Existing law provides for the licensure and regulation of clinics, including primary care clinics and specialty clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

Commencing January 1, 2027, this bill would repeal and recast these reporting requirements, including, but not limited to, extending their application to intermittent clinics operated by licensed clinics. The bill would establish specific reporting requirements for specialty clinics, as defined. The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would require the department to adopt regulations necessary to implement these reporting requirements and to require the first annual reports to be submitted on or before February 15, 2028, using information relating to the calendar year beginning January 1, 2027.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics and specialty clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

Commencing January 1, 2027, this bill would repeal and recast these reporting requirements, including, but not limited to, extending their application to intermittent clinics operated by licensed clinics. The bill would establish specific reporting requirements for specialty clinics, as defined. The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would require the department to adopt regulations necessary to implement these reporting requirements and to require the first annual reports to be submitted on or before February 15, 2028, using information relating to the calendar year beginning January 1, 2027.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics and specialty clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

Commencing January 1, 2027, this bill would repeal and recast these reporting requirements, including, but not limited to, extending their application to intermittent clinics operated by licensed clinics. The bill would establish specific reporting requirements for specialty clinics, as defined. The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would require the department to adopt regulations necessary to implement these reporting requirements on or before January 1, 2025. and to require the first annual reports to be submitted on or before February 15, 2028, using information relating to the calendar year beginning January 1, 2027.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would authorize require the department to adopt regulations necessary to implement these reporting requirements. requirements on or before January 1, 2025.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, the percentage of all revenue spent on workforce expenditures, as specified, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would impose specified civil penalties on a primary care clinic or intermittent clinic that fails to file a required report pursuant to the bills requirements. The bill would authorize a clinic affected by a determination made pursuant to the bills requirements to petition the department for a review of the decision, and would further provide for judicial review of any final action by the department, as specified. The bill would authorize the department to adopt regulations necessary to implement these reporting requirements.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, the percentage of all revenue spent on workforce expenditures, as specified, a report of all mergers and acquisitions, and a report of quality and equity measures. The bill would impose specified civil penalties on a primary care clinic or intermittent clinic that fails to file a required report pursuant to the bills requirements. The bill would authorize a clinic affected by a determination made pursuant to the bills requirements to petition the department for a review of the decision, and would further provide for judicial review of any final action by the department, as specified. The bill would authorize the department to adopt regulations necessary to implement these reporting requirements.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, the percentage of all revenue spent on workforce expenditures, as specified, a report of all mergers and aqcuisitions, acquisitions, and a report of quality and equity measures. The bill would impose specified civil penalties on a primary care clinic or intermittent clinic that fails to file a required report pursuant to the bills requirements. The bill would authorize a clinic affected by a determination made pursuant to the bills requirements to petition the department for a review of the decision, and would further provide for judicial review of any final action by the department, as specified. The bill would authorize the department to adopt regulations necessary to implement these reporting requirements.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those 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 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, the percentage of all revenue spent on workforce expenditures, as specified, a report of all mergers and aqcuisitions, and a report of quality and equity measures. The bill would impose specified civil penalties on a primary care clinic or intermittent clinic that fails to file a required report pursuant to the bills requirements. The bill would authorize a clinic affected by a determination made pursuant to the bills requirements to petition the department for a review of the decision, and would further provide for judicial review of any final action by the department, as specified. The bill would authorize the department to adopt regulations necessary to implement these reporting requirements.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would imposes a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 779

Author: Stern (D), et al.

Amended: 9/8/23

Vote: 21

SENATE HEALTH COMMITTEE: 9-2, 4/12/23

AYES: Eggman, Gonzalez, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

NOES: Nguyen, Glazer

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/23

AYES: Portantino, Ashby, Bradford, Wahab, Wiener

NOES: Jones, Seyarto

SENATE FLOOR: 26-8, 5/31/23

AYES: Allen, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Durazo, Eggman, Gonzalez, Hurtado, Laird, Limón, McGuire, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

NOES: Dahle, Glazer, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto

NO VOTE RECORDED: Alvarado-Gil, Archuleta, Caballero, Dodd, Menjivar, Wilk

ASSEMBLY FLOOR: 48-17, 9/13/23 - See last page for vote

SUBJECT: Primary Care Clinic Data Modernization Act

SOURCE: SEIU California

DIGEST:

This bill, effective on January 1, 2027, adds intermittent clinics that are exempt from licensure to an existing requirement that clinics file an annual report to the Department of Health Care Access and Information (HCAI) with specified information. This bill creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including a labor report and a workforce development report.

Assembly Amendments

delete the reporting of clinic mergers and acquisitions, delete the reporting of quality and equity measures, delay implementation until January 1, 2027, add a requirement that clinics report the five highest compensated employees who make more than $100,000 if the clinic is already required to report this information to the Internal Revenue Service on a Form 990, and make a number of technical, clarifying, and conforming changes.

ANALYSIS:

Existing law:

1. Licenses and regulates clinics, including primary care and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
2. Defines a primary care clinic as either a “community clinic,” which is operated by a non-profit corporation and uses 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 charge patients. [HSC §1204]
3. Exempts various types of clinics from licensure by CDPH, including clinics operated by the federal government or by a federally recognized Indian tribe on tribal land, any primary care clinic operated by the state, counties, or cities, a clinic operated by any institution of learning that teaches a healing art, medical foundation clinics, and the offices of physicians in group practice who provide the preponderance of their services to members of a health plan. [HSC §1206]
4. Exempts from licensure by CDPH 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 no more than 40 hours each week. An intermittent clinic operated under this exemption is still required to meet other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
5. Requires every clinic holding a license to file with HCAI an annual report (known as the annual utilization report, or AUR) showing the following information relating to the previous calendar year:
   1. Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients;
   2. Number of patient visits by type of service, including child health and disability prevention screens, treatment, and follow-up services, medical services, dental services, and other health services;
   3. Total clinic operating expenses;
   4. Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county programs, private insurance, self-paying patients, nonpaying patients, and other payers;
   5. Deductions from revenue by payer category, bad debts, and charity care charges; and,
   6. Additional information as required by HCAI or CDPH. [HSC §1216]
6. Permits CDPH, in the event a clinic fails to file a timely report as required in 5) above, to suspend the license of the clinic until the report is completed and filed with HCAI. [HSC §1216(b)]

This bill:

