H-0710.1 HOUSE BILL 1643 State of Washington 68th Legislature 2023 Regular Session By Representatives Riccelli, Slatter, Berry, Lekanoff, Senn, Simmons, Ramel, Timmons, Stonier, Pollet, and Doglio Read first time 01/27/23. Referred to Committee on Postsecondary Education & Workforce. 1 AN ACT Relating to creating the hospital-based nurse student loan 2 repayment assistance program under the Washington health corps; 3 amending RCW 28B.115.010, 28B.115.020, 28B.115.030, 28B.115.080, 4 28B.115.090, and 28B.115.110; adding a new section to chapter 28B.115 5 RCW; creating a new section; and providing an expiration date. 6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON: 7 Sec. 1. RCW 28B.115.010 and 2019 c 302 s 1 are each amended to 8 read as follows: 9 The legislature finds that changes in demographics, the delivery 10 of health care services, and an escalation in the cost of educating 11 health professionals has resulted in shortages of health 12 professionals. A poor distribution of health care professionals has 13 resulted in a surplus of some professionals in some areas of the 14 state and a shortage of others in other parts of the state, such as 15 in the more rural areas and in behavioral health services. The high 16 cost of health professional education requires that health care 17 practitioners command higher incomes to repay the financial 18 obligations incurred to obtain the required training. Health 19 professional shortage areas are often areas that have troubled 20 economies and lower per capita incomes. These areas often require 21 more services because the health care needs are greater due to p. 1 HB 1643 1 poverty or because the areas are difficult to service due to 2 geographic circumstances. The salary potentials for shortage areas 3 are often not as favorable when compared to nonshortage areas and 4 practitioners are unable to serve. The legislature further finds that 5 encouraging health professionals to serve in shortage areas is 6 essential to assure continued access to health care for persons 7 living in these parts of the state. 8 The legislature also finds that one in five adults in the United 9 States experiences mental illness in any given year, but only forty- 10 one percent of adults with a mental health condition received mental 11 health services in 2016, according to the national institute of 12 mental health. The ((children's mental)) children and youth 13 behavioral health work group found that in 2013, only forty percent 14 of children on medicaid with mental health treatment needs were 15 receiving services. Individuals seeking behavioral health services 16 may have trouble receiving the help they need from health care 17 professionals because behavioral health services are limited due to 18 workforce shortages of behavioral health providers. The legislature 19 further finds that encouraging more health care professionals to 20 practice behavioral health in areas with limited services would 21 benefit the state by creating greater access to behavioral health 22 services and by having more health care professionals experienced in 23 providing behavioral health services. 24 The legislature also finds that hospitals in all parts of 25 Washington state are facing a long-standing registered nurse 26 workforce shortage that has been exacerbated by the COVID-19 27 pandemic. Workforce shortages lead to reductions and closures of 28 hospital services and stress on the existing workforce. The 29 legislature further finds that encouraging more already-trained 30 registered nurses to move to Washington to practice in hospitals 31 would benefit the state by maintaining access to hospital services 32 across the state. 33 Therefore, the legislature intends to establish the Washington 34 health corps to encourage more health care professionals to work in 35 underserved areas by providing loan repayment and conditional 36 scholarships in return for completing a service commitment. 37 Sec. 2. RCW 28B.115.020 and 2022 c 276 s 1 are each amended to 38 read as follows: p. 2 HB 1643 1 Unless the context clearly requires otherwise, the definitions in 2 this section apply throughout this chapter. 3 (1) "Approved nursing program" means a nursing educational 4 program that leads to a degree or licensure in nursing that is 5 approved by the nursing care quality assurance commission under RCW 6 18.79.070 and is located at an institution of higher education that 7 is authorized to participate in state financial aid programs under 8 chapter 28B.92 RCW. 9 (2) "Credentialed health care profession" means a health care 10 profession regulated by a disciplining authority in the state of 11 Washington under RCW 18.130.040 or by the pharmacy quality assurance 12 commission under chapter 18.64 RCW and designated by the department 13 in RCW 28B.115.070 as a profession having shortages of credentialed 14 health care professionals in the state. 15 (3) "Credentialed health care professional" means a person 16 regulated by a disciplining authority in the state of Washington to 17 practice a health care profession under RCW 18.130.040 or by the 18 pharmacy quality assurance commission under chapter 18.64 RCW. 19 (4) "Department" means the state department of health. 20 (5) "Eligible education and training programs" means education 21 and training programs approved by the department that lead to 22 eligibility for a credential as a credentialed health care 23 professional. 24 (6) "Eligible expenses" means reasonable expenses associated with 25 the costs of acquiring an education such as tuition, books, 26 equipment, fees, room and board, and other expenses determined by the 27 office. 