BILL REQ. #:  H-0359.1 

Prefiled 12/29/08. Read first time 01/12/09.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to establishing the family medicine residency training grant program; amending RCW 43.72.900; reenacting and amending RCW 43.79A.040; adding a new section to chapter 82.24 RCW; adding a new chapter to Title 70 RCW; and providing an effective date.

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

NEW SECTION.  Sec. 1   Sections 2 through 5 of this act constitute a new chapter in Title 70 RCW.

NEW SECTION.  Sec. 2   The legislature finds that:
     (1) Many rural and urban communities, and economically disadvantaged and minority populations, are medically underserved and are likely to become even more so if, as predicted by the health resources and services administration in 2006, a national shortage of physicians emerges by 2020.
     (2) Community health centers provide primary and preventive health care services for people living in rural and urban medically underserved communities. Service is provided regardless of a patient's ability to pay. There are over one hundred thirty community health center sites in Washington.
     (3) Community health centers are already facing a health workforce crisis. A recent national survey of eight hundred ninety community health centers found a pronounced shortage of family medicine physicians, with more than four hundred family medicine vacancies, forty percent of which had been open for more than seven months. As of November 13, 2008, there were twenty-one family medicine vacancies at Sea Mar community health centers in Washington.
     (4) Physicians in the United States are licensed by individual states, all of whom require a degree as a medicinae doctor or doctor of osteopathy as well as postgraduate training in an accredited residency program. Following receipt of a medicinae doctor or doctor of osteopathy degree, residents complete their training in residency programs in their chosen area of specialty, providing patient care under the supervision of teaching physicians.
     (5) The University of Washington school of medicine has recently expanded the number of allopathic medical students.
     (6) The Pacific Northwest University of Health Sciences college of osteopathic medicine opened in August of 2008 with its first class of seventy-five osteopathic medical students.
     (7) Studies have shown that physicians in this region who do their postgraduate family medicine residency training at community health centers are almost twice as likely to subsequently work in underserved settings and almost four times as likely to subsequently work in a community health center as compared with physicians who do their family medicine residency training in other settings.
     (8) There are currently thirteen accredited family medicine residency programs in Washington, only three of which are sponsored or sited at a community health center.
     (9) In order to be accredited, sponsoring and participating residency sites must provide all residents with appropriate financial support and benefits to ensure that they are able to fulfill the responsibilities of their residency program. At each participating site, there must be a sufficient faculty with documented qualifications to instruct and supervise all residents at that location.
     (10) Medicare dollars have historically provided a significant source of funding to offset some of the costs associated with educating medical residents. In 1997, the federal balanced budget act placed a cap on the number of residency positions that the program supports. The cap remains today, despite calls by the association of American medical colleges and others for the elimination of the cap and an increase in residency positions in order to address the projected shortage of physicians.

NEW SECTION.  Sec. 3   Within funds appropriated to the department of health for this purpose, and with the goal of increasing the number of family medicine residency positions at community health centers, and thereby increasing the number of family medicine physicians working in underserved settings, a family medicine residency training grant program is created. Grant funds provided for the purpose of increasing the number of family medicine residency positions at community health centers shall be disbursed by the department of health to at least three accredited, three-year family medicine residency programs sponsored or sited at community health centers in rural or urban medically underserved areas. In the first year, and each subsequent year thereafter, family medicine residency programs to which the grant funds are awarded shall offer at least two first-year postgraduate residency positions in family medicine. In the second year, and each subsequent year thereafter, these family medicine residency programs shall also offer at least two second-year postgraduate residency positions in family medicine. In the third year, and each subsequent year thereafter, these family medicine residency programs shall also offer at least two third-year postgraduate residency positions in family medicine.

NEW SECTION.  Sec. 4   The joint legislative audit and review committee shall conduct a performance audit and evaluation of the family medicine residency training grant program created in section 3 of this act every five years. The first audit must be conducted by December 31, 2015. The audit must include a comparison of family medicine physicians who did their postgraduate family medicine residency training at community health centers with those who did their postgraduate family medicine residency training in other programs to determine whether the location of the family medicine residency training influenced or affected where the resident ultimately chose to work.

