AB 2204: Clinics: licensure and regulation: exemption.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-09-06
Existing law provides for the regulation and licensure of clinics, as defined, by the State Department of Public Health. Under existing law, specified types of clinics are exempted from these licensing provisions, including a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours a week.
This bill would instead exempt a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week.
Existing law provides for the regulation and licensure of clinics, as defined, by the State Department of Public Health. Under existing law, specified types of clinics are exempted from these licensing provisions, including a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours a week.
This bill would instead exempt a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week.
Existing law provides for the regulation and licensure of clinics, as defined, by the State Department of Public Health. Under existing law, specified types of clinics are exempted from these licensing provisions, including a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours a week.
This bill would instead exempt a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week.
This chapter does not apply to the following:
(a)Except with respect to the option provided with regard to surgical clinics in paragraph (1) of subdivision (b) of Section 1204 and, further, with respect to specialty clinics specified in paragraph (2) of subdivision (b) of Section 1204, any place or establishment owned or leased and operated as a clinic or office by one or more licensed health care practitioners and used as an office for the practice of their profession, within the scope of their license, regardless of the name used publicly to identify the place or establishment.
(b)Any clinic directly conducted, maintained, or operated by the United States or by any of its departments, officers, or agencies, and any primary care clinic specified in subdivision (a) of Section 1204 that is directly conducted, maintained, or operated by this state or by any of its political subdivisions or districts, or by any city. Nothing in this subdivision precludes the state department from adopting regulations that utilize clinic licensing standards as eligibility criteria for participation in programs funded wholly or partially under Title XVIII or XIX of the federal Social Security Act.
(c)(1)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, that is located on land recognized as tribal land by the federal government.
(2)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act (Public Law 93-638), regardless of the location of the clinic, except that if the clinic chooses to apply to the State Department of Public Health for a state facility license, then the State Department of Public Health will retain authority to regulate that clinic as a primary care clinic as defined by subdivision (a) of Section 1204.
(d)Clinics conducted, operated, or maintained as outpatient departments of hospitals.
(e)Any facility licensed as a health facility under Chapter 2 (commencing with Section 1250).
(f)Any freestanding clinical or pathological laboratory licensed under Chapter 3 (commencing with Section 1200) of Division 2 of the Business and Professions Code.
(g)A clinic operated by, or affiliated with, any institution of learning that teaches a recognized healing art and is approved by the state board or commission vested with responsibility for regulation of the practice of that healing art.
(h)A clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week. An intermittent clinic as described in this subdivision shall, however, meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety.
(i)The offices of physicians in group practice who provide a preponderance of their services to members of a comprehensive group practice prepayment health care service plan subject to Chapter 2.2 (commencing with Section 1340).
(j)Student health centers operated by public institutions of higher education.
(k)Nonprofit speech and hearing centers, as defined in Section 1201.5. Any nonprofit speech and hearing clinic desiring an exemption under this subdivision shall make application therefor to the director, who shall grant the exemption to any facility meeting the criteria of Section 1201.5. Notwithstanding the licensure exemption contained in this subdivision, a nonprofit speech and hearing center shall be deemed to be an organized outpatient clinic for purposes of qualifying for reimbursement as a rehabilitation center under the Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).
(l)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, that conducts medical research and health education and provides health care to its patients through a group of 40 or more physicians and surgeons, who are independent contractors representing not less than 10 board-certified specialties, and not less than two-thirds of whom practice on a full-time basis at the clinic.
(m)Any clinic, limited to in vivo diagnostic services by magnetic resonance imaging functions or radiological services under the direct and immediate supervision of a physician and surgeon who is licensed to practice in California. This shall not be construed to permit cardiac catheterization or any treatment modality in these clinics.
(n)A clinic operated by an employer or jointly by two or more employers for their employees only, or by a group of employees, or jointly by employees and employers, without profit to the operators thereof or to any other person, for the prevention and treatment of accidental injuries to, and the care of the health of, the employees comprising the group.
(o)A community mental health center, as defined in Section 5667 of the Welfare and Institutions Code.
(p)(1)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, as an entity organized and operated exclusively for scientific and charitable purposes and that satisfied all of the following requirements on or before January 1, 2005:
(A)Commenced conducting medical research on or before January 1, 1982, and continues to conduct medical research.
(B)Conducted research in, among other areas, prostatic cancer, cardiovascular disease, electronic neural prosthetic devices, biological effects and medical uses of lasers, and human magnetic resonance imaging and spectroscopy.
(C)Sponsored publication of at least 200 medical research articles in peer-reviewed publications.
(D)Received grants and contracts from the National Institutes of Health.
(E)Held and licensed patents on medical technology.
(F)Received charitable contributions and bequests totaling at least five million dollars ($5,000,000).
(G)Provides health care services to patients only:
(i)In conjunction with research being conducted on procedures or applications not approved or only partially approved for payment (I) under the Medicare program pursuant to Section 1359y(a)(1)(A) of Title 42 of the United States Code, or (II) by a health care service plan registered under Chapter 2.2 (commencing with Section 1340), or a disability insurer regulated under Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code; provided that services may be provided by the clinic for an additional period of up to three years following the approvals, but only to the extent necessary to maintain clinical expertise in the procedure or application for purposes of actively providing training in the procedure or application for physicians and surgeons unrelated to the clinic.
(ii)Through physicians and surgeons who, in the aggregate, devote no more than 30 percent of their professional time for the entity operating the clinic, on an annual basis, to direct patient care activities for which charges for professional services are paid.
(H)Makes available to the public the general results of its research activities on at least an annual basis, subject to good faith protection of proprietary rights in its intellectual property.
(I)Is a freestanding clinic, whose operations under this subdivision are not conducted in conjunction with any affiliated or associated health clinic or facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as affiliated only if it directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, a clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as associated only if more than 20 percent of the directors or trustees of the clinic are also the directors or trustees of any individual clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). Any activity by a clinic under this subdivision in connection with an affiliated or associated entity shall fully comply with the requirements of this subdivision. This subparagraph shall not apply to agreements between a clinic and any entity for purposes of coordinating medical research.