28 (7) "Eligible student" means a student who has been accepted into 29 an eligible education or training program and has a declared 30 intention to serve in a health professional shortage area upon 31 completion of the education or training program. 32 (8) "Forgiven" or "to forgive" or "forgiveness" means to render 33 health care services in a health professional shortage area, an 34 underserved behavioral health area, or as a nurse educator in the 35 state of Washington in lieu of monetary repayment. 36 (9) "Health professional shortage areas" means those areas where 37 credentialed health care professionals are in short supply as a 38 result of geographic maldistribution or as the result of a short 39 supply of credentialed health care professionals in specialty health 40 care areas and where vacancies exist in serious numbers that p. 3 HB 1643 1 jeopardize patient care and pose a threat to the public health and 2 safety. The department shall determine health professional shortage 3 areas as provided for in RCW 28B.115.070. In making health 4 professional shortage area designations in the state the department 5 may be guided by applicable federal standards for "health manpower 6 shortage areas," and "medically underserved areas," and "medically 7 underserved populations." 8 (10) "Loan repayment" means a loan that is paid in full or in 9 part if the participant: 10 (a) Renders health care services in a health professional 11 shortage area or an underserved behavioral health area as defined by 12 the department; or 13 (b) Teaches as a nurse educator for an approved nursing program. 14 (11) "Nonshortage rural area" means a nonurban area of the state 15 of Washington that has not been designated as a rural physician 16 shortage area. The department shall identify the nonshortage rural 17 areas of the state. 18 (12) "Nurse" or "nursing" has the same meaning as described under 19 chapter 18.79 RCW. 20 (13) "Nurse educator" means an individual with an advanced 21 nursing degree beyond a bachelor's degree that teaches nursing 22 curriculum and is a faculty member for an approved nursing program. 23 (((13))) (14) "Office" means the office of student financial 24 assistance. 25 (((14))) (15) "Participant" means: 26 (a) A credentialed health care professional who has received a 27 loan repayment award and has commenced practice as a credentialed 28 health care provider in a designated health professional shortage 29 area or an underserved behavioral health area; 30 (b) A nurse educator teaching in an approved nursing program; or 31 (c) An eligible student who has received a scholarship under this 32 program. 33 (((15))) (16) "Participating hospital" means a hospital licensed 34 under chapter 70.41 RCW or a psychiatric hospital licensed under 35 chapter 71.12 RCW that has elected to participate in the hospital- 36 based nurse student loan repayment assistance program. 37 (17) "Required service obligation" means an obligation by the 38 participant to: p. 4 HB 1643 1 (a) Provide health care services in a health professional 2 shortage area or an underserved behavioral health area for a period 3 to be established as provided for in this chapter; ((or)) 4 (b) Teach as a nurse educator for a period to be established as 5 provided for in this chapter; or 6 (c) Provide nursing services as an employee of a participating 7 hospital for a period to be established as provided for in this 8 chapter. 9 (((16))) (18) "Rural physician shortage area" means rural 10 geographic areas where primary care physicians are in short supply as 11 a result of geographic maldistributions and where their limited 12 numbers jeopardize patient care and pose a threat to public health 13 and safety. The department shall designate rural physician shortage 14 areas. 15 (((17))) (19) "Satisfied" means paid-in-full. 16 (((18))) (20) "Scholarship" means a loan that is forgiven in 17 whole or in part if the recipient renders health care services in a 18 health professional shortage area or an underserved behavioral health 19 area. 20 (((19))) (21) "Sponsoring community" means a rural hospital or 21 hospitals as authorized in chapter 70.41 RCW, a rural health care 22 facility or facilities as authorized in chapter 70.175 RCW, or a city 23 or county government or governments. 24 (((20))) (22) "Underserved behavioral health area" means a 25 geographic area, population, or facility that has a shortage of 26 health care professionals providing behavioral health services, as 27 determined by the department. 28 Sec. 3. RCW 28B.115.030 and 2022 c 276 s 2 are each amended to 29 read as follows: 30 The Washington health corps is the state's initiative to 31 encourage health care professionals to work in underserved 32 communities. In exchange for service, the health care professional 33 receives assistance with higher education, in the form of loan 34 repayment or a conditional scholarship. The Washington health corps 35 consists of the health professional loan repayment and scholarship 36 program, the behavioral health loan repayment program, the hospital- 37 based nurse student loan repayment assistance program, and the nurse 38 educator loan repayment program. p. 5 HB 1643 1 (1) The health professional loan repayment and scholarship 2 program is established for credentialed health professionals and 3 residents serving in health professional shortage areas. 4 (2) The behavioral health loan repayment program is established 5 for credentialed health professionals serving in underserved 6 behavioral health areas. 