1. Adds intermittent clinics, beginning on January 1, 2027, that are exempt from licensure to an existing requirement that licensed clinics file an annual report with certain specified information for the previous calendar year, known as the AUR.
2. Revises the AUR, beginning on January 1, 2027, to require clinics to report more detailed demographic information on patients served, including preferred language spoken, disability status, sexual orientation, gender identity, and payer category. Prohibits a clinic from being subject to any adverse action for not providing sexual orientation and gender identity information if the patient refuses to provide that information.
3. Revises the AUR, beginning on January 1, 2027, to require primary care clinics participating in the Medi-Cal program to include the number of members per Medi-Cal managed care plan and county indigent program, and the number of assigned members per Medi-Cal managed care plan and county indigent program that had clinic visits.
4. Revises the AUR, beginning on January 1, 2027, to require primary care clinics to report the average weekly number of clinic operating hours and whether or not the clinic is licensed or intermittent.
5. Requires, beginning on January 1, 2027, an organization that operates or owns a primary care clinic, and intermittent clinics operated by a licensed clinic, to file with HCAI, by February 15th each year, the following:
   1. The Medi-Cal FQHC/RHC prospective payment system rate, if applicable;
   2. A detailed labor report, including the following information:
      1. The actual number of employees and full-time equivalents, as well as contracted or registry staff, by job classification, including nonlicensed and noncredentialed positions at the beginning and end of the reporting period;
      2. The number of staff vacancies by job classification;
      3. The average base hourly wages and base hourly wage ranges by job classification for each classification with three or more employees; and,
      4. For clinics required to file a Form 990 with the Internal Revenue Service, information identifying job title and salary of the five highest compensated employees, who receive reportable compensation of more than $100,000.
      5. Aggregated workforce demographic information for each clinic site, including age, gender, race, ethnicity, languages spoken, disability status, sexual orientation, and gender identity. Prohibits workers from being required to provide this information or from being disciplined for not providing the information; and,
   3. A detailed workforce development report, including the following:
      1. Participation in any local, regional, or statewide labor-management cooperation committee (LMCC) , and the identity of all partners; and,
      2. Data about the nature and extent of participation in allied health care professional degrees and certificate programs, including, but not limited to, the number of clinical placements for each program.
6. Repeals a requirement, effective January 1, 2027, that specialty clinics who receive funds from a tobacco tax, as specified, complete the full AUR report, and recast the specialty clinic reporting requirements to delete obsolete references.
7. Requires HCAI to maintain a file of all reports under this bill and under existing law at its Sacramento office, and subject to any rules HCAI may prescribe, and in compliance with federal and state laws, requires these reports to be produced and made available for inspection upon the demand of any person, and to also be posted on HCAI’s website, to the extent permissible.
8. Revises a provision of law that permits CDPH to suspend the license of a clinic until its AUR report is filed by applying this provision to the new reporting requirements in this bill, and also permitting CDPH to suspend the license of any clinic who does not file a report for any intermittent clinic it operates.
9. Requires HCAI to send a written notice of violation to every clinic that fails to file a timely report under this bill or under specified provisions of existing law, either for itself or for any intermittent clinic it operates, and to also provide CDPH with a list of every clinic that receives a written notice of violation. Requires these notices to be available on HCAI’s internet website.

Comments

1. Author’s statement. According to the author, community clinics are integral to our state’s health care system, but we are facing a crisis exacerbated by the pandemic and its aftermath. Recent events have brought into sharp focus the workforce shortages faced by our clinics, exposing vulnerabilities in California’s social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. Accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.
2. Background on primary care clinics and intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics, and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics. In 2018, which is the year AB 2204 (Gray, Chapter 279, Statutes of 2018) extended the number of hours an intermittent clinic could operate from 30 to 40 hours, CDPH reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics. Clearly, the expansion of the number of hours an intermittent clinic could operate has led to an increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics.
3. Background on existing data collection for clinics. There are a number of existing data reporting obligations for clinics. As noted in existing law, a primary reporting requirement is the AUR report to HCAI. In addition, the federal Health Resources and Services Administration (HRSA) requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a core set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients’ use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported in some fashion, or (in the case of the PPS rate) public disclosure of something already collected. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item.
4. Clinic workforce shortage. According to a 2016 report by National Association of Community Health Centers, workforce challenges are one of the primary barriers to health center patient growth. If all health center clinical vacancies were filled today, health centers could serve two million more patients. At that time, prior to COVID-19’s impact on the health care workforce, 95% of health centers had at least one clinical vacancy, and were averaging a vacancy rate for clinical positions of 13%. The number one challenge in recruitment and retention named was the ability to offer competitive salaries. According to the Kaiser Family Foundation, California has 643 areas with a Health Professional Shortage Area designation for primary care, meaning one-third of Californians live in an area with a primary care provider shortage.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Assembly Appropriations Committee:

1. HCAI estimates costs of $2,037,000 in fiscal year (FY) 2024-25, $1,064,000 in FY 2025-26, $1,186,000 in FY 2026-27, and $1,186,000 per year, ongoing, to pay for seven additional staff positions, contracting resources, and enhancements to existing information systems and data infrastructure (California Health Data and Planning Fund).

HCAI reports the additional staff positions will be needed to support the development of regulations, initial program design, and the enhancement of information systems and data infrastructure. Some of the funds would also be needed for consulting resources in FY 2024-25 to support the enhancement of HCAI information systems and data infrastructure. In FY 2025-26 and ongoing, additional staff will support data collection, data review, and data dissemination of the new clinic utilization reports, as well as to ensure data is reported only in an aggregate form that cannot be used to identify an individual.

1. DPH reports minor and absorbable costs.

SUPPORT: (Verified 9/7/23)

SEIU California (source)

Buen Vecino

California Alliance for Retired Americans

California Black Health Network

California Labor Federation

California League of United Latin American Citizens

California Rural Legal Assistance Foundation

California School Employees Association

California Teachers Association

Center on Policy Initiatives

Central Coast Alliance United for a Sustainable Economy

Central Coast Labor Council

Clergy and Laity United for Economic Justice

Council on American-Islamic Relations, California

Dolores Huerta Foundation

Fresno, Madera, Tulare, Kings Counties, Center Labor Council

Los Angeles Alliance for a New Economy

Los Angeles County Democratic Party

North Valley Labor Federation

OPPOSITION: (Verified 9/7/23)

AltaMed Health Services

Altura Centers for Health

APLA Health & Wellness

Calexico Wellness Center

CaliforniaHealth+ Advocates

California Human Development

California Medical Association

Center for Employment Training

Central City Community Health Center

Central Valley Opportunity Center

Clinica Sierra Vista

CommuniCare Health Centers

Community Health Association Inland Southern Region

Community Medical Centers

El Proyecto del Barrio, Inc.

