualified health center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or school’s, academic medical center’s center’s, or federally qualified health center’s educational program and for which the medical school or school, academic medical center center, or federally qualified health center has assumed direct responsibility. The holder of a special faculty permit shall not engage in the practice of medicine except as provided above.
(2) For the purposes of this section, the term “academic medical center” is defined as being all of the following:
(A) A facility licensed by the State of California.
(B) The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis.
(C) The facility conducts clinical and basic research for the purpose of advancing patient care.
(D) The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1.
(E) The facility meets all of the following requirements:
(i) The facility has more than 100 research students or postdoctoral researchers annually.
(ii) The facility has foreign medical graduates in clinical research.
(iii) The facility offers clinical observership training.
(iv) The facility has an intern and resident-to-bed ratio meeting the federal Centers for Medicare and Medicaid Services definition as a major teaching hospital and conducts research in an amount of one hundred million dollars ($100,000,000) or more annually.
(b) Time spent in a faculty position under a special faculty permit shall not be counted toward the postgraduate training required for licensure and shall not qualify the holder of the permit for waiver of any written examination required for licensure.
(c) The medical school or school, academic medical center center, or federally qualified health center shall not appoint the holder of a special faculty permit to a position as a division chief or head of a department without express written authorization from the board.
(d) For purposes of this section, “federally qualified health center” has the same meaning as defined in Section 2112.5.

SEC. 4.

 Section 2168.1 of the Business and Professions Code is amended to read:

2168.1.
 (a) Any person who meets all of the following eligibility requirements may apply for a special faculty permit:
(1) Is academically eminent. For purposes of this article, paragraph, “academically eminent” means the applicant meets either any of the following criteria:
(A) The person holds or has been offered a full-time appointment at the level of full professor in a tenure track position, or its equivalent, at an academic medical center, as defined in Section 2168, or a California medical school approved by the board.
(B) The person is clearly outstanding in a specific field of medicine or surgery and has been offered by the dean of a medical school or the dean or chief medical officer of an academic medical center a full-time academic appointment at the level of full professor or associate professor, and a great need exists to fill that position.
(C) The person is an immigrant international medical graduate participating in a fellowship program in a specialty or subspecialty field in a rural community or underserved community.
(2) Possesses a current valid license to practice medicine issued by another state, country, or other jurisdiction.
(3) Is not subject to denial under Section 480 or any provision of this chapter.
(4) Pays the fee prescribed for application for, and initial licensure as, a physician and surgeon.
(5) Has not held a position under Section 2113 for a period of two years or more preceding the date of the application. The board may, in its discretion, waive this requirement.
(b) The board shall exercise its discretion in determining whether an applicant satisfies the requirements of paragraph (1) of subdivision (a).
(c) (1) The board shall establish a review committee composed of two members of the division, one of whom shall be a physician and surgeon and one of whom shall be a public member, one representative from each of the medical schools, and one individual selected pursuant to paragraph (3) to represent academic medical centers in California. The committee shall review and make recommendations to the board regarding the applicants applying pursuant to this section, including those applicants that a medical school or academic medical center proposes to appoint as a division chief or head of a department or as nontenure track faculty.
(2) The representative of the medical school or academic medical center offering the applicant an academic appointment shall not participate in any vote on the recommendation to the board for that applicant.
(3) The academic medical centers shall select by consensus, one individual to represent academic medical centers on the review committee.
(d) The board shall not approve more than five applications submitted pursuant to this section by academic medical centers in any calendar year.
(e) As used in this section, “academic medical center” has the same meaning as defined in subdivision (a) of Section 2168. section:
(1) “Academic medical center” has the same meaning as defined in Section 2168.
(2) “Immigrant international medical graduate” means an international medical graduate who meets all of the following requirements:
(A) The graduate was born outside the United States.
(B) The graduate now resides permanently in the United States.
(C) The graduate 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.
(D) The graduate is proficient in a threshold language, as defined in Section 1810.410 of Title 9 of the California Code of Regulations.
(3) “Rural community” means a rural community included in the list developed pursuant to Section 124425 of the Health and Safety Code.
(4) “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.

SEC. 5.

 Section 2168.2 of the Business and Professions Code is amended to read:

2168.2.
 An application for a special faculty permit shall be made on a form prescribed by the board and shall include any information that the board may prescribe to establish an applicant’s eligibility for a permit. This information shall include, but is not limited to, the following:
(a) A statement from the dean of the medical school or school, dean or chief medical officer at an academic medical center center, or the clinical or medical director of a federally qualified health center at which the applicant will be employed describing the applicant’s qualifications and justifying the dean’s or dean’s, chief medical officer’s officer’s, or the clinical or medical director’s determination that the applicant satisfies the requirements of paragraph (1) of subdivision (a) of Section 2168.1.
(b) A statement by the dean of the medical school or dean or chief medical officer of the academic medical center listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s or academic medical center’s educational program and justifying any clinical activities at each of the institutions listed by the dean or chief medical officer.
(c) For purposes of this section, “federally qualified health center” has the same meaning as defined in Section 2112.5.