BILL REQ. #:  S-1765.3 

READ FIRST TIME 02/25/09.   

     AN ACT Relating to primary care physician training; amending RCW 28B.15.910; adding new sections to chapter 28B.15 RCW; adding new sections to chapter 28B.20 RCW; creating new sections; and providing an expiration date.

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

NEW SECTION.  Sec. 1   INTENT. The legislature finds that there is a critical shortage of primary care physicians in the state especially in rural areas. Primary care physicians operate as the entry point into the health care system and as such play a vital role in improving quality and controlling the costs of health care. It is the legislature's intent to create incentives for medical school students to choose primary care practice for their medical careers.

NEW SECTION.  Sec. 2   DEFINITIONS. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Conditional tuition waiver" means a loan that is forgiven in whole or in part if the recipient renders service as a primary care physician in this state.
     (2) "Eligible student" means a resident student, as defined in RCW 28B.15.012, who is registered for at least six credit hours or the equivalent, is making satisfactory academic progress as defined by the university, has declared primary care medicine for his or her major, and has a declared intention to practice primary care medicine in the state of Washington.
     (3) "Forgiven" or "to forgive" or "forgiveness" means to practice primary care medicine in the state of Washington in lieu of monetary repayment.
     (4) "Participant" means an eligible student who has received a conditional tuition waiver under this chapter.
     (5) "Primary care" means a physician licensed under chapter 18.71 RCW who is specifically trained for family practice medicine and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern not limited by problem origin, organ system, or diagnosis. Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, and diagnosis and treatment of acute and chronic illness, in a variety of health care settings. Primary care is performed and managed by a personal physician often collaborating with other health professionals and using consultation or referral as appropriate.
     (6) "Satisfied" means paid-in-full.
     (7) "University" means the University of Washington.

NEW SECTION.  Sec. 3   PROGRAM ESTABLISHED. The primary care physician conditional tuition waiver program is established. The program shall be administered by the university. In administering the program, the university has the following powers and duties:
     (1) To adopt necessary rules and guidelines;
     (2) To publicize the program;
     (3) To collect and manage repayments from students who do not meet their obligations under this chapter; and
     (4) To solicit and accept grants and donations from public and private sources for the program.

NEW SECTION.  Sec. 4   SELECTION OF PARTICIPANTS--PROCESS. (1) The university shall select participants based on the application process conducted by the university.
     (2) The university shall create a standard process for medical school students to declare their intention to be primary care physicians for the purposes of participating in the primary care physician conditional tuition waiver program. Applicants accepted into the program must provide the university with a signed contract accepting the terms of the program.
     (3) Students who comply with subsection (2) of this section may be awarded conditional tuition waivers under this chapter, subject to available funds.

NEW SECTION.  Sec. 5   CONTINUED ELIGIBILITY. To remain an eligible student and receive continuing disbursements under the program, a participant must be considered by the university to be making satisfactory academic progress.

NEW SECTION.  Sec. 6   AWARD OF TUITION WAIVERS--AMOUNT--DURATION. The amount of the conditional tuition waiver awarded an individual may not exceed the amount of resident tuition and fees at the university incurred by an eligible student and approved by a financial aid administrator at the university. Participants are eligible to receive conditional tuition waivers for a maximum of four years.

NEW SECTION.  Sec. 7   REPAYMENT OBLIGATION--RULES. (1) A participant in the conditional tuition waiver program incurs an obligation to repay the tuition waiver, with interest, unless he or she is employed as a primary care physician in Washington state for two years for every one year of tuition received, under rules adopted by the university.
     (2) The interest rate shall be determined annually by the university.
     (3) The minimum payment shall be set by the university. The maximum period for repayment is ten years, with payments of principal and interest accruing quarterly commencing six months from the date the participant completes or discontinues the course of study, including any internship or residency in primary care medicine. Provisions for deferral of payment shall be determined by the university.
     (4) The entire principal and interest of each payment shall be forgiven for each payment period in which the participant is employed as a primary care physician in this state until the entire repayment obligation is satisfied. Should the participant cease to be employed as a primary care physician in this state before the participant's repayment obligation is completed, payments on the unsatisfied portion of the principal and interest shall begin the next payment period and continue until the remainder of the participant's repayment obligation is satisfied.
     (5) The university is responsible for collection of repayments made under this section and shall exercise due diligence in such collection, maintaining all necessary records to ensure that maximum repayments are made. Collection and servicing of repayments under this section shall be pursued using the full extent of the law, including wage garnishment if necessary. The university is responsible to forgive all or parts of such repayments under the criteria established in this section and shall maintain all necessary records of forgiven payments.
     (6) Receipts from the payment of principal or interest or any other subsidies to which the university as administrator is entitled, that are paid by or on behalf of participants under this section, shall be deposited in the primary care physician conditional tuition waiver account and shall be used to cover the costs of granting the conditional tuition waivers, maintaining necessary records, and making collections under subsection (5) of this section. The university shall maintain accurate records of these costs, and all receipts beyond those necessary to pay such costs shall be used to grant conditional tuition waivers to eligible students.
     (7) The university shall adopt rules to define the terms of repayment, including applicable interest rates, fees, and deferments.

