SF 1049

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 08/31/2015 03:04pm

A bill for an act
relating to health; addressing barriers to integrating international medical
graduates into the Minnesota health care delivery system; appropriating money;
proposing coding for new law in Minnesota Statutes, chapter 144.

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

Section 1.

[144.1911] INTERNATIONAL MEDICAL GRADUATES
ASSISTANCE PROGRAM.

Subdivision 1.

Establishment.

The international medical graduates assistance
program is established to address barriers to practice and facilitate pathways to assist
immigrant international medical graduates to integrate into the Minnesota health
care delivery system, with the goal of increasing access to primary care in rural and
underserved areas of the state.

Subd. 2.

Definitions.

(a) For the purposes of this section, the following terms
have the meanings given.

(b) "Commissioner" means the commissioner of health.

(c) "Immigrant international medical graduate" means an international medical
graduate who was born outside the United States, now resides permanently in the United
States, and who did not enter the United States on a J1 or similar nonimmigrant visa
following acceptance into a United States medical residency or fellowship program.

(d) "International medical graduate" means a physician who received a basic medical
degree or qualification from a medical school located outside the United States and Canada.

(e) "Minnesota immigrant international medical graduate" means an immigrant
international medical graduate who has lived in Minnesota for at least two years.

(f) "Rural community" means a city or township that is: (1) outside the seven-county
metropolitan area as defined in section 473.121, subdivision 2; and (2) has a population
under 15,000.

(g) "Underserved community" means a Minnesota area or population included in
the list of designated primary medical care health professional shortage areas, medically
underserved areas, or medically underserved populations (MUPs) maintained and updated
by the United States Department of Health and Human Services.

Subd. 3.

Program administration.

(a) In administering the international medical
graduates assistance program, the commissioner shall:

(1) provide overall coordination for the planning, development, and implementation
of a comprehensive system for integrating qualified immigrant international medical
graduates into the Minnesota health care delivery system, particularly those willing to
serve in rural or underserved communities of the state;

(2) develop and maintain, in partnership with community organizations working
with international medical graduates, a voluntary roster of immigrant international medical
graduates interested in entering the Minnesota health workforce, to assist in planning
and program administration, including making available summary reports that show the
aggregate number and distribution, by geography and specialty, of immigrant international
medical graduates in Minnesota;

(3) award grants to eligible nonprofit organizations to provide career guidance
and support services to immigrant international medical graduates seeking to enter the
Minnesota health workforce. No grant shall exceed $500,000. Eligible activities under
this program include the following:

(i) educational and career navigation, including information on training and licensing
requirements for physician and nonphysician health care professions, and guidance in
determining which pathway is best suited for an individual international medical graduate
based on the graduate's skills, experience, resources, and interests;

(ii) support in becoming proficient in medical English;

(iii) support in becoming proficient in the use of information technology, including
computer skills and use of electronic health record technology;

(iv) support for increasing knowledge of and familiarity with the United States
health care system;

(v) support for other foundational skills identified by the commissioner;

(vi) support for immigrant international medical graduates in becoming certified
by the Educational Commission on Foreign Medical Graduates, including help with
preparation for required licensing examinations and financial assistance for fees; and

(vii) assistance to international medical graduates in registering with the program's
Minnesota international medical graduate roster;

(4) award the initial round of grants under this program by December 2015;

(5) work with graduate clinical medical training programs to address barriers
faced by immigrant international medical graduates in securing residency positions in
Minnesota, including the requirement that applicants for residency positions be recent
graduates of medical school. The annual report required in subdivision 6 shall include
any progress in addressing these barriers;

(6) develop a standardized assessment of the clinical readiness of eligible immigrant
international medical graduates to serve in a residency program. The commissioner may
initially develop assessments for clinical readiness to practice one or more primary care
specialties, adding additional assessments as resources are available. The commissioner
may contract with an independent entity or another state agency to conduct the assessment.
In order to be assessed for clinical readiness, eligible international medical graduates
must have obtained certification from the Educational Commission on Foreign Medical
Graduates;

(7) issue a Minnesota certificate of clinical readiness for residency to those who
pass the assessment;

(8) develop a plan for the assessment and certification system by December 31, 2015,
including proposed legislation, a proposed budget, and an implementation schedule that
allows for assessment and certification of international medical graduates by July 1, 2017;