Farmworkers Institute of Education and Leadership Development

First Day Foundation

Fresno American Indian Health Project

Gardner Health Services

Golden Valley Health Centers

Health Alliance of Northern California

Health Center Partners of Southern California

Hill Country Health & Wellness

Inland Coalition for Immigrant Justice

La Clinica de la Raza

La Cooperativa Campesina de California

Lifelong Medical Care

Los Amigos de la Comunidad

Neighborhood Healthcare

North Coast Clinics Network

North East Medical Services

Northeast Valley Health Corporation

Ochin, Inc.

OLE Health

Proteus

San Diego Regional Chamber of Commerce

San Francisco Community Clinic Consortium

San Ysidro Health

Shasta Community Health Center

St. Jude Neighborhood Health Center

TCC Family Health

To Help Everyone Health and Wellness Centers

Valley Community Healthcare

Venice Family Clinic

Westside Family Health Center

ARGUMENTS IN SUPPORT: This bill is sponsored by the SEIU California to increase accountability, quality, and transparency in health care by updating annual data reporting for California’s licensed primary care clinics. According to SEIU California, over the past decade, the number of clinics in California have grown significantly with much of this growth being in intermittent clinic sites. Today, intermittent clinic sites do not report data directly, but under the licensed clinic they are affiliated with, which means data across two or more physical locations is aggregated under one licensed clinic site. SEIU California states there is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This results in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders. SEIU California points to data that indicate the number of clinic sites, inclusive of licensed and intermittent sites, has grown from roughly 1,500 sites in 2012 to 2,700 sites in 2021. In 2012, just under over 1,000 licensed sites reported data, or 70% of all CDPH listed sites. In 2021, on the other hand, just under 1,200 licensed sites reported data, or just 43% of all CDPH listed sites. The total number of licensed sites completing the AUR is decreasing, and not just because clinic corporations are choosing to open more intermittent sites, but also because they are converting previously licensed sites to be intermittent sites. Additionally, SEIU California states that we need to modernize the data we collect by building upon currently collected workforce data, incorporating quality data, and expanding financial data reporting.

ARGUMENTS IN OPPOSITION: Calexico Wellness Center opposes this bill, stating that it creates unnecessary burdensome data reporting requirements on community clinics and exposes these community clinics to civil penalties. Such burdensome requirements and penalties should not be places on clinics at a time when hospitals are closing their doors due to financial strains. Rural, low-income communities are facing many challenges, including food shortage, unemployment, violence and health disparities, and these communities are mainly served by FQHCs. This bill will have a negative impact on undocumented communities, and California should not place additional requirements on community clinics that have limited financial resources to serve patients. The Farmworkers Institute of Education and Leadership Development (FIELD) makes similar arguments in opposition, and states that the Central Valley, Imperial Valley and rural areas have historically experienced a shortage of healthcare facilities and workers, and California must prioritize these communities in investing job training funds for health care worker, not create burdens. CaliforniaHealth+ Advocates, the advocacy affiliate of the California Primary Care Association, opposes this bill unless amended, stating that this bill is a solution in search of a problem, and that clinics already report to multiple entities such as the Health Resource and Services Administration, HCAI, and various payors. Additionally, just last session the Legislature created the Office of Health Care Affordability, with responsibilities to manage spending targets, monitor system performance, and assess market consolidation. According to CaliforniaHealth+ Advocates, under current law, clinics report PPS rates, a full income statement, and patient data, among other data. While improving data standardization is an on-going and worthy effort, the amount of data clinics already submit on an annual basis is robust.

ASSEMBLY FLOOR: 48-17, 9/13/23

AYES: Addis, Aguiar-Curry, Alvarez, Arambula, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Wendy Carrillo, Cervantes, Connolly, Mike Fong, Friedman, Gabriel, Gipson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Ortega, Papan, Petrie-Norris, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Ting, Villapudua, Ward, Wicks, Wood, Zbur, Robert Rivas

NOES: Alanis, Chen, Megan Dahle, Davies, Dixon, Essayli, Flora, Vince Fong, Gallagher, Hoover, Lackey, Jim Patterson, Joe Patterson, Sanchez, Ta, Waldron, Wallis

NO VOTE RECORDED: Bains, Bauer-Kahan, Juan Carrillo, Garcia, Grayson, Mathis, Stephanie Nguyen, Pacheco, Pellerin, Quirk-Silva, Ramos, Soria, Valencia, Weber, Wilson

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

9/14/23 9:58:26

**** END ****

SENATE THIRD READING

STR Bill Id:SB 779

Author:(Stern)

As Amended Ver:September 8, 2023

Majority vote

SUMMARY

Requires, beginning January 1, 2027, an organization that operates or maintains a primary care clinic (PCC) or an intermittent clinic, to file an annual report with the Department of Health Care Access and Information (HCAI) containing specified information for the previous calendar year. Creates new reporting requirements for all PCCs, including intermittent clinics, to report various types of data to HCAI, including a labor report, workforce demographic information, and a detailed workforce development report. Revises and recasts current reporting requirements for specialty clinics.

Major Provisions

COMMENTS

1. PCCs and intermittent clinics. Under existing law, a licensed PCC is permitted to operate an off-site (intermittent) clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed PCCs include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics. AB 2204 (Gray), Chapter 279, Statutes of 2018, extended the number of hours an intermittent clinic could operate from 30 to 40 hours. That year, the Department of Public Health (DPH) reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics.

According to the California Health and Human Services Agency's (CHHSA) Open Data Portal, there were 2,052 licensed clinics (these include PCCs, surgical clinics, chronic dialysis clinics, rehabilitation clinics, psychology clinics, and alternative birth centers) as of May 15, 2023. Of these, 1,325 were licensed PCCs (these do not include intermittent clinics). According to the Open Data Portal, there were 1,218 intermittent clinics as of May 15, 2023. According to the Department of Health Care Services (DHCS), based on provider enrollment data, there are 818 intermittent clinics. The expansion of the number of hours an intermittent clinic could operate has led to a significant increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics, although the number of intermittent clinics appears debatable, given CHHSA and DHCS' conflicting numbers.

While information regarding clinics' daily hours of operation is reported in various ways, to various departments, because it is not reported to HCAI as part of the annual utilization report (AUR), the information does not seem to be easily trackable by either DPH or DHCS.

1. Current clinic data collection. Licensed clinics are required to provide an AUR to HCAI. In addition, the Health Resources and Services Administration (HRSA) requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a specific set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients' use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). However, when licensed clinics file the AUR with HCAI, the data regarding intermittent clinics associated with that "parent" clinic is aggregated into the licensed clinic data.

