BILL REQ. #:  S-0455.4 

Read first time 01/23/09.   Referred to Committee on Higher Education & Workforce Development.

     AN ACT Relating to primary care physician training; amending RCW 28B.15.020; adding new sections to chapter 70.112 RCW; adding a new section to chapter 28B.20 RCW; and adding a new chapter to Title 28B RCW.

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 his section shall be awarded conditional tuition waivers under this chapter.

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 university shall award primary care physician conditional tuition waivers to eligible students from the funds appropriated to the university for this purpose, from assessments collected under section 9 of this act, from any private donations, or any other funds given to the university for this program. 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 five 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 one year for every two years 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.

NEW SECTION.  Sec. 8   SPECIALTY MEDICAL EDUCATION TUITION ADJUSTMENT. The university shall adjust the tuition of each student who, upon admission to the university medical school, does not choose to participate in the primary care physician conditional tuition waiver program. The tuition adjustment to these students shall be calculated to fund the cost for students who do participate.

NEW SECTION.  Sec. 9   PRIMARY CARE PHYSICIAN CONDITIONAL TUITION WAIVER ACCOUNT. (1) The primary care physician conditional tuition waiver 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 university shall deposit into the account all moneys received for the program. The account shall be self-sustaining and consist of funds appropriated by the legislature for the primary care physician conditional tuition waiver program, specialty medical education tuition adjustments, private contributions to the program, and receipts from participant repayments.
     (3) Expenditures from the account may be used solely for conditional tuition waivers to participants in the program established by this chapter and costs associated with program administration by the university.
     (4) Disbursements from the account may be made only on the authorization of the university.

NEW SECTION.  Sec. 10   CAPTIONS NOT LAW. Captions used in this chapter are not any part of the law.

Sec. 11   RCW 28B.15.020 and 1985 c 390 s 11 are each amended to read as follows:
     The term "tuition fees" as used in this chapter shall mean the fees charged students registering at the state's colleges and universities which consist of:
     (1) The "building fees" as defined in RCW 28B.15.025; ((and))
     (2) The "operating fees" as defined in RCW 28B.15.031; and
     (3) The "specialty medical education tuition adjustment" established in section 8 of this act.

NEW SECTION.  Sec. 12   A new section is added to chapter 70.112 RCW to read as follows:
     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. 13   A new section is added to chapter 70.112 RCW to read as follows:
     (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. 14   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 following their residency programs.

NEW SECTION.  Sec. 15   Sections 1 through 10 of this act constitute a new chapter in Title 28B RCW.