(9) award grants to support clinical preparation for Minnesota international medical
graduates needing additional clinical preparation or experience to qualify for residency. A
grant shall not exceed $750,000. The grant program shall include:

(i) proposed training curricula;

(ii) associated policies and procedures for clinical training sites, which must be part
of existing clinical medical education programs in Minnesota; and

(iii) monthly stipends for international medical graduate participants. Priority shall
be given to primary care sites in rural or underserved areas of the state, and international
medical graduate participants must commit to serving at least five years in a rural or
underserved community of the state;

(10) develop policies and procedures for the clinical preparation program by
December 2015, including an implementation schedule that allows for grants to clinical
preparation programs beginning in June 2016;

(11) award grants to support primary care residency positions designated for
Minnesota immigrant physicians who are willing to serve in rural or underserved areas
of the state. A grant shall not exceed $150,000 per residency position per year. The
program shall include:

(i) a prerequisite that participating international medical graduates have lived in
Minnesota for at least two years and are certified by the Educational Commission on
Foreign Medical Graduates and hold a Minnesota certificate of clinical readiness for
residency once such certificates become available;

(ii) a requirement that participants commit to providing primary care for at least five
years in a rural or underserved area of Minnesota;

(iii) a requirement that participants commit to pay back a portion of program costs,
with those costs being determined by the commissioner; and

(iv) the option that the program include sponsored primary care residency positions,
if private funding is made available;

(12) explore and facilitate more streamlined pathways for immigrant international
medical graduates to serve in nonphysician professions in the Minnesota workforce; and

(13) study, in consultation with the Board of Medical Practice and other stakeholders,
changes necessary in health professional licensure and regulation to ensure full utilization
of immigrant international medical graduates in the Minnesota health care delivery
system. The commissioner shall include recommendations in the annual report required
under subdivision 6 due January 1, 2017.

Subd. 4.

Consultation with stakeholders.

The commissioner shall administer the
international medical graduates assistance program, in consultation with the following
sectors:

(1) state agencies:

(i) Board of Medical Practice;

(ii) Office of Higher Education; and

(iii) Department of Employment and Economic Development;

(2) health care industry:

(i) a health care employer in a rural or underserved area of Minnesota;

(ii) a health insurer;

(iii) the Minnesota Medical Association;

(iv) licensed physicians experienced in working with international medical
graduates; and

(v) the Minnesota Academy of Physician Assistants;

(3) community-based organizations:

(i) organizations serving immigrant and refugee communities of Minnesota; and

(ii) organizations serving the international medical graduate community, such as the
New Americans Alliance for Development and Women's Initiative for Self Empowerment;

(4) higher education:

(i) University of Minnesota;

(ii) Mayo Clinic School of Health Professions;

(iii) graduate medical education programs not located at the University of Minnesota
or Mayo Clinic School of Health Professions; and

(iv) Minnesota physician assistant education program; and

(5) two international medical graduates.

Subd. 5.

Board of Medical Practice.

Nothing in this section alters the authority of
the Board of Medical Practice to regulate the practice of medicine.

Subd. 6.

Report.

The commissioner shall submit an annual report to the chairs and
ranking minority members of the legislative committees with jurisdiction over health care
and higher education on the progress of the integration of international medical graduates
into the Minnesota health care delivery system. The report shall be submitted by January
15 each year, beginning January 15, 2016.

Subd. 7.

Voluntary hospital programs.

A hospital may establish residency
programs for foreign-trained physicians to become candidates for licensure to practice
medicine in the state of Minnesota. A hospital may partner with organizations, such as
the New Americans Alliance for Development to screen for and identify foreign-trained
physicians eligible for a hospital's particular residency program.

Sec. 2. APPROPRIATION.

$....... is appropriated in fiscal year 2016 and $....... is appropriated in fiscal year
2017 from the general fund to the commissioner of health for the grant programs and
operations described in Minnesota Statutes, section 144.1911. The commissioner shall
develop recommendations for any additional funding required for initiatives needed to
achieve the objectives of Minnesota Statutes, section 144.1911. The commissioner shall
report the funding recommendations to the legislature by January 15, 2016.