Currently HCAI produces two files using the PCC AUR data that can be downloaded from the CHHSA Portal. One is the full PCC AUR dataset, which contains all of the information that each clinic submitted in their AUR, and the other is a "pivot profile" table that uses select data from the PCC AUR to produce a more user friendly display and aggregation of the data. For example, in the pivot table one can see a summary of the clinic data at the statewide, county, or legislative district level.

According to HCAI the clinic data on intermittent clinics is only reported in aggregate; HCAI currently has no way to distinguish the data of intermittent clinics from the parent clinic.

1. Other health facility data reporting requirements. Under existing law, HCAI is designated as the single state agency to collect specified health facility or clinic data for use by all state agencies. All licensed health facilities are required to file annual financial reports detailing assets and liabilities, income and expenses, and patient revenue by payer, among other data elements. Additionally, licensed acute care hospitals are required to file the Hospital Discharge Abstract Data Record that includes 19 specified data elements for each admission, including date of birth, sex, admission date, discharge date, principal diagnosis, other diagnoses, principal procedures, and disposition of the patient. In addition to this discharge report, hospitals are required to file an Emergency Care Data Record for each patient encounter in a hospital emergency department, and hospitals and freestanding ambulatory surgery clinics are required to file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed.
2. New clinic data collected under this bill. For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported elsewhere, or (in the case of the prospective payment system (PPS) rate) public disclosure of something already collected. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item, including information on the number of staff vacancies by job classification, and the percentage of all revenue spent on workforce expenditures. This bill also adds the requirement that all licensed clinics report on patients' ethnicity, preferred language spoken, disability status, sexual orientation, gender identity, and payor category. Existing law currently only requires age, gender, race and the ethnic background of patients to be reported on the AUR. However, the additional patient data required by this bill data is currently collected by FQHCs submitting to HRSA at the corporate level. If a patient does not want to provide the information there are options for "don't know, chose not to disclose or unknown," to report patients whose sexual orientation is not known because the clinic did not have systems in place to routinely ask about sexual orientation, or the patient left that section blank. HRSA notes that this data can be used to identify and reduce health disparities and promote culturally competent care.
3. Workforce. In 2021 the Legislature established the Health Workforce Research Data Center at HCAI as the state's central source of health care workforce and education data. HCAI is responsible for collecting, analyzing, and distributing information on the educational and employment trends for health care occupations and distribution in the state. The statute requires HCAI to produce an annual report to the Legislature that: a) Identifies education and employment trends in the health care professions; b) Reports the current supply and demand for health care workers in California and gaps in the educational pipeline producing workers in specific occupations and geographic areas; c) Recommends state policy to address issues of health workforce shortage and distribution; and, d) Describes the health care workforce program outcomes and effectiveness. However, the effort has primarily been focused on licensed professionals. Currently, there is no detailed workforce data for the primary care clinic workforce that is unlicensed.

According to the Author

Community clinics are integral to the state's health care system, however, the state is facing a crisis exacerbated by the pandemic and its aftermath. The author states that recent events have brought into sharp focus the workforce shortages faced by clinics, exposing vulnerabilities in California's social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care.

Arguments in Support

SEIU California is the sponsor of this bill and notes that intermittent clinic sites do not report data directly to HCAI, but under the licensed clinic they are affiliated with. This means data across two or more physical locations is aggregated under one licensed clinic site. There is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This is resulting in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders. SEIU California notes that this bill gets us back on track by requiring data collection of intermittent sites.

Arguments in Opposition

The San Diego Regional Chamber of Commerce (the Chamber) is opposed to this bill and notes that the Chamber supports the reporting of necessary health information by primary care and intermittent clinics, which increases transparency for patients and holds bad actors accountable. However, the Chamber contends that this bill creates duplicative reporting requirements, that almost all of the information that the bill requires is already publicly available; and, requesting it again only serves to catalyze a subset of special interest groups.

Arguments in Opposition Unless Amended

CaliforniaHealth+ Advocates (CPCA) opposed this bill unless it is amended and notes that under current law, Community Health Clinics (CHCs) report the following information: PPS rates, full income statement including operating revenue and expenses, and major capital expenditures, including any building projects commenced during the reporting period. Additionally, CHCs already report patient data broken down by preferred language spoken, sexual orientation, gender identity, and payor status category. As it relates to workforce data, CHCs provide a detailed labor report broken down by salaried, contract, and volunteer staff along with their respective number of encounters. CHCs also provide workforce development information delineated by pre-graduate and post-graduate training. Between the reporting to HRSA and HCAI alone, CHCs report over 500 data points for the sake of transparency, accountability, and to improve patient outcomes. CPCA contends that while CHCs may need to improve the standardization of the data provided, the amount of data already submitted on an annual basis is robust.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. HCAI estimates costs of $2,037,000 in fiscal year (FY) 2024-25, $1,064,000 in FY 2025-26, $1,186,000 in FY 2026-27, and $1,186,000 per year, ongoing, to pay for seven additional staff positions, contracting resources, and enhancements to existing information systems and data infrastructure (California Health Data and Planning Fund).

HCAI reports the additional staff positions will be needed to support the development of regulations, initial program design, and the enhancement of information systems and data infrastructure. Some of the funds would also be needed for consulting resources in FY 2024-25 to support the enhancement of HCAI information systems and data infrastructure. In FY 2025-26 and ongoing, additional staff will support data collection, data review, and data dissemination of the new clinic utilization reports, as well as to ensure data is reported only in an aggregate form that cannot be used to identify an individual.

1. DPH reports minor and absorbable costs.

VOTES

SENATE FLOOR: 26-8-6

YES: Allen, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Durazo, Eggman, Gonzalez, Hurtado, Laird, Limón, McGuire, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

NO: Dahle, Glazer, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto

ABS, ABST OR NV: Alvarado-Gil, Archuleta, Caballero, Dodd, Menjivar, Wilk

ASM HEALTH: 11-4-0

YES: Wood, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Maienschein, McCarty, Rodriguez, Santiago, Villapudua, Weber

NO: Waldron, Flora, Vince Fong, Joe Patterson

ASM APPROPRIATIONS: 11-3-2

YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Papan, Pellerin, Weber, Wilson

NO: Megan Dahle, Dixon, Sanchez

ABS, ABST OR NV: Mathis, Soria

ASSEMBLY FLOOR: 57-16-7

YES: Addis, Aguiar-Curry, Alvarez, Arambula, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Connolly, Mike Fong, Friedman, Gabriel, Garcia, Gipson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Ortega, Pacheco, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Ting, Valencia, Villapudua, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO: Alanis, Chen, Megan Dahle, Davies, Dixon, Essayli, Flora, Vince Fong, Gallagher, Hoover, Lackey, Joe Patterson, Sanchez, Ta, Waldron, Wallis

ABS, ABST OR NV: Bains, Grayson, Mathis, Stephanie Nguyen, Papan, Jim Patterson, Soria

UPDATED

VERSION: September 8, 2023

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0002190

SENATE THIRD READING

STR Bill Id:SB 779

Author:(Stern)

As Amended Ver:July 13, 2023

Majority vote

SUMMARY

Requires intermittent clinics to file an annual report with the Department of Health Care Access and Information (HCAI) containing specified information for the previous calendar year. Creates new reporting requirements for all primary care clinics (PCCs), including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a detailed labor report, a detailed workforce development report, and a report of quality and equity measures.

