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COMMITTEE REPORT
April 13, 2005
H. 3741
Introduced by Reps. Ballentine, Wilkins, Harrell, Merrill, Ott, Hinson, Mack, Bowers, Taylor, Sinclair, Bales, Norman, Martin, Rutherford, Funderburk, Hiott, Cotty, Harrison, Haley, Govan, Scott, Vick, McGee, Anderson, Hardwick, Frye, W.D. Smith, Leach, J.H. Neal, G.R. Smith, Huggins, Skelton, McLeod, Cato, Witherspoon, Clemmons, Clark, Agnew, Barfield, Bingham, Brady, Branham, J. Brown, Ceips, Chalk, Cobb-Hunter, Cooper, Duncan, Herbkersman, Howard, Jefferson, Mahaffey, Neilson, Owens, Parks, Pinson, E.H. Pitts, M.A. Pitts, Rice, Sandifer, J.E. Smith, Talley, Thompson, Toole, Townsend, White, Umphlett, Allen, Simrill and Bailey
S. Printed 4/13/05--H.
Read the first time March 14, 2005.
To whom was referred a Bill (H. 3741) to amend the Code of Laws of South Carolina, 1976, by adding Section 43-21-200 so as to establish within the Division of Aging the State Loan Repayment Program, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass:
JOE E. BROWN for Committee.
EXPLANATION OF IMPACT:
Section 1(C)(2) of the bill states that no more than four physicians a year may participate in the program. Using the maximum reimbursement of $35,000 per year for each physician would result in an annual cost to the general fund of $140,000.
Approved By:
Don Addy
Office of State Budget
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 43-21-200 SO AS TO ESTABLISH WITHIN THE DIVISION OF AGING THE STATE LOAN REPAYMENT PROGRAM, TO REIMBURSE THE STUDENT LOAN PAYMENTS OF PHYSICIANS COMPLETING FELLOWSHIPS IN GERIATRICS OR GEROPSYCHIATRY, WHO CONTRACT TO PRACTICE IN THIS STATE FOR NO FEWER THAN FIVE CONSECUTIVE YEARS, TO PROVIDE ADDITIONAL ELIGIBILITY QUALIFICATIONS, TO ESTABLISH THE PHYSICIAN ADVISORY BOARD TO ASSIST THE DIVISION IN REVIEWING APPLICATIONS AND PROVIDE FOR ITS MEMBERSHIP, POWERS, AND DUTIES, TO ESTABLISH A LIMIT ON PARTICIPATING PHYSICIANS AND PROVIDE AN ANNUAL AND OVERALL LIMIT OF AMOUNTS THAT MAY BE REIMBURSED, TO PROVIDE A PENALTY FOR FAILURE TO COMPLETE THE PROGRAM CONTRACT, AND TO PROVIDE THAT THE GENERAL ASSEMBLY SHALL APPROPRIATE FUNDS FOR THE PROGRAM IN THE ANNUAL GENERAL APPROPRIATIONS ACT.
