SF 1049

as introduced - 89th Legislature (2015 - 2016) Posted on 03/25/2015 08:47am

A bill for an act
relating to health; creating a Council on International Medical Graduates;
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.

new text begin [144.1911] COUNCIL ON INTERNATIONAL MEDICAL
GRADUATES.
new text end

new text begin Subdivision 1. new text end

new text begin Findings; establishment. new text end

new text begin (a) The legislature finds that Minnesota
has a valuable and untapped resource in its population of international medical graduates,
who are highly skilled immigrants willing to provide health care in rural and underserved
areas of the state, but who face multiple barriers to practice.
new text end

new text begin (b) The Council on International Medical Graduates is created 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 overall goal of
increasing access to primary care in rural and underserved areas of the state.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (b) "Board" means the Board of Medical Practice.
new text end

new text begin (c) "Commissioner" means the commissioner of health.
new text end

new text begin (d) "Council" means the Council on International Medical Graduates.
new text end

new text begin (e) "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.
new text end

new text begin (f) "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.
new text end

new text begin (g) "Minnesota immigrant international medical graduate" means an immigrant
international medical graduate who has lived in Minnesota for at least two years.
new text end

new text begin (h) "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.
new text end

new text begin (i) "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.
new text end

new text begin Subd. 3. new text end

new text begin Governance. new text end

new text begin (a) The Council on International Medical Graduates shall
consist of 15 members, appointed by the commissioner of health in consultation with the
Board of Medical Practice. The commissioner shall appoint the initial members of the
council by July 1, 2015. The council shall include members who represent the following
sectors:
new text end

new text begin (1) state agencies:
new text end

new text begin (i) Department of Health;
new text end

new text begin (ii) Board of Medical Practice;
new text end

new text begin (iii) Office of Higher Education; and
new text end

new text begin (iv) Department of Employment and Economic Development;
new text end

new text begin (2) health care industry:
new text end

new text begin (i) a health care employer in a rural or underserved area of Minnesota;
new text end

new text begin (ii) a health insurer;
new text end

new text begin (iii) the Minnesota Medical Association; and
new text end

new text begin (iv) licensed physicians experienced in working with international medical graduates;
new text end

new text begin (3) community-based organizations:
new text end

new text begin (i) organizations serving immigrant and refugee communities of Minnesota; and
new text end

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

new text begin (4) higher education:
new text end

new text begin (i) University of Minnesota;
new text end

new text begin (ii) Mayo Clinic School of Health Professions;
new text end

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

new text begin (iv) Minnesota physician assistant education program; and
new text end

new text begin (5) two international medical graduates.
new text end

new text begin (b) The terms, compensation, and removal of members of the council shall be
governed by section 15.059, except that the council shall not expire unless by action
of the council.
new text end

new text begin Subd. 4. new text end

new text begin Powers; duties; program administration. new text end

new text begin The council shall:
new text end

new text begin (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;
new text end

new text begin (2) develop and maintain, in partnership with the Board of Medical Practice and
community organizations working with international medical graduates, a voluntary roster
of immigrant international medical graduates interested in entering the Minnesota health
workforce. The council shall use this information to assist its 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;
new text end

new text begin (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. A grant shall not exceed $500,000. Eligible activities under
this program include the following:
new text end

new text begin (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;
new text end

new text begin (ii) support in becoming proficient in medical English;
new text end

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

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

new text begin (v) support for other foundational skills identified by the council;
new text end

new text begin (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
new text end

new text begin (vii) assistance to international medical graduates in registering with the council's
Minnesota international medical graduate roster;
new text end

new text begin (4) disburse its initial round of grants under this program by December 2015;
new text end

new text begin (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 to residency be recent graduates of medical
school. The council will include its findings in the annual report required in subdivision 8;
new text end

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

new text begin (7) issue a Minnesota certificate of clinical readiness for residency, apprenticeship,
or both to those who pass the assessment;
new text end

new text begin (8) work with the Board of Medical Practice to 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;
new text end