Major Provisions

COMMENTS

1. PCCs and intermittent clinics. Under existing law, a licensed PCC is permitted to operate an off-site (intermittent) clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed PCCs include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics. AB 2204 (Gray), Chapter 279, Statutes of 2018, extended the number of hours an intermittent clinic could operate from 30 to 40 hours. That year, the Department of Public Health (DPH) reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics.

According to the California Health and Human Services Agency's (CHHSA) Open Data Portal, there were 2,052 licensed clinics (these include PCCs, surgical clinics, chronic dialysis clinics, rehabilitation clinics, psychology clinics, and alternative birth centers) as of May 15, 2023. Of these, 1,325 were licensed PCCs (these do not include intermittent clinics). According to the Open Data Portal, there were 1,218 intermittent clinics as of May 15, 2023. According to the Department of Health Care Services (DHCS), based on provider enrollment data, there are 818 intermittent clinics. The expansion of the number of hours an intermittent clinic could operate has led to a significant increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics, although the number of intermittent clinics appears debatable, given CHHSA and DHCS' conflicting numbers.

While information regarding clinics' daily hours of operation is reported in various ways, to various departments, because it is not reported to HCAI as part of the annual utilization report (AUR), the information does not seem to be easily trackable by either DPH or DHCS.

1. Current clinic data collection. Licensed clinics are required to provide an AUR to HCAI. In addition, the Health Resources and Services Administration (HRSA) requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a specific set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients' use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). However, when licensed clinics file the AUR with HCAI, the data regarding intermittent clinics associated with that "parent" clinic is aggregated into the licensed clinic data.

Currently HCAI produces two files using the PCC AUR data that can be downloaded from the CHHSA Portal. One is the full PCC AUR dataset, which contains all of the information that each clinic submitted in their AUR, and the other is a "pivot profile" table that uses select data from the PCC AUR to produce a more user friendly display and aggregation of the data. For example, in the pivot table one can see a summary of the clinic data at the statewide, county, or legislative district level.

According to HCAI the clinic data on intermittent clinics is only reported in aggregate; HCAI currently has no way to distinguish the data of intermittent clinics from the parent clinic.

1. Other health facility data reporting requirements. Under existing law, HCAI is designated as the single state agency to collect specified health facility or clinic data for use by all state agencies. All licensed health facilities are required to file annual financial reports detailing assets and liabilities, income and expenses, and patient revenue by payer, among other data elements. Additionally, licensed acute care hospitals are required to file the Hospital Discharge Abstract Data Record that includes 19 specified data elements for each admission, including date of birth, sex, admission date, discharge date, principal diagnosis, other diagnoses, principal procedures, and disposition of the patient. In addition to this discharge report, hospitals are required to file an Emergency Care Data Record for each patient encounter in a hospital emergency department, and hospitals and freestanding ambulatory surgery clinics are required to file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed.
2. New clinic data collected under this bill. For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported elsewhere, or (in the case of the prospective payment system (PPS) rate) public disclosure of something already collected. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item, including information on the number of staff vacancies by job classification, and the percentage of all revenue spent on workforce expenditures. This bill also adds the requirement that all licensed clinics report on patients' ethnicity, preferred language spoken, disability status, sexual orientation, gender identity, and payor category. Existing law currently only requires age, gender, race and the ethnic background of patients to be reported on the AUR. However, the additional patient data required by this bill data is currently collected by FQHCs submitting to HRSA at the corporate level. If a patient does not want to provide the information there are options for "don't know, chose not to disclose or unknown," to report patients whose sexual orientation is not known because the clinic did not have systems in place to routinely ask about sexual orientation, or the patient left that section blank. HRSA notes that this data can be used to identify and reduce health disparities and promote culturally competent care.
3. Workforce. In 2021 the Legislature established the Health Workforce Research Data Center at HCAI as the state's central source of health care workforce and education data. HCAI is responsible for collecting, analyzing, and distributing information on the educational and employment trends for health care occupations and distribution in the state. The statute requires HCAI to produce an annual report to the Legislature that: a) Identifies education and employment trends in the health care professions; b) Reports the current supply and demand for health care workers in California and gaps in the educational pipeline producing workers in specific occupations and geographic areas; c) Recommends state policy to address issues of health workforce shortage and distribution; and, d) Describes the health care workforce program outcomes and effectiveness. However, the effort has primarily been focused on licensed professionals. However these efforts have focused on licensed health professionals such as physicians, nurses, social workers, therapists and nurse practitioners. Currently, there is no detailed workforce data for the primary care clinic workforce that is unlicensed.

According to the Author

Community clinics are integral to the state's health care system, however, the state is facing a crisis exacerbated by the pandemic and its aftermath. The author states that recent events have brought into sharp focus the workforce shortages faced by clinics, exposing vulnerabilities in California's social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. The author concludes that accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.

Arguments in Support

SEIU California is the sponsor of this bill and notes that intermittent clinic sites do not report data directly to HCAI, but under the licensed clinic they are affiliated with. This means data across two or more physical locations is aggregated under one licensed clinic site. There is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This is resulting in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders. SEIU California notes that this bill gets us back on track by requiring data collection of intermittent sites.

Arguments in Opposition

The San Diego Regional Chamber of Commerce (the Chamber) is opposed to this bill and notes that the Chamber supports the reporting of necessary health information by primary care and intermittent clinics, which increases transparency for patients and holds bad actors accountable. However, the Chamber contends that this bill creates duplicative reporting requirements, that almost all of the information that the bill requires is already publicly available; and, requesting it again only serves to catalyze a subset of special interest groups.