(2)By January 1, 2007, and every five years thereafter, the Legislature shall receive a report from each clinic meeting the criteria of this subdivision and any other interested party concerning the operation of the clinics activities. The report shall include, but not be limited to, an evaluation of how the clinic impacted competition in the relevant health care market, and a detailed description of the clinics research results and the level of acceptance by the payer community of the procedures performed at the clinic. The report shall also include a description of procedures performed both in clinics governed by this subdivision and those performed in other settings. The cost of preparing the reports shall be borne by the clinics that are required to submit them to the Legislature pursuant to this paragraph.
This chapter does not apply to the following:
(a)Except with respect to the option provided with regard to surgical clinics in paragraph (1) of subdivision (b) of Section 1204 and, further, with respect to specialty clinics specified in paragraph (2) of subdivision (b) of Section 1204, any place or establishment owned or leased and operated as a clinic or office by one or more licensed health care practitioners and used as an office for the practice of their profession, within the scope of their license, regardless of the name used publicly to identify the place or establishment.
(b)Any clinic directly conducted, maintained, or operated by the United States or by any of its departments, officers, or agencies, and any primary care clinic specified in subdivision (a) of Section 1204 that is directly conducted, maintained, or operated by this state or by any of its political subdivisions or districts, or by any city. Nothing in this subdivision precludes the state department from adopting regulations that utilize clinic licensing standards as eligibility criteria for participation in programs funded wholly or partially under Title XVIII or XIX of the federal Social Security Act.
(c)(1)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, that is located on land recognized as tribal land by the federal government.
(2)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act (Public Law 93-638), regardless of the location of the clinic, except that if the clinic chooses to apply to the State Department of Public Health for a state facility license, then the State Department of Public Health will retain authority to regulate that clinic as a primary care clinic as defined by subdivision (a) of Section 1204.
(d)Clinics conducted, operated, or maintained as outpatient departments of hospitals.
(e)Any facility licensed as a health facility under Chapter 2 (commencing with Section 1250).
(f)Any freestanding clinical or pathological laboratory licensed under Chapter 3 (commencing with Section 1200) of Division 2 of the Business and Professions Code.
(g)A clinic operated by, or affiliated with, any institution of learning that teaches a recognized healing art and is approved by the state board or commission vested with responsibility for regulation of the practice of that healing art.
(h)A clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week. An intermittent clinic as described in this subdivision shall, however, meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety.
(i)The offices of physicians in group practice who provide a preponderance of their services to members of a comprehensive group practice prepayment health care service plan subject to Chapter 2.2 (commencing with Section 1340).
(j)Student health centers operated by public institutions of higher education.
(k)Nonprofit speech and hearing centers, as defined in Section 1201.5. Any nonprofit speech and hearing clinic desiring an exemption under this subdivision shall make application therefor to the director, who shall grant the exemption to any facility meeting the criteria of Section 1201.5. Notwithstanding the licensure exemption contained in this subdivision, a nonprofit speech and hearing center shall be deemed to be an organized outpatient clinic for purposes of qualifying for reimbursement as a rehabilitation center under the Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).
(l)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, that conducts medical research and health education and provides health care to its patients through a group of 40 or more physicians and surgeons, who are independent contractors representing not less than 10 board-certified specialties, and not less than two-thirds of whom practice on a full-time basis at the clinic.
(m)Any clinic, limited to in vivo diagnostic services by magnetic resonance imaging functions or radiological services under the direct and immediate supervision of a physician and surgeon who is licensed to practice in California. This shall not be construed to permit cardiac catheterization or any treatment modality in these clinics.
(n)A clinic operated by an employer or jointly by two or more employers for their employees only, or by a group of employees, or jointly by employees and employers, without profit to the operators thereof or to any other person, for the prevention and treatment of accidental injuries to, and the care of the health of, the employees comprising the group.
(o)A community mental health center, as defined in Section 5667 of the Welfare and Institutions Code.
(p)(1)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, as an entity organized and operated exclusively for scientific and charitable purposes and that satisfied all of the following requirements on or before January 1, 2005:
(A)Commenced conducting medical research on or before January 1, 1982, and continues to conduct medical research.
(B)Conducted research in, among other areas, prostatic cancer, cardiovascular disease, electronic neural prosthetic devices, biological effects and medical uses of lasers, and human magnetic resonance imaging and spectroscopy.
(C)Sponsored publication of at least 200 medical research articles in peer-reviewed publications.
(D)Received grants and contracts from the National Institutes of Health.
(E)Held and licensed patents on medical technology.
(F)Received charitable contributions and bequests totaling at least five million dollars ($5,000,000).
(G)Provides health care services to patients only:
(i)In conjunction with research being conducted on procedures or applications not approved or only partially approved for payment (I) under the Medicare program pursuant to Section 1359y(a)(1)(A) of Title 42 of the United States Code, or (II) by a health care service plan registered under Chapter 2.2 (commencing with Section 1340), or a disability insurer regulated under Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code; provided that services may be provided by the clinic for an additional period of up to three years following the approvals, but only to the extent necessary to maintain clinical expertise in the procedure or application for purposes of actively providing training in the procedure or application for physicians and surgeons unrelated to the clinic.
(ii)Through physicians and surgeons who, in the aggregate, devote no more than 30 percent of their professional time for the entity operating the clinic, on an annual basis, to direct patient care activities for which charges for professional services are paid.
(H)Makes available to the public the general results of its research activities on at least an annual basis, subject to good faith protection of proprietary rights in its intellectual property.
