128250-128290

HEALTH AND SAFETY CODE
SECTION 128250-128290




128250.  This article shall be known and may be cited as the Health
Education and Academic Loan Act.



128255.  The Legislature finds and declares all of the following:
   (a) Lower levels of reimbursement in rural and inner-city areas
for certain critical primary care practices combined with increasing
student costs deter medical students from entering the primary care
specialties.
   (b) Physicians typically begin their practices heavily in debt
from student loans acquired to finance their education.
   (c) Because of the lower levels of reimbursement and the burden of
educational debts, the number of primary care physicians who choose
to practice in California is insufficient to adequately meet the
health needs of the state's population.
   (d) Repayment of student loans for medical students as a means to
encourage increased provision of primary care medical services will
benefit all citizens of California.



128260.  As used in this article, unless the context otherwise
requires, the following definitions shall apply:
   (a) "Commission" means the California Healthcare Workforce Policy
Commission.
   (b) "Director" means the Director of Statewide Health Planning and
Development.
   (c) "Medically underserved designated shortage area" means any of
the following:
   (1) An area designated by the commission as a critical health
workforce shortage area.
   (2) A medically underserved area, as designated by the United
States Department of Health and Human Services.
   (3) A critical workforce shortage area, as defined by the United
States Department of Health and Human Services.
   (d) "Primary care physician" means a physician who has the
responsibility for providing initial and primary care to patients,
for maintaining the continuity of patient care, and for initiating
referral for care by other specialists. A primary care physician
shall be a board-certified or board-eligible general internist,
general pediatrician, general obstetrician-gynecologist, or family
physician.


128265.  (a) The commission may provide assistance for the repayment
of any student loan for medical education received by a medical
student in an institution of higher education in California. The
director, with the advice and upon the recommendation of the
commission, shall make loan assumption payments using the criteria
developed pursuant to this section and Sections 128270 and 128275 any
other criteria developed by the commission that are consistent with
this section and Sections 128270 and 128275. The commission may not
provide loan assumption assistance for a loan that is in default at
the time of the application.
   (b) The Office of Statewide Health Planning and Development, in
consultation with the commission, may adopt, by regulation, rules and
procedures necessary to administer the loan assumption program
established pursuant to this section and Sections 128270 and 128275.




128270.  To be eligible for loan assumption assistance, an applicant
shall meet both of the following requirements:
   (a) Be enrolled as a full-time student in an accredited California
medical school and be a resident of California at the time of the
application.
   (b) Enter a primary care residency training program in California
and provide primary care medical services for a minimum of three
years after completion of residency.



128275.  (a) Each recipient of loan assumption assistance shall
enter into a written contract with the commission, which shall be
considered a contract with the State of California. In executing
contracts, the commission shall give priority to those applicants who
agree to provide primary care services for a minimum of three years
in a medically underserved designated shortage area.
   (b) The contract shall include all of the following terms and
conditions:
   (1) An unlicensed applicant shall apply for a license to practice
medicine in California at the earliest practicable opportunity.
   (2) Within six months after licensure and the completion of all
requirements for the primary care specialty, the applicant shall
engage in the practice of primary care medicine.
   (3) The recipient shall agree to provide three consecutive years
of service as a primary care physician in a medically underserved
designated shortage area, or five consecutive years of service in an
area not designated by the commission or the United States Department
of Health and Human Services as a medically underserved area in
order to receive loan assumption assistance made on his or her behalf
directly to the lending institution. Loan assumption assistance
shall be provided only for the principal amount of the recipient's
loan. If any recipient takes pregnancy or paternity leave or suffers
temporary disability, the recipient shall perform an amount of
service equal to the amount of service lost because of the pregnancy
or paternity leave or temporary disability. Performance of that
service by the recipient shall commence immediately upon his or her
return to work following the leave or disability. Under a three-year
term of service, 20 percent of the total grant shall be provided on
behalf of the recipient upon completion of the first year of service;
30 percent shall be provided on behalf of the recipient upon
completion of the second year of service; and 50 percent shall be
provided to the recipient or to the lending institution on behalf of
the recipient upon completion of three years of service as a primary
care physician if the recipient received medical student loan
deferment. If a recipient agrees to provide five years of service
pursuant to this paragraph, 20 percent of the total grant shall be
provided on behalf of the recipient upon completion of the first year
of service; 10 percent shall be provided upon completion of the
second year of service; 10 percent shall be provided upon completion
of the third year of service; 10 percent shall be provided upon
completion of the fourth year of service; and 50 percent shall be
provided to the recipient or to the lending institution on behalf of
the recipient upon completion of five years of service as a primary
care physician if the recipient received medical student loan
deferment.
   (4) The physician shall treat patients in the area who are
eligible for medicaid, Medicare, Medi-Cal, and county reimbursement
for low-income and medically indigent adults in addition to
fee-for-service patients and shall develop a sliding fee scale for
low-income patients.
   (5) Those applicants who agree to practice in underserved areas
shall practice full time in the medically underserved designated
shortage area.
   (6) The physician shall permit the commission to monitor his or
her practice to determine compliance with the terms of the contract.
   (7) The commission shall certify compliance with the terms of the
contract for purposes of receipt by the physician of the loan
assumption assistance for years subsequent to the initial year of
loan assumption assistance.
   (8) If the recipient dies or becomes totally or permanently
disabled, the commission shall nullify the service obligation of the
recipient and the commission shall repay the student loan in full.
   (9) If the recipient is convicted of a felony or misdemeanor
involving moral turpitude, commits an act of gross negligence in the
performance of service obligations, or his or her license to practice
is revoked or suspended by the appropriate licensing board, the
commission may demand repayment of any funds expended as loan
assumption assistance on behalf of the physician.
   (10) Any recipient of loan assumption assistance who fails to
fulfill the obligations for which he or she contracted shall pay to
the commission the full amount received plus interest from the date
of the original contract at the rate of 2 percent above the prime
rate at the time of the breach. The director may recover all costs
and attorney fees incurred as a result of collecting payments
resulting from the breach.
   (11) The loan assumption program provided by this section shall
apply only to government loans, or those loans insured or made
available by federal or state government.
   (12) Not more than 10 percent of the funds obtained from
alternative sources, as specified in Section 128290, may be used to
cover the administrative costs incurred by the Office of Statewide
Health Planning and Development to implement the loan assumption
program.


128280.  Each publicly funded medical school in California shall
inform incoming medical students of all student loan, loan repayment,
and medical student scholarship programs available to them. This
information shall include, but need not be limited to, information
concerning the National Health Service Corps program, the Health
Professions Education Foundation Program, and the Loan Assumption
Program created pursuant to this article.



128285.  No requirement contained in this article shall apply to the
University of California unless the Regents of the University of
California, by resolution, make that requirement applicable.



128290.  (a) This article shall only be implemented if private funds
are made available from private sources for all program and
administrative costs related to the implementation of this article.
   (b) No state funds shall be used to implement this article.
   (c) This article shall become operative only upon certification by
the Director of the Office of Statewide Health Planning and
Development that sufficient private funds have been made available
from private sources to implement this article.