Arguments in Opposition Unless Amended

CaliforniaHealth+ Advocates (CPCA) opposed this bill unless it is amended and notes that under current law, Community Health Clinics (CHCs) report the following information: PPS rates, full income statement including operating revenue and expenses, and major capital expenditures, including any building projects commenced during the reporting period. Additionally, CHCs already report patient data broken down by preferred language spoken, sexual orientation, gender identity, and payor status category. As it relates to workforce data, CHCs provide a detailed labor report broken down by salaried, contract, and volunteer staff along with their respective number of encounters. CHCs also provide workforce development information delineated by pre-graduate and post-graduate training. Between the reporting to HRSA and HCAI alone, CHCs report over 500 data points for the sake of transparency, accountability, and to improve patient outcomes. CPCA contends that while CHCs may need to improve the standardization of the data provided, the amount of data already submitted on an annual basis is robust.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. HCAI estimates costs of $2,037,000 in fiscal year (FY) 2024-25, $1,064,000 in FY 2025-26, $1,186,000 in FY 2026-27, and $1,186,000 per year, ongoing, to pay for seven additional staff positions, contracting resources, and enhancements to existing information systems and data infrastructure (California Health Data and Planning Fund).

HCAI reports the additional staff positions will be needed to support the development of regulations, initial program design, and the enhancement of information systems and data infrastructure. Some of the funds would also be needed for consulting resources in FY 2024-25 to support the enhancement of HCAI information systems and data infrastructure. In FY 2025-26 and ongoing, additional staff will support data collection, data review, and data dissemination of the new clinic utilization reports, as well as to ensure data is reported only in an aggregate form that cannot be used to identify an individual.

1. DPH reports minor and absorbable costs.

VOTES

SENATE FLOOR: 26-8-6

YES: Allen, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Durazo, Eggman, Gonzalez, Hurtado, Laird, Limón, McGuire, Min, Newman, Padilla, Portantino, Roth, Rubio, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

NO: Dahle, Glazer, Grove, Jones, Nguyen, Niello, Ochoa Bogh, Seyarto

ABS, ABST OR NV: Alvarado-Gil, Archuleta, Caballero, Dodd, Menjivar, Wilk

ASM HEALTH: 11-4-0

YES: Wood, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Maienschein, McCarty, Rodriguez, Santiago, Villapudua, Weber

NO: Waldron, Flora, Vince Fong, Joe Patterson

ASM APPROPRIATIONS: 11-3-2

YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Papan, Pellerin, Weber, Wilson

NO: Megan Dahle, Dixon, Sanchez

ABS, ABST OR NV: Mathis, Soria

UPDATED

VERSION: July 13, 2023

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001605

Date of Hearing: August 16, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

SBPCA Bill Id:SB 779

Author:(Stern) – As Amended Ver:July 13, 2023

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill expands the data reporting requirements for primary care clinics (PCCs) and requires intermittent clinics to report data to the Department of Health Care Access and Information (HCAI).

Specifically, this bill:

1. Adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual utilization report (AUR).
   
2. Requires PCCs to include in the AUR, on or before February 15, 2025, and annually thereafter, specified descriptive information for patients, including preferred language, disability status, sexual orientation, gender identity, and payer type; clinic operating hours; and whether the clinic is licensed or intermittent.
   
3. Requires PCCs participating in the Medi-Cal program or county indigent programs to include the number of assigned members per Medi-Cal plan and county indigent program and number with one or more clinic visits.
   
4. Requires HCAI to send a notice of violation to clinics that fail to report on time, post the list on its website, and send a list of those clinics to the Department of Public Health (DPH).
   
5. Requires a PCC or intermittent clinic to file with HCAI, on or before February 15 each year, a report that includes the following:
6. The Medi-Cal prospective payment system rate.
   
7. A report of mergers and acquisitions, as specified.
   
8. A detailed labor report, including number of employees and vacancies by job classification and average wages and demographic information.
   
9. A detailed workforce development report, including participation in any labor-management cooperation committee, and participation in professional degree and certificate programs.
   
10. A report of quality and equity measures.
    
11. Requires HCAI to coordinate with the Department of Health Care Services and stakeholders on determining quality measure data and other information to include in the report in 5, above, and to complete related regulations on or before January 1, 2025.

FISCAL EFFECT:

1. HCAI estimates costs of $2,037,000 in fiscal year (FY) 2024-25, $1,064,000 in FY 2025-26, $1,186,000 in FY 2026-27, and $1,186,000 per year, ongoing, to pay for seven additional staff positions, contracting resources, and enhancements to existing information systems and data infrastructure (California Health Data and Planning Fund).
   
   HCAI reports the additional staff positions will be needed to support the development of regulations, initial program design, and the enhancement of information systems and data infrastructure. Some of the funds would also be needed for consulting resources in FY 2024-25 to support the enhancement of HCAI information systems and data infrastructure. In FY 2025-26 and ongoing, additional staff will support data collection, data review, and data dissemination of the new clinic utilization reports, as well as to ensure data is reported only in an aggregate form that cannot be used to identify an individual.
2. DPH reports minor and absorbable costs.
   

COMMENTS:

1. Purpose. This bill is sponsored by SEIU California. According to the author:

Community clinics are integral to our state’s health care system, but we are facing a crisis exacerbated by the pandemic and its aftermath. Recent events have brought into sharp focus the workforce shortages faced by our clinics, exposing vulnerabilities in California’s social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. Accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.

1. Background.

PCCs. A PCC is either a “community clinic,” operated by a non-profit corporation and that uses a sliding fee scale to charge patients based on their ability to pay, or a “free clinic,” which is also operated by a non-profit but is not allowed to directly charge patients for services or drugs, medicines, or apparatuses furnished. Under state law, every licensed PCC must file with HCAI an AUR with the following information for the previous calendar year:

• 1. Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients.
     
  2. Number of patient visits by type of service.
     
  3. Total clinic operating expenses.
     
  4. Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county programs, private insurance, self-paying patients, nonpaying patients, and other payers.
     
  5. Deductions from revenue by payer category, bad debts, and charity care charges.
     
  6. Additional information as may be required by HCAI or DPH.
     

Intermittent Clinics. A licensed PCC may operate an off-site (intermittent) clinic for up to 40 hours per week without obtaining a separate license for the offsite location. Licensed PCCs include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.

1. Data Collection and Reporting Requirements. The sponsors contend some of the data reporting required by this bill is already reported or collected for other purposes. Some of the data is required for other types of facilities; for example, hospitals and long-term care facilities must report mergers and acquisitions. However, the sponsor states many of the requirements in this bill, including reporting information on the number of staff vacancies by job classification and the percentage of all revenue spent on workforce expenditures, would be entirely new requirements.