(I)Is a freestanding clinic, whose operations under this subdivision are not conducted in conjunction with any affiliated or associated health clinic or facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as affiliated only if it directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, a clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as associated only if more than 20 percent of the directors or trustees of the clinic are also the directors or trustees of any individual clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). Any activity by a clinic under this subdivision in connection with an affiliated or associated entity shall fully comply with the requirements of this subdivision. This subparagraph shall not apply to agreements between a clinic and any entity for purposes of coordinating medical research.
(2)By January 1, 2007, and every five years thereafter, the Legislature shall receive a report from each clinic meeting the criteria of this subdivision and any other interested party concerning the operation of the clinics activities. The report shall include, but not be limited to, an evaluation of how the clinic impacted competition in the relevant health care market, and a detailed description of the clinics research results and the level of acceptance by the payer community of the procedures performed at the clinic. The report shall also include a description of procedures performed both in clinics governed by this subdivision and those performed in other settings. The cost of preparing the reports shall be borne by the clinics that are required to submit them to the Legislature pursuant to this paragraph.
This chapter does not apply to the following:
(a)Except with respect to the option provided with regard to surgical clinics in paragraph (1) of subdivision (b) of Section 1204 and, further, with respect to specialty clinics specified in paragraph (2) of subdivision (b) of Section 1204, any place or establishment owned or leased and operated as a clinic or office by one or more licensed health care practitioners and used as an office for the practice of their profession, within the scope of their license, regardless of the name used publicly to identify the place or establishment.
(b)Any clinic directly conducted, maintained, or operated by the United States or by any of its departments, officers, or agencies, and any primary care clinic specified in subdivision (a) of Section 1204 that is directly conducted, maintained, or operated by this state or by any of its political subdivisions or districts, or by any city. Nothing in this subdivision precludes the state department from adopting regulations that utilize clinic licensing standards as eligibility criteria for participation in programs funded wholly or partially under Title XVIII or XIX of the federal Social Security Act.
(c)(1)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, that is located on land recognized as tribal land by the federal government.
(2)Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in Section 450 or 1603 of Title 25 of the United States Code, under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act (Public Law 93-638), regardless of the location of the clinic, except that if the clinic chooses to apply to the State Department of Public Health for a state facility license, then the State Department of Public Health will retain authority to regulate that clinic as a primary care clinic as defined by subdivision (a) of Section 1204.
(d)Clinics conducted, operated, or maintained as outpatient departments of hospitals.
(e)Any facility licensed as a health facility under Chapter 2 (commencing with Section 1250).
(f)Any freestanding clinical or pathological laboratory licensed under Chapter 3 (commencing with Section 1200) of Division 2 of the Business and Professions Code.
(g)A clinic operated by, or affiliated with, any institution of learning that teaches a recognized healing art and is approved by the state board or commission vested with responsibility for regulation of the practice of that healing art.
(h)A clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 30 40 hours a week. An intermittent clinic as described in this subdivision shall, however, meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety.
(i)The offices of physicians in group practice who provide a preponderance of their services to members of a comprehensive group practice prepayment health care service plan subject to Chapter 2.2 (commencing with Section 1340).
(j)Student health centers operated by public institutions of higher education.
(k)Nonprofit speech and hearing centers, as defined in Section 1201.5. Any nonprofit speech and hearing clinic desiring an exemption under this subdivision shall make application therefor to the director, who shall grant the exemption to any facility meeting the criteria of Section 1201.5. Notwithstanding the licensure exemption contained in this subdivision, a nonprofit speech and hearing center shall be deemed to be an organized outpatient clinic for purposes of qualifying for reimbursement as a rehabilitation center under the Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).
(l)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, that conducts medical research and health education and provides health care to its patients through a group of 40 or more physicians and surgeons, who are independent contractors representing not less than 10 board-certified specialties, and not less than two-thirds of whom practice on a full-time basis at the clinic.
(m)Any clinic, limited to in vivo diagnostic services by magnetic resonance imaging functions or radiological services under the direct and immediate supervision of a physician and surgeon who is licensed to practice in California. This shall not be construed to permit cardiac catheterization or any treatment modality in these clinics.
(n)A clinic operated by an employer or jointly by two or more employers for their employees only, or by a group of employees, or jointly by employees and employers, without profit to the operators thereof or to any other person, for the prevention and treatment of accidental injuries to, and the care of the health of, the employees comprising the group.
(o)A community mental health center, as defined in Section 5667 of the Welfare and Institutions Code.
(p)(1)A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (c) of Section 501 of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, as an entity organized and operated exclusively for scientific and charitable purposes and that satisfied all of the following requirements on or before January 1, 2005:
(A)Commenced conducting medical research on or before January 1, 1982, and continues to conduct medical research.
(B)Conducted research in, among other areas, prostatic cancer, cardiovascular disease, electronic neural prosthetic devices, biological effects and medical uses of lasers, and human magnetic resonance imaging and spectroscopy.
(C)Sponsored publication of at least 200 medical research articles in peer-reviewed publications.
(D)Received grants and contracts from the National Institutes of Health.
(E)Held and licensed patents on medical technology.
(F)Received charitable contributions and bequests totaling at least five million dollars ($5,000,000).
(G)Provides health care services to patients only:
(i)In conjunction with research being conducted on procedures or applications not approved or only partially approved for payment (I) under the Medicare program pursuant to Section 1359y(a)(1)(A) of Title 42 of the United States Code, or (II) by a health care service plan registered under Chapter 2.2 (commencing with Section 1340), or a disability insurer regulated under Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code; provided that services may be provided by the clinic for an additional period of up to three years following the approvals, but only to the extent necessary to maintain clinical expertise in the procedure or application for purposes of actively providing training in the procedure or application for physicians and surgeons unrelated to the clinic.
(ii)Through physicians and surgeons who, in the aggregate, devote no more than 30 percent of their professional time for the entity operating the clinic, on an annual basis, to direct patient care activities for which charges for professional services are paid.