Sec. 8   RCW 28B.15.910 and 2008 c 188 s 3 are each amended to read as follows:
     (1) For the purpose of providing state general fund support to public institutions of higher education, except for revenue waived under programs listed in subsections (3) and (4) of this section, and unless otherwise expressly provided in the omnibus state appropriations act, the total amount of operating fees revenue waived, exempted, or reduced by a state university, a regional university, The Evergreen State College, or the community colleges as a whole, shall not exceed the percentage of total gross authorized operating fees revenue in this subsection. As used in this section, "gross authorized operating fees revenue" means the estimated gross operating fees revenue as estimated under RCW 82.33.020 or as revised by the office of financial management, before granting any waivers. This limitation applies to all tuition waiver programs established before or after July 1, 1992.
     (a) University of Washington       21 percent
     (b) Washington State University       20 percent
     (c) Eastern Washington University       11 percent
     (d) Central Washington University       10 percent
     (e) Western Washington University       10 percent
     (f) The Evergreen State College       10 percent
     (g) Community colleges as a whole       35 percent
     (2) The limitations in subsection (1) of this section apply to waivers, exemptions, or reductions in operating fees contained in the following:
     (a) RCW 28B.15.014;
     (b) RCW 28B.15.100;
     (c) RCW 28B.15.225;
     (d) RCW 28B.15.380;
     (e) RCW 28B.15.520;
     (f) RCW 28B.15.526;
     (g) RCW 28B.15.527;
     (h) RCW 28B.15.543;
     (i) RCW 28B.15.545;
     (j) RCW 28B.15.555;
     (k) RCW 28B.15.556;
     (l) RCW 28B.15.615;
     (m) RCW 28B.15.621 (2) and (4);
     (n) RCW 28B.15.730;
     (o) RCW 28B.15.740;
     (p) RCW 28B.15.750;
     (q) RCW 28B.15.756;
     (r) RCW 28B.50.259; ((and))
     (s) RCW 28B.70.050; and
     (t) Section 4 of this act.
     (3) The limitations in subsection (1) of this section do not apply to waivers, exemptions, or reductions in services and activities fees contained in the following:
     (a) RCW 28B.15.522;
     (b) RCW 28B.15.540;
     (c) RCW 28B.15.558; and
     (d) RCW 28B.15.621(3).
     (4) The total amount of operating fees revenue waived, exempted, or reduced by institutions of higher education participating in the western interstate commission for higher education western undergraduate exchange program under RCW 28B.15.544 shall not exceed the percentage of total gross authorized operating fees revenue in this subsection.
     (a) Washington State University       1 percent
     (b) Eastern Washington University       3 percent
     (c) Central Washington University       3 percent
     (5) The institutions of higher education will participate in outreach activities to increase the number of veterans who receive tuition waivers. Colleges and universities shall revise the application for admissions so that all applicants shall have the opportunity to advise the institution that they are veterans who need assistance. If a person indicates on the application for admissions that the person is a veteran who is in need of assistance, then the institution of higher education shall ask the person whether they have any funds disbursed in accordance with the Montgomery GI Bill available to them. Each institution shall encourage veterans to utilize funds available to them in accordance with the Montgomery GI Bill prior to providing the veteran a tuition waiver.

NEW SECTION.  Sec. 9   A new section is added to chapter 28B.20 RCW to read as follows:
     The University of Washington shall provide medical school students with information about the growth of patient and family-centered primary care medical homes throughout the state as a desirable and important strategy to improve quality of care.

NEW SECTION.  Sec. 10   A new section is added to chapter 28B.20 RCW to read as follows:
     Funding for graduate medical education shall be directed toward residents-in-training in family medicine, internal medicine, and pediatrics who plan to pursue primary care in Washington following their residency programs.

NEW SECTION.  Sec. 11   CAPTIONS NOT LAW. Captions used in this act are not any part of the law.

NEW SECTION.  Sec. 12   Sections 2 through 7 of this act are each added to chapter 28B.15 RCW.

NEW SECTION.  Sec. 13   This act expires July 1, 2019.