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

new text begin (i) proposed training curricula;
new text end

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

new text begin (iii) monthly stipends for international medical graduate participants. Priority will
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;
new text end

new text begin (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;
new text end

new text begin (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:
new text end

new text begin (i) a prerequisite that participating international medical graduates have lived in
Minnesota for at least two years and are certified by both the council and the Educational
Commission on Foreign Medical Graduates;
new text end

new text begin (ii) participants would commit to providing primary care for at least five years in a
rural or underserved area of Minnesota;
new text end

new text begin (iii) participants would also commit to pay back a portion of program costs, with
those costs being determined by the council; and
new text end

new text begin (iv) the program could include sponsored primary care residency positions, if private
funding is made available;
new text end

new text begin (12) in consultation with the Board of Medical Practice and other partners,
develop and administer an apprenticeship program for international medical graduates
who are certified under subdivision 5. Apprentices who subsequently become fully
licensed physicians must commit to serving at least five years in a rural or underserved
community of the state following the apprenticeship. Those successfully completing the
apprenticeship shall be eligible to petition the Board of Medical Practice for a full medical
license or a permanent limited license to practice under supervision of another physician;
new text end

new text begin (13) award grants to clinical sites participating in this apprenticeship program. A
grant shall not exceed $20,000 per apprentice per year to participating sites;
new text end

new text begin (14) work with the board to develop the apprenticeship program, including any
additional admissions criteria such as length of experience as a physician outside the
United States, length of the apprenticeship program, proposed legislation for licensing
changes needed, a proposed budget, and an implementation schedule that allows for the
enrollment of eligible international medical graduates as apprentices by June 2017;
new text end

new text begin (15) work with the board to develop and propose legislation to grant qualified
immigrant international medical graduates a time-limited apprenticeship permit equivalent
to the residency permit established in section 147.0391, full medical licensure or limited
licensure to practice under supervision. The legislation must include a procedure to assess
the qualifications of immigrant international medical graduates. The legislation must
require that candidates for licensure possess an Educational Commission for Foreign
Medical Graduates certificate, pass all United States medical licensing examinations
tests and be clinically qualified to practice medicine. The legislation may propose that
the certificate of clinical readiness in whole or in part serve as evidence a candidate is
clinically qualified to practice medicine. The legislation need not require that candidates
obtain United States medical residency experience. The council and board shall submit
recommendations and proposed legislation by December 15, 2016;
new text end

new text begin (16) explore and facilitate more streamlined pathways for immigrant international
medical graduates to serve in nonphysician professions in the Minnesota workforce;
new text end

new text begin (17) work with physician assistant training programs to explore alternatives for
admission requirements for international medical graduates, including allowing an
international medical graduate's scores on the United States medical licensing exams to
fulfill basic and higher science prerequisites in physician assistant program admissions;
new text end

new text begin (18) work with at least one interested physician assistant education program in
Minnesota, in partnership with the Board of Medical Practice and national physician
assistant accreditation and certification bodies, to create a program by July 1, 2017, that
meets the existing professional standards for physician assistants, but is designed to
meet the unique needs of the immigrant international medical graduate who wishes to
practice as a physician assistant, including expedited training and specially designed
clinical rotations. No later than December 31, 2016, the council shall propose legislation
to begin an immigrant international medical graduate physician assistant pilot program
in Minnesota; and
new text end

new text begin (19) award grants for the development of the immigrant international medical
graduate physician assistant pilot program. Grants shall not exceed $450,000 for this
purpose.
new text end

new text begin Subd. 5. new text end

new text begin Coordination with Board of Medical Practice. new text end

new text begin The council and
the Board of Medical Practice shall work in partnership to develop the standardized
assessment of clinical readiness, the certificate of clinical readiness, and the apprenticeship
program and licensing options in subdivision 4. Nothing in this section alters the authority
of the Board of Medical Practice to regulate the practice and licensing of medicine.
new text end

new text begin Subd. 6. new text end

new text begin Appropriations; gifts; grants. new text end

new text begin The council may apply for, accept, and
disburse gifts, grants, and loans for any of the council's purposes. Money received by
the council from gifts and grants is appropriated to the council for purposes specified
in the gift or grant.
new text end

new text begin Subd. 7. new text end

new text begin Staffing. new text end

new text begin The commissioner shall conduct the activities in subdivision 4 on
behalf of the council, with input from the council. The commissioner shall provide staff,
including but not limited to professional, technical, and clerical staff necessary to perform
the duties assigned to the council. The council may ask for assistance from other units of
state government as needed to fulfill its duties and responsibilities.
new text end

new text begin Subd. 8. new text end

new text begin Report. new text end

new text begin The council shall submit an annual report to the commissioner and
the chairs and ranking minority members of the legislative committees with jurisdiction
over health care matters on the status of the council's activities. The reports will be due
by January 15 each year.
new text end

Sec. 2. new text begin APPROPRIATION. new text end

new text begin
$....... is appropriated in fiscal year 2016 from the general fund to the commissioner
of health for the grant programs and operations of the council. The council and
commissioner shall develop recommendations for any additional funding required
for council programs and initiatives. The commissioner shall report the funding
recommendations to the legislature by December 31, 2015.
new text end