NEW SECTION.  Sec. 5   (1) The family medicine residency training account is created in the custody of the state treasurer. No appropriation is required for expenditures of funds from the account. The account is not subject to allotment procedures under chapter 43.88 RCW except for moneys used for program administration.
     (2) The department of health shall deposit into the account all moneys received from private contributions for the program. The account shall be self-sustaining and consist of private contributions for the family medicine residency training grant program.
     (3) Expenditures from the account may be used solely for grants to family medicine residency programs sponsored or sited in community health centers in rural or urban medically underserved areas and costs associated with program administration by the department of health.
     (4) Disbursements from the account may be made only on the authorization of the department of health.

NEW SECTION.  Sec. 6   A new section is added to chapter 82.24 RCW to read as follows:
     (1) An additional tax is imposed upon the sale, use, consumption, handling, possession, or distribution of cigarettes, in an amount equal to seven and one-half cents per pack.
     (2) The revenue collected under this section shall be deposited in the health services account created in RCW 43.72.900.

Sec. 7   RCW 43.72.900 and 2005 c 518 s 930 are each amended to read as follows:
     (1) The health services account is created in the state treasury. Moneys in the account may be spent only after appropriation. Subject to the transfers described in subsection (3) of this section, moneys in the account may be expended only for maintaining and expanding health services access for low-income residents, maintaining and expanding the public health system, maintaining and improving the capacity of the health care system, containing health care costs, and the regulation, planning, and administering of the health care system.
     (2) Funds deposited into the health services account under RCW 82.24.028 ((and 82.26.028)) shall be used solely as follows:
     (a) Five million dollars for the state fiscal year beginning July 1, 2002, and five million dollars for the state fiscal year beginning July 1, 2003, shall be appropriated by the legislature for programs that effectively improve the health of low-income persons, including efforts to reduce diseases and illnesses that harm low-income persons. The department of health shall submit a report to the legislature on March 1, 2002, evaluating the cost-effectiveness of programs that improve the health of low-income persons and address diseases and illnesses that disproportionately affect low-income persons, and making recommendations to the legislature on which of these programs could most effectively utilize the funds appropriated under this subsection.
     (b) Ten percent of the funds deposited into the health services account under RCW 82.24.028 ((and 82.26.028)) remaining after the appropriation under (a) of this subsection shall be transferred no less frequently than annually by the treasurer to the tobacco prevention and control account established by RCW 43.79.480. The funds transferred shall be used exclusively for implementation of the Washington state tobacco prevention and control plan and shall be used only to supplement, and not supplant, funds in the tobacco prevention and control account as of January 1, 2001, however, these funds may be used to replace funds appropriated by the legislature for further implementation of the Washington state tobacco prevention and control plan for the biennium beginning July 1, 2001. For each state fiscal year beginning on and after July 1, 2002, the legislature shall appropriate no less than twenty-six million two hundred forty thousand dollars from the tobacco prevention and control account for implementation of the Washington state tobacco prevention and control plan.
     (c) Because of its demonstrated effectiveness in improving the health of low-income persons and addressing illnesses and diseases that harm low-income persons, the remainder of the funds deposited into the health services account under RCW 82.24.028 ((and 82.26.028)) shall be appropriated solely for Washington basic health plan enrollment as provided in chapter 70.47 RCW. Funds appropriated under this subsection may be used to support outreach and enrollment activities only to the extent necessary to achieve the enrollment goals described in this section.
     (3) Prior to expenditure for the purposes described in subsection (2) of this section, funds deposited into the health services account under RCW 82.24.028 ((and 82.26.028)) shall first be transferred to the following accounts to ensure the continued availability of previously dedicated revenues for certain existing programs:
     (a) To the violence reduction and drug enforcement account under RCW 69.50.520, two million two hundred forty-nine thousand five hundred dollars for the state fiscal year beginning July 1, 2001, four million two hundred forty-eight thousand dollars for the state fiscal year beginning July 1, 2002, seven million seven hundred eighty-nine thousand dollars for the biennium beginning July 1, 2003, six million nine hundred thirty-two thousand dollars for the biennium beginning July 1, 2005, and six million nine hundred thirty-two thousand dollars for each biennium thereafter, as required by RCW 82.24.020(2);
     (b) To the health services account under this section, nine million seventy-seven thousand dollars for the state fiscal year beginning July 1, 2001, seventeen million one hundred eighty-eight thousand dollars for the state fiscal year beginning July 1, 2002, thirty-one million seven hundred fifty-five thousand dollars for the biennium beginning July 1, 2003, twenty-eight million six hundred twenty-two thousand dollars for the biennium beginning July 1, 2005, and twenty-eight million six hundred twenty-two thousand dollars for each biennium thereafter, as required by RCW 82.24.020(3); and
     (c) To the water quality account under RCW 70.146.030, two million two hundred three thousand five hundred dollars for the state fiscal year beginning July 1, 2001, four million two hundred forty-four thousand dollars for the state fiscal year beginning July 1, 2002, eight million one hundred eighty-two thousand dollars for the biennium beginning July 1, 2003, seven million eight hundred eighty-five thousand dollars for the biennium beginning July 1, 2005, and seven million eight hundred eighty-five thousand dollars for each biennium thereafter((, as required by RCW 82.24.027(2)(a))).
     During the 2005-2007 fiscal biennium, the legislature may transfer from the health services account such amounts as reflect the excess fund balance of the account to the state general fund.
     (4) Funds deposited into the health services account under section 6 of this act shall be used solely to fund the family medicine residency training grant program under section 3 of this act.