(H)Makes available to the public the general results of its research activities on at least an annual basis, subject to good faith protection of proprietary rights in its intellectual property.
(I)Is a freestanding clinic, whose operations under this subdivision are not conducted in conjunction with any affiliated or associated health clinic or facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as affiliated only if it directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, a clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as associated only if more than 20 percent of the directors or trustees of the clinic are also the directors or trustees of any individual clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). Any activity by a clinic under this subdivision in connection with an affiliated or associated entity shall fully comply with the requirements of this subdivision. This subparagraph shall not apply to agreements between a clinic and any entity for purposes of coordinating medical research.
(2)By January 1, 2007, and every five years thereafter, the Legislature shall receive a report from each clinic meeting the criteria of this subdivision and any other interested party concerning the operation of the clinics activities. The report shall include, but not be limited to, an evaluation of how the clinic impacted competition in the relevant health care market, and a detailed description of the clinics research results and the level of acceptance by the payer community of the procedures performed at the clinic. The report shall also include a description of procedures performed both in clinics governed by this subdivision and those performed in other settings. The cost of preparing the reports shall be borne by the clinics that are required to submit them to the Legislature pursuant to this paragraph.
CORRECTIONS: HeadingLines 2 and 3. REVISIONS: HeadingLine 2.|
Date
|
Status
|
|---|---|
| Sep 6, 2018 | Chaptered by Secretary of State - Chapter 279, Statutes of 2018. |
| Sep 6, 2018 | Approved by the Governor. |
| Aug 28, 2018 | Enrolled and presented to the Governor at 3 p.m. |
| Aug 23, 2018 | In Assembly. Ordered to Engrossing and Enrolling. |
| Aug 23, 2018 | Read third time. Passed. Ordered to the Assembly. |
| Jun 26, 2018 | Read second time. Ordered to third reading. |
| Jun 25, 2018 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jun 6, 2018 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 6). Re-referred to Com. on APPR. |
| Apr 25, 2018 | Referred to Com. on HEALTH. |
| Apr 12, 2018 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Apr 12, 2018 | Read third time. Passed. Ordered to the Senate. |
| Apr 5, 2018 | Read second time. Ordered to Consent Calendar. |
| Apr 4, 2018 | From committee: Do pass. To Consent Calendar. (Ayes 15. Noes 0.) (April 4). |
| Mar 27, 2018 | Introduced measure version corrected. |
| Mar 21, 2018 | Coauthors revised. |
| Mar 1, 2018 | Referred to Com. on HEALTH. |
| Feb 13, 2018 | From printer. May be heard in committee March 15. |
| Feb 12, 2018 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 23, 2018 | Assembly 3rd Reading AB2204 Gray et al. By Portantino | Senate Floor |
Passed |
|
| Jun 6, 2018 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Apr 12, 2018 | AB 2204 GRAY Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 4, 2018 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Mar 20, 2018 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Borego Community Health Foundation | ** Support | Jun 27, 2018 |
| CaliforniaHealth+ Advocates | ** Support | Jun 27, 2018 |
| Camarena Health | * Support | Mar 20, 2018 |
| Central California Partnership For Health | ** Support | Jun 27, 2018 |
| Central Valley Health Network | * Support | Mar 20, 2018 |
| clinicas de salud del pueblo | ** Support | Jun 27, 2018 |
| Community Health Systems, Inc. | ** Support | Jun 27, 2018 |
| Family HealthCare Network | * Support | Jun 6, 2018 |
| Health Alliance of Northern California | ** Support | Jun 27, 2018 |
| Health Center Partners of Southern California | ** Support | Jun 27, 2018 |
| Imperial Beach Community Clinic | ** Support | Jun 27, 2018 |
| indian health council, inc. | ** Support | Jun 27, 2018 |
| la maestra health centers | ** Support | Jun 27, 2018 |
| Livingston Community Health | * Support | Mar 20, 2018 |
| mountain health & community services | ** Support | Jun 27, 2018 |
| Neighborhood Healthcare | ** Support | Jun 27, 2018 |
| North Coast Clinics Network | ** Support | Jun 27, 2018 |
| North County Health Services | ** Support | Jun 27, 2018 |
| Operation Samahan | ** Support | Jun 27, 2018 |
| Planned Parenthood of the Pacific Southwest | ** Support | Jun 27, 2018 |
| Rural County Representatives of California | ** Support | Jun 27, 2018 |
| San Diego American Indian Health Center | ** Support | Jun 27, 2018 |
| san diego family care | ** Support | Jun 27, 2018 |
| San Ysidro Health Center | ** Support | Jun 27, 2018 |
| Southern Indian Health Council | ** Support | Jun 27, 2018 |
| sycuan medical dental care | ** Support | Jun 27, 2018 |
| Tenent Healthcare | ** Support | Jun 27, 2018 |
| Vista Community Clinic | ** Support | Jun 27, 2018 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2204
:
SENATE HEALTH COMMITTEE: 7-0, 6/6/18
AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Nielsen, Roth
NO VOTE RECORDED: Newman, Pan
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 68-0, 4/12/18 (Consent) - See last page for vote
DIGEST:
This bill extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
Existing law:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (DPH). [HSC §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by DPH, including clinics operated by the federal government or by a federally recognized Indian tribe on tribal land. [HSC §1206]
- Exempts from licensure by DPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours each week. However, an intermittent clinic operated under this exemption is still required to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
- Requires a licensed primary care clinic to report to DPH, when renewing its license, whether it is currently operating an intermittent clinic, the location of any intermittent clinic, and the estimated hours of operation of any intermittent clinic. [HSC §1218.4]
This bill extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
Comments
- Author’s statement. According to the author, primary care clinics use intermittent clinics to offer services in communities that would otherwise not support a full-time licensed clinic such as school-based health centers or underserved communities. The sharp rise in health insurance coverage under the Affordable Care Act and the Medi-Cal expansion has significantly increased demand for non-emergency room medical services in communities without sufficient infrastructure and personnel to provide that care. This bill increases the number of hours that an intermittent health clinic can be open from 30 hours per week to 40 hours per week. Expanding hours will aid in overcoming barriers for patients who are not able to access full-time health clinics and allow flexibility for clinics to serve their patients
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic, for up to 30 hours per week, without obtaining a separate license for these off-site locations. According to DPH, there are a total of 1630 licensed primary care clinics, and 171 intermittent clinics. Intermittent clinics can range from a small one-provider clinic inside a homeless shelter that is open just a few hours per week, to larger school-based health centers that may operate up to 30 hours per week. There are no regulations specific to intermittent clinics, and under California statute, these clinics are only required to meet fire and life safety requirements of law, which are established by the State Fire Marshall. As stated by the many supporting organizations, primary care clinics use these satellite locations to offer services in communities that might not otherwise support a full-time licensed clinic, such as school-based health centers, or in rural or underserved communities.
