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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
graduate medical education; residency programs
Purpose
Requires the Arizona Area Health Education System (Arizona AHEC), by May 1, 2024, to establish a primary care residency program for outlined health care facilities. Appropriates $5,000,000 from the state General Fund (state GF) in FY 2024 to the Arizona AHEC and $5,000,000 from the state GF in FYs 2024, 2025 and 2026 to the Arizona Health Care Cost Containment System Administration (AHCCCS).
Background
Established within the University of Arizona College of Medicine by the Arizona Board of Regents, the Arizona AHEC consists of six area health education centers, five of which represent a geographic area with identified populations that lack services by health care professions and one that represents the Indian health care delivery system. Each health education center conducts physician and other health professional education programs, including: 1) physician and other health professional education programs, including a undergraduate clinical training program, graduate program and postgraduate continuing education; 2) programs to recruit and retain minority students in health professions; and 3) continuing education programs for health professionals (A.R.S. § 15-1643).
AHCCCS must establish, contingent on approval by the U.S. Centers for Medicare and Medicaid Services (CMS), a separate graduate medical education program (GME program) to reimburse qualifying community health centers and rural health clinics that have an approved primary care GME program. A qualifying community health center is a community-based primary care facility that provides medical care in or to medically underserved areas or populations through the employment of specified health professionals. AHCCCS must distribute monies appropriated for GME programs to approved health entities for primary care GME program costs. Each GME program that receives appropriated monies must identify and report to AHCCCS the number of new residency positions created with the appropriated monies, including positions in rural areas (A.R.S. § 36-2907.06).
A GME program prepares a physician for the independent practice of medicine by providing didactic and clinical education in a medical discipline to a medical student who has completed a recognized undergraduate medical education program (A.R.S. § 36-2901).
H.B. 2753 appropriates $5,000,000 from the state GF in FY 2024 to the Arizona AHEC and $5,000,000 from the state GF in FYs 2024, 2025 and 2026 to AHCCCS.
Provisions
1. Requires the Arizona AHEC, by May 1, 2024, to establish a program for qualifying community health centers, rural health clinics and tribal health facilities that:
a) supports and expands the number of primary care residency positions;
b) provides support and technical assistance for starting or expanding primary care residency programs in rural and health professional shortage areas; and
c) facilitates information and resource sharing and provides training and technical assistance, including preceptor training and development, continuing education, medical library access and other functions, to support the success of qualifying community health center, rural health clinic and tribal health facility primary care residency programs.
2. Appropriates $5,000,000 from the state GF in FY 2024 to the Arizona AHEC to establish the primary care residency program.
3. Allows the Arizona AHEC to use up to $500,000 of the appropriation to support a collaborative of qualifying community health centers', rural health clinics' and tribal health facilities primary care residency programs.
4. Expands the AHCCCS-established GME program to provide reimbursements for qualifying health care services to advanced practice registered nurse (APRN) residency and fellowship programs.
5. Appropriates $5,000,000 from the state GF in FYs 2024, 2025 and 2026 to AHCCCS for the direct and indirect costs of primary care GME or APRN residency or fellowship programs at qualifying community health centers, rural health clinics and tribal health facilities.
6. Requires AHCCCS, if AHCCCS has not received GME program approval from CMS by June 1, 2024, to distribute the GME program monies for that fiscal year to the qualifying community health centers, rural health clinics and tribal health facilities that have approved primary care GME or APRN residency or fellowship programs.
7. Allows the distributed monies, if CMS approval is received after June 1, 2024, to qualify as the required match for the subsequent fiscal year.
8. Exempts the appropriations from lapsing.
9. Defines primary care and tribal health facility.
10. Makes conforming changes.
11. Becomes effective on the general effective date.
Amendments Adopted by the Health and Human Services Committee
· Adds, to the authorized uses of the $5,000,000 AHCCCS appropriation, the direct and indirect costs of APRN residency or fellowship programs.
Amendments Adopted by the Appropriations Committee
1. Expands the AHCCCS-established GME program to provide reimbursements for qualifying health care services to APRN residency and fellowship programs.
2. Adds, to the authorized uses of the $5,000,000 AHCCCS appropriation, the direct and indirect costs of APRN residency or fellowship programs.
3. Requires AHCCCS, if AHCCCS has not received GME program approval from CMS by June 1, 2024, to distribute the GME program monies for that fiscal year to qualifying health care facilities that have approved primary care GME or APRN residency or fellowship programs.
4. Allows the distributed monies, if CMS approval is received after June 1, 2024, to qualify as the required match for the subsequent fiscal year.
5. Makes technical and conforming changes.
House Action Senate Action
ED 2/14/23 DPA 8-0-1-1 HHS 3/21/23 DPA 7-0-0
3rd Read 2/28/23 31-28-1 APPROP 3/28/23 DPA 6-2-2
Prepared by Senate Research
March 29, 2023
MG/MC/slp