Whereas, South Carolina's population is aging and people are living longer with more medically complex conditions. All can benefit from care provided by physicians specializing in geriatric care. There are few such physicians to care for seniors in this State. In the Midlands there are no geriatric medicine psychiatrists to see outpatients and there is a six-month waiting list to see a geriatric medicine physician. Today, there are about 660,000 South Carolinians sixty years or older. By 2025, the number of South Carolinians older than sixty will have doubled to almost 1.4 million; and
Whereas, just as children's developing bodies require the specialized attention of pediatricians, the chemistry of seniors' mature bodies requires a geriatrician. Geriatric medicine physicians provide primary care for the elderly because they are specifically trained to deal with the issues, illnesses, and medications of seniors; and
Whereas, while the number of seniors in the United States is expected to double in the next thirty years, the number of doctors who specialize in treating the elderly is declining. Low Medicare reimbursements do not attract recruits. Medical students increasingly are making career decisions based on the amount of debt they carry. The average medical student-loan debt at the time of graduation is $109,456; and twenty-five percent have loans in excess of $150,000; and
Whereas, currently, the USC School of Medicine is accredited for four geriatric medicine fellows but generally only fills two slots, and while MUSC is accredited for two geriatric medicine psychiatry fellows, enactment of a geriatric physician loan program could lead to expanding its program by two positions; and
Whereas, a geriatric medicine physician loan-repayment program would be a substantial incentive to increase the number of physicians choosing a career in geriatric medicine. It could also lower health-care costs. Geriatric care can reduce lengths of stay for senior hospital patients by reducing drug reactions and other complications; and
Whereas, meanwhile, absent the availability of geriatric care, seniors are increasingly turning to costly specialists for their primary care needs. The March, 2005, issue of Academic Medicine reports older adults are making more visits to nonprimary-care specialists and suggest faculty development and curriculum changes be made to better prepare future physicians to handle this growing patient base. In 2001, fifty-three percent of ambulatory visits by patients sixty-five and older were to nonprimary-care physicians, an increase of thirteen percent from 1980. Now, therefore,
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 21, Title 43 of the 1976 Code is amended by adding;
"Section 43-21-200. (A) There is established within the Division of Aging the State Loan Repayment Program to reimburse student loan payments of a physician licensed or certified to practice in this State, who has completed a fellowship training program in geriatrics or geropsychiatry accredited by the Accreditation Council for Graduate Medical Education, is accepted into the program, and contracts with the division as provided in Subsection (C) of this section.
(B)(1) To assist the division in selecting program participants, there is established the Physician Advisory Board to review applicants for the repayment reimbursement program. The board consists of five members, one each appointed by the division to represent:
(a) the South Carolina Medical Association;
(b) the South Carolina Commission on Higher Education;
(c) the Medical University of South Carolina;
(d) the School of Medicine of the University of South Carolina;
(e) a fellow in geriatrics or geropsychiatry. Board members serve at the pleasure of the division and without compensation, but may receive the mileage, subsistence, and per diem allowed by law for members of boards, committees, and commissions, to be paid from approved accounts of the division.
(2) The board shall meet as necessary to review program applications and from among these applications recommend program candidates to the division. No physician may participate in the program who has not been recommended by the board. In considering applications, the board shall consider demonstrable need and make every effort to select those who intend to continue to practice in this State after completing the program. In order of priority in considering applicants for the program, the board shall consider first South Carolina natives completing fellowship programs in this State, then out-of-state applicants completing fellowships in this State, then South Carolina natives completing out-of-state fellowship programs, and finally out-of-state applicants completing out-of-state fellowships.
(C)(1) A physician accepted for the program shall execute a contract with the division in which the physician agrees:
(a) to practice in this State for no fewer than five consecutive years;
(b) to accept patients funded by Medicare and Medicaid;
(c) to accept assignment rates; and
(d) not to discriminate against patients based on the ability to pay.
(2) Upon execution of the contract, the division shall reimburse student-loan payments made by the physician during the last completed calendar semester. No more than four physicians a year may participate in the program. The maximum reimbursement that may be reimbursed to a single physician in a year is thirty-five thousand dollars. The total amount that may be reimbursed to one physician is thirty five thousand dollars multiplied by the number of years of the fellowship completed, prorated for periods less than one year.
(D) If the division determines that the physician is not in compliance with the contract, it shall refer this matter to the Physicians Advisory Board, which shall recommend an appropriate penalty which may be imposed by the division for noncompliance, which must be an amount not to exceed three times the total of reimbursement received plus interest at the prime rate plus ten percent calculated from the date noncompliance was determined.
(E) The division shall prescribe the form of applications and the procedures for reimbursement and may require such information and documentation as it determines appropriate for these applications and reimbursements.
(F) The General Assembly, in the annual General Appropriations act, shall appropriate the funds necessary for the operation of the State Loan Repayment Program.
SECTION 2. This act takes effect upon approval by the Governor.
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