- Affiliate clinic licensure and consolidated clinic licensure. SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined provisions related to primary care clinic affiliate licensure. Under SB 442, a primary care clinic that has held a license for five years with no history of repeated or uncorrected violations can apply for an “affiliate clinic” license to establish a primary care clinic at an additional site. An affiliate license application does not require an initial onsite survey, and is a more simplified and streamlined process than applying for a new stand-alone license. Additionally, primary care clinics operating under a single corporation utilizing the affiliate licensing option are entitled to consolidate certain administrative functions such as billing and related financial functions, purchasing functions, and offsite storage and maintenance of certain patient and personnel records.
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) established a process for DPH to issue a single consolidated license to primary care clinics that include more than one physical plant operated on separate premises, as long as the physical plants are within one-half of a mile of the licensed primary care clinic. The concept for a consolidated license was to avoid the need for multiple licenses (even if affiliated licenses) when several buildings, close by but not physically attached, functioned as a single clinic.
- Avoiding specific building code requirements for licensed clinics. While primary care clinics are not required to comply with seismic safety standards that apply to hospitals, clinics are required to meet certain building code requirements, known as OSHPD 3 requirements. In addition to primary care clinics, OSHPD 3 requirements also apply to outpatient clinical services of a hospital, but do not apply to unlicensed settings, such as intermittent clinics. OSHPD 3 requirements include a number of specific requirements, including minimum space for examination rooms, minimum requirements for handwashing stations, specific ventilation requirements, among many others building code requirements relating to electrical, mechanical, and plumbing systems. The ability to avoid having to comply with OSHPD 3 requirements is one of the main advantages of operating a site as an intermitted clinic rather than obtaining an affiliated license.
- Policy comment. Since the provision of law was enacted more than 30 years ago, intermittent clinics were only exempt from licensure if they were open for no more than 20 hours per week. Then, in 2015, AB 1130 (Gray, Chapter 412) was enacted to permit intermittent clinics to be open for up to 30 hours per week. Now, three years later, this bill is proposing to increase the hours to 40 hours per week. Many licensed primary care clinics have extended hours and are open on weekends, for a total of much more than 40 hours per week. Still, 40 hours per week is starting to move beyond “intermittent,” and getting closer to full operation. Clearly, having the ability to open satellite offices in schools or homeless shelters is providing a vital service to many underserved communities, and expanding the hours that these satellite locations are open increases the availability of these services. The question for the Legislature is when do these “intermittent” or “satellite” locations become full service clinics, and be licensed as such.
Related/Prior Legislation
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) required DPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
AB 1130 (Gray, Chapter 412, Statutes of 2015) expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
AB 941 (Wood, Chapter 502, Statutes of 2015) expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003) revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from DPH. Required DPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
Borego Community Health Foundation
CaliforniaHealth+ Advocates
Central California Partnership for Health
Clinicas de Salud del Pueblo
Community Health Systems, Inc.
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Council, Inc.
La Maestra Health Centers
Mountain Health & Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Operation Samahan
Planned Parenthood of the Pacific Southwest
Rural County Representatives of California
San Diego American Indian Health Center
San Diego Family Care
San Ysidro Health Center
Southern Indian Health Council
Sycuan Medical Dental Care
Tenent Healthcare
Vista Community Clinic
OPPOSITION: (Verified 6/26/18)
None received
ARGUMENTS IN SUPPORT: CaliforniaHealth+ Advocates states in support that intermittent clinics have been effective tools in increasing services for hard to reach populations, and frequently have been used to provide care for homeless, rural and agricultural communities, and school-age children. Health Center Partners of Southern California, which includes a number of community health centers in San Diego, Riverside, and Imperial Counties, states in support that the 30 hours per week which intermittent clinics can operate at limits the ability to meet the ever-growing demand for healthcare services. The North Coast Clinics Network states that increasing the number of hours to 40 hours per week would give clinics the ability to increase access to healthcare services to underserved communities, and would additionally increase the ability to open new clinical sites.
ASSEMBLY FLOOR: 68-0, 4/12/18
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Grayson, Harper, Holden, Irwin, Kalra, Kiley, Lackey, Levine, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Bloom, Cristina Garcia, Gray, Jones-Sawyer, Limón, Low, Mullin, Santiago, Steinorth
6/27/18 9:18:10
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2204
AUTHOR: | Gray | ||
VERSION: | February 12, 2018 | ||
HEARING DATE: | June 6, 2018 | ||
CONSULTANT: | Vincent D. Marchand | ||
SUBJECT: Clinics: licensure and regulation: exemption
SUMMARY:
Extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
Existing law:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (DPH). [HSC §1200, et seq.]