7 (3) The hospital-based nurse student loan repayment assistance 8 program is established for nurses employed by and serving in 9 participating hospitals. 10 (4) The nurse educator loan repayment program is established for 11 nurse educators teaching for approved nursing programs. 12 (((4))) (5) The office is the administrator of the programs under 13 the Washington health corps. In administering the programs, the 14 office shall: 15 (a)(i) Select credentialed health care professionals and 16 residents to participate in the loan repayment portion and in the 17 scholarship portion of the health professional loan repayment and 18 scholarship program; 19 (ii) Select credentialed health care participants to participate 20 in the behavioral health loan repayment program; ((and)) 21 (iii) Select nurses to participate in the hospital-based nurse 22 student loan repayment assistance program on a quarterly basis; and 23 (iv) Select nurse educators to participate in the nurse educator 24 loan repayment program; 25 (b) Adopt rules and develop guidelines to administer the 26 programs; 27 (c) Collect and manage repayments from participants who do not 28 meet their service obligations under this chapter; 29 (d) Publicize the programs, particularly to maximize 30 participation among individuals in shortage and underserved areas and 31 among populations expected to experience the greatest growth in the 32 workforce; 33 (e) Solicit and accept grants and donations from public and 34 private sources for the programs; 35 (f) Use a competitive procurement to contract with a fund-raiser 36 to solicit and accept grants and donations from private sources for 37 the programs. The fund-raiser shall be paid on a contingency fee 38 basis on a sliding scale but must not exceed fifteen percent of the 39 total amount raised for the programs each year. The fund-raiser shall 40 not be a registered state lobbyist; ((and)) p. 6 HB 1643 1 (g) Administer a process for hospitals to elect to become 2 participating hospitals and collect payments from participating 3 hospitals, other than a hospital designated by medicare as a critical 4 access hospital or sole community hospital, that amount to 50 percent 5 of the amounts paid to nurses serving in their hospitals and 6 participating in the hospital-based nurse student loan repayment 7 assistance program in the previous quarter; and 8 (h) Develop criteria for a contract for service in lieu of the 9 service obligation where appropriate, that may be a combination of 10 service and payment. 11 Sec. 4. RCW 28B.115.080 and 2022 c 276 s 5 are each amended to 12 read as follows: 13 After June 1, 1992, the office, in consultation with the 14 department and the department of social and health services, shall: 15 (1) Establish the annual award amount for each credentialed 16 health care profession which shall be based upon an assessment of 17 reasonable annual eligible expenses involved in training and 18 education for each credentialed health care profession for both the 19 health professional loan repayment and scholarship program and the 20 behavioral health loan repayment program. The annual award amount may 21 be established at a level less than annual eligible expenses. The 22 annual award amount shall be established by the office for each 23 eligible health profession. The awards shall not be paid for more 24 than a maximum of five years per individual; 25 (2) Determine any scholarship awards for prospective physicians 26 in such a manner to require the recipients declare an interest in 27 serving in rural areas of the state of Washington. Preference for 28 scholarships shall be given to students who reside in a rural 29 physician shortage area or a nonshortage rural area of the state 30 prior to admission to the eligible education and training program in 31 medicine. Highest preference shall be given to students seeking 32 admission who are recommended by sponsoring communities and who 33 declare the intent of serving as a physician in a rural area. The 34 office may require the sponsoring community located in a nonshortage 35 rural area to financially contribute to the eligible expenses of a 36 medical student if the student will serve in the nonshortage rural 37 area; 38 (3) Establish the required service obligation for each 39 credentialed health care profession, which shall be no less than p. 7 HB 1643 1 three years or no more than five years, for the health professional 2 loan repayment and scholarship program and the behavioral health loan 3 repayment program. The required service obligation may be based upon 4 the amount of the scholarship or loan repayment award such that 5 higher awards involve longer service obligations on behalf of the 6 participant; 7 (4) Establish the annual award amount and the required service 8 obligation for nurse educators participating in the nurse educator 9 loan repayment program. The annual award amount shall be based upon 10 an assessment of reasonable annual eligible expenses involved in 11 training and education. The awards shall not be paid for more than a 12 maximum of five years per individual. The required service obligation 13 shall be no less than three years or no more than five years. The 14 required service obligation may be based upon the amount of the loan 15 repayment award such that higher awards involve longer service 16 obligations on behalf of the participant; 17 (5) Establish the annual award amount and the required service 18 obligation for nurses participating in the hospital-based nurse