CaliforniaHealth+ Advocates (CPCA) notes clinics already report to the federal Health Resources & Services Administration (HRSA) and HCAI over 500 data points for the sake of transparency and accountability, and to improve patient outcomes. CPCA contends the amount of data already submitted on an annual basis is robust, and with any effort to increase data reporting requirements, their members are particularly concerned about patient and staff privacy protections. In particular, some clinics provide sensitive services where privacy is of utmost importance. CPCA states the requirements in this bill may compromise the safety and privacy of its patients.

CPCA also notes small intermittent sites, such as school-based health centers, operate with very thin staffing, and may need to hire an additional staff position or pull staff from providing care to meet the requirements of this bill. CPCA further argues the detailed workforce data may be challenging for smaller sites because staff may work at different sites every day during their workweek.

1. Related Legislation.
   
   1. AB 616 (Rodriguez) authorizes the Office of Health Care Affordability to publicly disclose audited financial reports and comprehensive financial statements of providers and physician organizations and the Department of Managed Health Care to publicly disclose financial and other records of risk-bearing organizations. AB 616 is pending in Senate Appropriations Committee.
      
   2. AB 1612 (Pacheco) authorizes a licensed PCC with a license in good standing with DPH for the preceding five years to construct a new outpatient clinic, acquire ownership or control of an outpatient setting, or acquire ownership or control of a previously licensed PCC, and authorizes such a facility to be deemed compliant with the minimum construction standards of adequacy and safety required for the PCC constructing or acquiring the facility. AB 1612 requires DPH to immediately approve a license for such a facility without the necessity of an initial onsite survey upon receipt of a written notice, as specified. AB 1612 is pending in Senate Appropriations Committee.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: July 11, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 779

Author:(Stern) – As Amended Ver:April 17, 2023

SENATE VOTE: 26-8

SUBJECT: Primary Care Clinic Data Modernization Act.

SUMMARY: Requires intermittent clinics to file an annual report with the Department of Health Care Access and Information (HCAI) containing specified information for the previous calendar year. Creates new reporting requirements for all primary care clinics (PCCs), including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a detailed labor report, a detailed workforce development report, and a report of quality and equity measures. Specifically, this bill:

1. Adds intermittent clinics that are exempt from licensure to existing requirements that licensed clinics file an annual utilization report (AUR) with HCAI, including specified information for the previous calendar year.
   
2. Revises the AUR to require clinics to report more detailed demographic information on patients served, including preferred language spoken, disability status, sexual orientation, gender identity, and payer category.
3. Revises the AUR to require PCCs participating in the Medi-Cal program to include the number of members per Medi-Cal managed care plan and county indigent program, and the number of assigned members per Medi-Cal managed care plan and county indigent program that had one or more clinic visits.
   
4. Requires HCAI, in order to facilitate timely enforcement of this bill, on or before March 1st of each year, to send a written notice of violation to every clinic that fails to file a timely report pursuant to this bill or existing law, either for itself or for any intermittent clinic it operates. Requires HCAI to also provide the Department of Public Health (DPH) with a list of every clinic that receives a written notice of violation and notify DPH when a clinic on the list completes and files all delinquent reports. Requires HCAI to make these notices and lists, including notifications of when a clinic on the list completes and files all delinquent reports, available on its internet website.
   
5. Requires an organization that operates or owns a PCC or intermittent clinic, and the officers thereof, to file with HCAI, for each PCC and each intermittent clinic that it owns or operates, on or before the 15^th day of February each year, in conjunction with existing required reports, the following:
   
   1. The Medi-Cal Federally Qualified Health Center/ Rural Health Center (FQHC/RHC) prospective payment system (PPS) rate, if applicable;
   2. A report of all mergers and acquisitions, including, but not limited to, whether the clinic has been purchased, acquired, or merged with any other clinic parent corporation since the prior reporting period; information identifying all purchased, acquired or merged clinics, including all applicable clinic sites;
   3. A detailed labor report, including, but not limited to, the following information:
      1. The actual number, not full-time equivalents, of employees by job classification, including nonlicensed and noncredentialed positions, at the beginning and end of the reporting period;
      2. The actual number, not full-time equivalents, of contracted or registry staff by job classification, including nonlicensed and noncredentialed positions at the beginning and end of the reporting period;
      3. The number of staff vacancies by job classification;
      4. The average base hourly wages and hourly base wage ranges (minimum and maximum base hourly wage) by job classification for each job classification with three or more employees; and,
      5. Workforce demographic information, including, but not limited to, age, sex, race, ethnicity, languages spoken, disability status, sexual orientation, and gender identity. Prohibits workers from being required to provide the information in this subparagraph and from being subject to discipline or any other adverse action for not providing the information listed. Requires data to be reported separately for licensed and credentialed persons, and for nonlicensed positions. Requires data to be reported only in an aggregate form that cannot be used to identify an individual.
   4. A detailed workforce development report, including, but not limited to, the following:
      1. Participation in any local, regional, or statewide labor-management cooperation committee (LMCC), and for each LMCC, the identity of all partners;
      2. Data about the nature and extent of participation in allied health care professional degrees and certificate programs, including, but not limited to, the number of clinical placements for each program; and,
      3. Data about the nature and extent of participation in behavioral health professional degree and certificate programs, including, but not limited to, the number of clinical placements for each program.
         
   5. A report of quality and equity measures. Requires HCAI to coordinate with the State Department of Health Care Services (DHCS), in consultation with stakeholders, on quality measure data and other information necessary to include in this report. Requires HCAI to align reporting with HCAI’s Health Equity Measures Advisory Committee, the Department of Managed Health Care Health Equity and Quality Committee Recommendations, and the Centers for Medicare and Medicaid Services Framework for Health Equity.
      
6. Requires HCAI to maintain a file of all reports under this bill and under existing law at its Sacramento office, and subject to any rules HCAI may prescribe, requires these reports to be produced and made available for inspection upon the demand of any person, and to also be posted on HCAI’s website.
   
7. Makes various findings and declarations, and states that it is in the interest of the state and consumers to collect greater information about primary care clinics, including, but not limited to, workforce, workforce development, financial and patient care quality and equity data, and to make that information publicly available to study health care policy questions, to assess trends in workforce, care, finance, and corporate responsibility, including anticipating workforce shortages, and to inform public funding and public policy decisions related to health care equity, quality, and access.

EXISTING LAW:

1. Licenses and regulates clinics, including PCCs and specialty clinics, by DPH. [Health and Safety Code (HSC) §1200, et seq.]
   