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished. [HSC §1204]
- Exempts various types of clinics from licensure and regulation by DPH, including clinics operated by the federal government or by a federally recognized Indian tribe on tribal land. [HSC §1206]
- Exempts from licensure by DPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours each week. However, an intermittent clinic operated under this exemption is still required to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
- Requires a licensed primary care clinic to report to DPH, when renewing its license, whether it is currently operating an intermittent clinic, the location of any intermittent clinic, and the estimated hours of operation of any intermittent clinic. [HSC §1218.4]
This bill: Extends the limit on the number of hours an intermittent primary care clinic can operate, from 30 to 40 hours per week, and still be exempt from licensure.
FISCAL EFFECT:
According to the Assembly Appropriations Committee, costs to DPH are expected to be minor and absorbable (Licensing and Certification Fund).
PRIOR VOTES:
Assembly Floor: | 68 - 0 |
Assembly Appropriations Committee: | 15 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, primary care clinics use intermittent clinics to offer services in communities that would otherwise not support a full-time licensed clinic such as school-based health centers or underserved communities. The sharp rise in health insurance coverage under the Affordable Care Act and the Medi-Cal expansion has significantly increased demand for non-emergency room medical services in communities without sufficient infrastructure and personnel to provide that care. This bill increases the number of hours that an intermittent health clinic can be open from 30 hours per week to 40 hours per week. Expanding hours will aid in overcoming barriers for patients who are not able to access full-time health clinics and allow flexibility for clinics to serve their patients
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic, for up to 30 hours per week, without obtaining a separate license for these off-site locations. According to DPH, there are a total of 1630 licensed primary care clinics, and 171 intermittent clinics. Intermittent clinics can range from a small one-provider clinic inside a homeless shelter that is open just a few hours per week, to larger school-based health centers that may operate up to 30 hours per week. There are no regulations specific to intermittent clinics, and under California statute, these clinics are only required to meet fire and life safety requirements of law, which are established by the State Fire Marshall. As stated by the many supporting organizations, primary care clinics use these satellite locations to offer services in communities that might not otherwise support a full-time licensed clinic, such as school-based health centers, or in rural or underserved communities.
- Affiliate clinic licensure and consolidated clinic licensure. SB 442 (Ducheny, Chapter 502, Statutes of 2010) streamlined provisions related to primary care clinic affiliate licensure. Under SB 442, a primary care clinic that has held a license for five years with no history of repeated or uncorrected violations can apply for an “affiliate clinic” license to establish a primary care clinic at an additional site. An affiliate license application does not require an initial onsite survey, and is a more simplified and streamlined process than applying for a new stand-alone license. Additionally, primary care clinics operating under a single corporation utilizing the affiliate licensing option are entitled to consolidate certain administrative functions such as billing and related financial functions, purchasing functions, and offsite storage and maintenance of certain patient and personnel records.
AB 2053 (Gonzalez, Chapter 639, Statutes of 2016) established a process for DPH to issue a single consolidated license to primary care clinics that include more than one physical plant operated on separate premises, as long as the physical plants are within one-half of a mile of the licensed primary care clinic. The concept for a consolidated license was to avoid the need for multiple licenses (even if affiliated licenses) when several buildings, close by but not physically attached, functioned as a single clinic. - Avoiding specific building code requirements for licensed clinics. While primary care clinics are not required to comply with seismic safety standards that apply to hospitals, clinics are required to meet certain building code requirements, known as OSHPD 3 requirements. In addition to primary care clinics, OSHPD 3 requirements also apply to outpatient clinical services of a hospital, but do not apply to unlicensed settings, such as intermittent clinics. OSHPD 3 requirements include a number of specific requirements, including minimum space for examination rooms, minimum requirements for handwashing stations, specific ventilation requirements, among many others building code requirements relating to electrical, mechanical, and plumbing systems. The ability to avoid having to comply with OSHPD 3 requirements is one of the main advantages of operating a site as an intermitted clinic rather than obtaining an affiliated license.
- Prior legislation. AB 2053 (Gonzalez) required DPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
AB 1130 (Gray, Chapter 412, Statutes of 2015) expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
AB 941 (Wood, Chapter 502, Statutes of 2015) expanded a licensure exemption for tribal clinics, which were previously exempted if located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
SB 442 (Ducheny) streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003) revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from DPH. Required DPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions. - Support. CaliforniaHealth+ Advocates states in support that intermittent clinics have been effective tools in increasing services for hard to reach populations, and frequently have been used to provide care for homeless, rural and agricultural communities, and school-age children. Health Center Partners of Southern California, which includes a number of community health centers in San Diego, Riverside, and Imperial Counties, states in support that the 30 hours per week which intermittent clinics can operate at limits the ability to meet the ever-growing demand for healthcare services. The North Coast Clinics Network states that increasing the number of hours to 40 hours per week would give clinics the ability to increase access to healthcare services to underserved communities, and would additionally increase the ability to open new clinical sites.
- Policy comment. Since the provision of law was enacted more than 30 years ago, intermittent clinics were only exempt from licensure if they were open for no more than 20 hours per week. Then, in 2015, AB 1130 was enacted to permit intermittent clinics to be open for up to 30 hours per week. Now, three years later, this bill is proposing to increase the hours to 40 hours per week. Many licensed primary care clinics have extended hours and are open on weekends, for a total of much more than 40 hours per week. Still, 40 hours per week is starting to move beyond “intermittent,” and getting closer to full operation. Clearly, having the ability to open satellite offices in schools or homeless shelters is providing a vital service to many underserved communities, and expanding the hours that these satellite locations are open increases the availability of these services. The question for the Legislature is when do these “intermittent” or “satellite” locations become full service clinics, and be licensed as such.
SUPPORT AND OPPOSITION:
Support: Borego Community Health Foundation
CaliforniaHealth+ Advocates
Central California Partnership for Health
Clinicas de Salud del Pueblo
Community Health Systems, Inc.
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Council, Inc.