Sec. 8   RCW 43.79A.040 and 2008 c 239 s 9, 2008 c 208 s 9, 2008 c 128 s 20, and 2008 c 122 s 24 are each reenacted and amended to read as follows:
     (1) Money in the treasurer's trust fund may be deposited, invested, and reinvested by the state treasurer in accordance with RCW 43.84.080 in the same manner and to the same extent as if the money were in the state treasury.
     (2) All income received from investment of the treasurer's trust fund shall be set aside in an account in the treasury trust fund to be known as the investment income account.
     (3) The investment income account may be utilized for the payment of purchased banking services on behalf of treasurer's trust funds including, but not limited to, depository, safekeeping, and disbursement functions for the state treasurer or affected state agencies. The investment income account is subject in all respects to chapter 43.88 RCW, but no appropriation is required for payments to financial institutions. Payments shall occur prior to distribution of earnings set forth in subsection (4) of this section.
     (4)(a) Monthly, the state treasurer shall distribute the earnings credited to the investment income account to the state general fund except under (b) and (c) of this subsection.
     (b) The following accounts and funds shall receive their proportionate share of earnings based upon each account's or fund's average daily balance for the period: The Washington promise scholarship account, the college savings program account, the Washington advanced college tuition payment program account, the agricultural local fund, the American Indian scholarship endowment fund, the foster care scholarship endowment fund, the foster care endowed scholarship trust fund, the students with dependents grant account, the basic health plan self-insurance reserve account, the contract harvesting revolving account, the Washington state combined fund drive account, the commemorative works account, the Washington international exchange scholarship endowment fund, the toll collection account, the developmental disabilities endowment trust fund, the energy account, the fair fund, the family leave insurance account, the family medicine residency training account, the food animal veterinarian conditional scholarship account, the fruit and vegetable inspection account, the future teachers conditional scholarship account, the game farm alternative account, the GET ready for math and science scholarship account, the grain inspection revolving fund, the juvenile accountability incentive account, the law enforcement officers' and firefighters' plan 2 expense fund, the local tourism promotion account, the pilotage account, the produce railcar pool account, the regional transportation investment district account, the rural rehabilitation account, the stadium and exhibition center account, the youth athletic facility account, the self-insurance revolving fund, the sulfur dioxide abatement account, the children's trust fund, the Washington horse racing commission Washington bred owners' bonus fund account, the Washington horse racing commission class C purse fund account, the individual development account program account, the Washington horse racing commission operating account (earnings from the Washington horse racing commission operating account must be credited to the Washington horse racing commission class C purse fund account), the life sciences discovery fund, the Washington state heritage center account, the reduced cigarette ignition propensity account, and the reading achievement account. However, the earnings to be distributed shall first be reduced by the allocation to the state treasurer's service fund pursuant to RCW 43.08.190.
     (c) The following accounts and funds shall receive eighty percent of their proportionate share of earnings based upon each account's or fund's average daily balance for the period: The advanced right-of-way revolving fund, the advanced environmental mitigation revolving account, the city and county advance right-of-way revolving fund, the federal narcotics asset forfeitures account, the high occupancy vehicle account, the local rail service assistance account, and the miscellaneous transportation programs account.
     (5) In conformance with Article II, section 37 of the state Constitution, no trust accounts or funds shall be allocated earnings without the specific affirmative directive of this section.

NEW SECTION.  Sec. 9   This act takes effect August 1, 2009.