La Maestra Health Centers
Mountain Health & Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Operation Samahan
Planned Parenthood of the Pacific Southwest
Rural County Representatives of California
San Diego American Indian Health Center
San Diego Family Care
San Ysidro Health Center
Southern Indian Health Council
Sycuan Medical Dental Care
Tenent Healthcare
Vista Community Clinic
Oppose: None received
-- END --
Date of Hearing: April 4, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 2204
Author:(Gray) – As Introduced Ver:February 12, 2018
Policy Committee: | Health | Vote: | 15 - 0 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill increases the number of hours an "intermittent clinic" can operate, from 30 to 40 hours per week.
FISCAL EFFECT:
Costs to the California Department of Public Health (CDPH) are expected to be minor and absorbable (Licensing and Certification Fund).
COMMENTS:
- Purpose. This bill is intended to expand access to health care in places that may not be able to support a separately licensed health clinic. It is supported by clinics, particularly by Central Valley and Northern California clinics, who indicate the additional hours will allow additional health care services to be provided at existing locations. It has no opposition.
- Background. CDPH licenses and certifies health care facilities. Current law allows a licensed primary care clinic to also operate an "intermittent clinic" off-site for up to 30 hours per week, without obtaining a separate license. According to CDPH, there are over 1,000 licensed clinics and 171 intermittent clinics operating in the state. More stringent regulatory requirements apply to licensed clinics, while intermittent clinics are only obligated to meet fire and life safety rules. Notably, AB 1130 (Gray), Chapter 412, Statutes of 2015, increased authorized hours for intermittent clinics from 20 hours to 30 hours per week, and this bill would be another significant expansion.
Clinics have alternatives to seeking a new, full licensure for additional sites. In addition to the intermittent clinic option, clinics also may apply for "affiliate clinic” licensure or apply for a consolidated license covering multiple clinics.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: March 20, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2204
Author:(Gray) – As Introduced Ver:February 12, 2018
SUBJECT: Clinics: licensure and regulation: exemption.
SUMMARY: Increases the number of hours an intermittent clinic that is exempt from licensure can operate, from 30 to 40 hours per week.
EXISTING LAW:
- Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (DPH).
- Defines a primary care clinic as either a “community clinic,” which is required to be operated by a non-profit corporation and to use a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also required to be operated by a non-profit but is not allowed to directly charge patients for services rendered or for any drugs, medicines, or apparatuses furnished.
- Exempts various types of clinics from licensure and regulation by DPH, including clinics operated by the United States or by a federally recognized Indian tribe.
- Exempts from licensure by DPH an intermittent clinic that is operated by a licensed primary care community clinic on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours each week. Requires an intermittent clinic operated under this exemption to meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety.
- Authorizes DPH to take various types of enforcement actions against a primary care clinic that has violated state law or regulation, including imposing fines, sanctions, civil or criminal penalties, and suspension or revocation of the clinic's license.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, primary care clinics use intermittent clinics to offer services in communities that would otherwise not support a full-time licensed clinic such as school-based health centers or underserved communities. The author notes that the sharp rise in health insurance coverage under the federal Patient Protection and Affordable Care Act (ACA) and Medi-Cal expansion has significantly increased demand for non-emergency room medical services in communities without sufficient infrastructure and personnel to provide that care. The author states that increasing the number of hours that an intermittent health clinic is open from 30 hours per week to 40 hours per week will aid in overcoming barriers for patients who are not able to access full-time health clinics and allow flexibility for clinics to serve their patients.
- BACKGROUND.
- Intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic, for up to 30 hours per week, without obtaining a separate license for these off-site locations. While there are a little more than 1,000 licensed primary care clinics, because no license is required for these off-site locations, DPH has historically not tracked the number of intermittent clinics. However, AB 1130 (Gray), Chapter 412, Statutes of 2015, which authorized intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week, was amended to require clinics to report to DPH the number of intermittent clinics and their hours of operation. According to DPH there are currently 171 intermittent clinics throughout the state. The clinics' hours of operation are kept in hard copy files at district offices throughout the state.
There are no regulations specific to intermittent clinics, and under California statute, these clinics are only required to meet fire and life safety requirements of law, which are established by the State Fire Marshall. Primary care clinics use these satellite locations to offer services in communities that might not otherwise support a full-time licensed clinic.
- Primary care clinic licensure process. A provider that wants to open a clinic submits an application to DPH. Upon receipt, DPH will process the application fee and enter the application into the licensing system. The application is then assigned to a DPH analyst who reviews the package to determine its completeness and sends the provider a letter requesting additional documentation or corrections to the submitted documentation. The provider has 60 days to respond. If no response is received, DPH sends the provider another letter with 30 days to respond. Upon receipt of the requested documentation, DPH completes its review and sends the approved application to the DPH district office for a survey to be conducted. The district office completes its survey and notifies DPH that it is appropriate to issue a six month provisional license. According to DPH, for an initial application, it is currently taking approximately 305 days from the date of submission to a license being issued.
There are no limitations on operating hours for licensed primary care clinics. Theoretically a licensed clinic could remain open 24 hours a day; however, it is not a common practice, and a clinic can only treat a patient for less than 24 hours. Urgent care centers, which are licensed either as primary care clinics, as outpatient clinics on a hospital's license, or operate under a physician's professional license, offer extended hours on evenings and weekends. - Affiliate clinic licensure. In 2011, SB 442 (Ducheny), Chapter 502, Statutes of 2010, streamlined provisions related to primary care clinic affiliate licensure. Under existing law, as amended by SB 442, a primary care clinic that has held a license for five years with no history of repeated or uncorrected violations can apply for an “affiliate clinic” license to establish a primary care clinic at an additional site. An affiliate license application does not require an initial onsite survey, and is a more simplified and streamlined process than applying for a new stand-alone license. Additionally, primary care clinics operating under a single corporation utilizing the affiliate licensing option are entitled to consolidate certain administrative functions such as billing and related financial functions, purchasing functions, and offsite storage and maintenance of certain patient and personnel records.
- Clinic building standards. The Office of Statewide Health Planning and Development (OSHPD) is responsible for writing regulations pertaining to licensed clinics. These regulations are identified in the California Building Standards Code as "OSHPD 3." OSHPD 3 requirements apply to clinics that are licensed pursuant to Health and Safety Code (H&S) Section 1200 (which includes primary care clinics and specialty clinics) or outpatient services of a hospital licensed pursuant to H&S Section 1250. Clinics located within a hospital would comply with hospital seismic safety standards. However, many outpatient clinics are located in the storefront of commercial buildings, which are not built to hospital seismic requirements. The OSHPD 3 requirements specify additional building standards that clinics must adhere to wherever they are located, for example, specific plumbing requirements that provide infection control by requiring sinks solely dedicated to handwashing, and a sterile storage area for supplies. Generally, the OSHPD standards follow the specific services a clinic is providing. For example, an outpatient surgery center would have additional electrical code requirements, including providing a back-up generator. OSHPD 3 regulations do not apply to intermittent clinics.
- Primary care clinic licensure process. A provider that wants to open a clinic submits an application to DPH. Upon receipt, DPH will process the application fee and enter the application into the licensing system. The application is then assigned to a DPH analyst who reviews the package to determine its completeness and sends the provider a letter requesting additional documentation or corrections to the submitted documentation. The provider has 60 days to respond. If no response is received, DPH sends the provider another letter with 30 days to respond. Upon receipt of the requested documentation, DPH completes its review and sends the approved application to the DPH district office for a survey to be conducted. The district office completes its survey and notifies DPH that it is appropriate to issue a six month provisional license. According to DPH, for an initial application, it is currently taking approximately 305 days from the date of submission to a license being issued.
- SUPPORT. The Central California Partnership for Health (CCPH) supports this bill, stating that given the expansion of Medi-Cal and covered individuals through the ACA, most health centers have many sites operating at much more than 40 hours per week. For example, Family Healthcare Network has two sites that are open 94 hours and 10 sites open 79 hours per week. CCPH notes that as a result of this, when a clinic operates in an intermittent status of 30 hours it is still below 50% of the eventual hours of care that will be provided, and that the reason for a facilities intermittent status is most often due to the need to move into an OSHPD 3 compliant facility or retrofit the existing one, and that both of these take some time and provide a significant decrease in access to care to communities during that period. CCPH contends that many private medical offices are closing these days and the majority of them are being occupied by community health centers, and provided the following example:
Camarena Health recently occupied the facility of a primary care office in small mountain community which was the only medical facility in the entire community and one that the residents greatly depend on. Before the physician shut his doors, it was operating six days per week. As soon as Camarena took over and licensed it as an intermittent clinic due to non-OSHPD 3 compliance, they cut access to care to the community by two days a week. Camarena is currently working to lease a new building and build it out as an OSHPD 3 medical facility. In the meantime, they are limited to providing 30 hours of medical access.
CCPH concludes that this bill would allow community health centers to bridge that gap between the time they acquire or occupy a non-OSHPD 3 facility or until they are able to retrofit the existing facility or transfer into one that is compliant, and that once that is complete they will be in a position to use either the Affiliate Clinic or Consolidated Licensing process to fully license the facility and operate it at true full time hours that are needed to meet the needs of the community.
CaliforniaHealth+ Advocates supports this bill, noting that intermittent clinics have been effective tools in increasing services for hard to reach populations, and frequently have been used to provide care for homeless, rural and agricultural communities, and school-age children, however there remains a need for continued growth to serve the needs of these vulnerable populations.
Additional supporters of the bill, including the Health Alliance of Northern California and the North Coast Clinics Network, state that as the demand for critical healthcare services increased under the ACA and Medi-Cal expansion, California's community health centers play a vital role in the healthcare delivery system, serving millions of individuals and families across California. They note, however, that the 30 hours a week intermittent clinics can currently operate at limit the ability to meet the ever-growing demand.
- PREVIOUS LEGISLATION.
- AB 941 (Wood), Chapter 502, Statutes of 2015, expanded the licensure exemption for tribal clinics, which were previously only exempted if they were located on tribal land, by exempting tribal clinics regardless of the location of the clinic, if the clinic is operated under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act.
- AB 1130 expanded the licensure exemption for intermittent clinics that are operated by licensed clinics on separate premises by permitting these intermittent clinics to be open for up to 30 hours per week, instead of only 20 hours per week.
- AB 2053 (Gonzalez), Chapter 639, Statutes of 2016 required DPH, upon written notification by a licensed primary care clinic or an affiliate clinic that it is adding an additional physical plant maintained and operated on separate premises, to issue a single consolidated license to the clinic.
- SB 937 (Ducheny), Chapter 602, Statutes of 2003, revised provisions relating to the licensure and operation of primary care clinics. Permitted a primary care clinic to add a service or remodel a site without first having to apply for a new license from DPH. Required DPH to issue an affiliate license to a primary care clinic to allow it to open a clinic at an additional site, under specified conditions.
- POLICY COMMENT. As noted by the author when discussing AB 1130 in 2015 (which increased the maximum hours an intermittent clinic could operate from 20 to 30 hours) the 20 hour limit was placed in statute 37 years ago, and based on a typical 40 hour work week. Today, full time healthcare centers are open much longer hours, (in some cases seven days a week) and continue to adapt in order to meet the needs of every community. Given the increase in patient population due to the Medi-Cal expansion and the ACA, increasing the hours to keep up with the demand for service in all areas of California made sense. However, a thorough examination of how many hours an intermittent clinic should operate is warranted.
REGISTERED SUPPORT / OPPOSITION:
Support
Central California Partnership for Health
Health Alliance of Northern California
North Coast Clinics Network
Opposition
None on file.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
Discussed in Hearing
4MIN
Senate Floor
6MIN
Senate Standing Committee on Health
6MIN
Assembly Standing Committee on Health
Bill Author