2. Defines a PCC 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]
3. 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, any PCC operated by the state, counties, or cities, a clinic operated by any institution of learning that teaches a healing art, medical foundation clinics, and the offices of physicians in group practice who provide the preponderance of their services to members of a health plan. [HSC §1206]
4. Exempts from licensure by DPH an intermittent clinic that is operated by a licensed PCC on separate premises from the licensed clinic and is only open for limited services of no more than 40 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. [HSC §1206 (h)]
5. Requires every clinic holding a license to file with HCAI an AUR with the following information relating to the previous calendar year:
   1. Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients;
   2. Number of patient visits by type of service, including child health and disability prevention screens, treatment, and follow-up services, medical services, dental services, and other health services;
   3. Total clinic operating expenses;
   4. Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county programs, private insurance, self-paying patients, nonpaying patients, and other payers;
   5. Deductions from revenue by payer category, bad debts, and charity care charges; and,
   6. Additional information as may be required by HCAI or DPH. [HSC §1216]
      
6. Permits DPH, in the event a clinic fails to file a timely report as required in 5) above, to suspend the license of the clinic until the report is completed and filed with HCAI. [HSC §1216 (b)]
   
7. Requires a licensed PCC or free 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]
   
8. Requires FQHC and RHC services to be covered benefits under the Medi-Cal program and requires these services to be reimbursed on a per-visit basis, as defined. [Welfare and Institutions Code (WIC) §14132.100]
   
9. Requires HCAI to convene a Health Care Equity Measures Advisory Committee (Advisory Committee) to assist and advise the HCAI Director in reviewing and amending the appropriate measures that align with the health equity measures developed by the federal Centers for Medicare and Medicaid Services at the hospital-, hospital system-, and integrated system-level related to access, quality, and outcomes, including any relevant Agency for Healthcare Research and Quality’s Quality Indicators, that hospitals are required to report in their annual equity reports. [HSC § 127372]
   
10. Requires hospitals to prepare an annual equity report. Requires the annual equity report to include an analysis of health status and access to care disparities for patients on the basis of age, sex, race, ethnicity, language, disability status, sexual orientation, gender identity, and payor. [Id]
    
11. Requires a hospital to annually submit the equity report to HCAI. Requires a hospital to annually post the equity report on its website, as specified. Requires data and information included in annual equity reports to be reported to the extent information is available and disclosed in a manner that protects the personal information of patients pursuant to state and federal privacy laws. [HSC § 127373]
    
12. Establishes the Office of Health Care Affordability (OHCA) within HCAI. Identifies OHCAs’ three primary responsibilities: managing spending targets, monitoring system performance, and assessing market consolidation. Requires OHCA to collect, analyze, and publicly report data on total health care expenditures, and enforce spending targets set by a Health Care Affordability Board. Requires OHCA to review and evaluate consolidation, market power, and other market failures through cost and market impact reviews of mergers, acquisitions, or corporate affiliations involving health care service plans, health insurers, hospitals, physician organizations, pharmacy benefit managers, and other health care entities. [HSC §127501]
    
13. Authorizes OHCA to collect the following types of data and make it accessible to the public:
    1. Overall trends in the health care workforce, including, but not limited to, statewide and regional workforce supply, unemployment and wage data, trends and projections of wages and compensation, projections of workforce supply by region and specialty, training needs, and other future trends in the health care workforce;
    2. The number and classification of workers in internship, clinical placements, apprenticeships, and other training programs sponsored by an employer;
    3. The percentage of employees employed through a registry or casual employment;
    4. The number of workers at health care entities that were retrained through established public training programs;
    5. Investments by health care entities in private training and retraining programs; and,
    6. The number of workers subject to relocation, termination, or mass layoff. [HSC § 127501.4 (j) (3)]

FISCAL EFFECT: According to the Senate Appropriations Committee, HCAI estimates costs to be $2,037,000 in 2024-25, $1,064,000 in 2025-26, $1,186,000 in 2026-27, and $1,186,000 ongoing thereafter (California Health Data and Planning Fund), which includes costs for staff, contracting resources, and enhancements to existing information systems and data infrastructure. DPH estimates minor and absorbable costs.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, community clinics are integral to the state’s health care system, however, the state is facing a crisis exacerbated by the pandemic and its aftermath. The author states that recent events have brought into sharp focus the workforce shortages faced by clinics, exposing vulnerabilities in California’s social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. The author concludes that accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.
   
2. BACKGROUND.
   1. PCCs and intermittent clinics. Under existing law, a licensed PCC is permitted to operate an off-site (intermittent) clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed PCCs include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operated clinics or tribal clinics.
      
      AB 2204 (Gray), Chapter 279, Statutes of 2018, extended the number of hours an intermittent clinic could operate from 30 to 40 hours. That year, DPH reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics.
      
      According to the California Health and Human Services Agency’s (CHHSA) Open Data Portal, there were 2,052 licensed clinics (these include PCCs, surgical clinics, chronic dialysis clinics, rehabilitation clinics, psychology clinics, and alternative birth centers) as of May 15, 2023. Of these, 1,325 were licensed PCCs (these do not include intermittent clinics). According to the Open Data Portal, there were 1,218 intermittent clinics as of May 15, 2023. According to DHCS, based on provider enrollment data, there are 818 intermittent clinics. The expansion of the number of hours an intermittent clinic could operate has led to a significant increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics, although the number of intermittent clinics appears debatable, given CHHSA and DHCS’ conflicting numbers.
      
   2. How “intermittent” are intermittent clinics, and how many are there? DPH tracks the location of intermittent clinics, and the DHCS provider enrollment form requires clinics (including intermittent clinics) to report the number of hours the clinic is open each day. The AUR, which is provided to HCAI, does not ask for hours of operation, however clinics must list their dates of operation during the reporting year (e.g. 1/1/2022 to 12/31/2022). On the DPH licensure & certification application form, there is a field asking for "Days and hours of operation." A licensed primary care clinic that operates intermittent clinics is supposed to report the location and the estimated hours of operation of any intermittent clinic to DPH when they renew their license. (As noted in 7) of existing law, above.) The DPH Form for Medi-Cal Certification of Primary Care Clinic (HS 269), also asks for hours of operation per day of the week for both the parent clinic and intermittent clinic. New intermittent clinics also report to DHCS Provider Enrollment Division, including change of operating hours, and DHCS provides this information to DPH. This information is reported during the initial application process as well as when there is a change in hours of operation. At the Federal level, the Health Resources and Services Administration (HRSA) requires FQHCs to report information regarding service delivery sites and total hours of operation.
      
      While information regarding clinics’ daily hours of operation is reported in various ways, to various departments, because it is not reported to HCAI as part of the AUR, the information does not seem to be easily trackable by either DPH or DHCS.
   3. Current clinic data collection. As noted in existing law, licensed clinics are required to provide the AUR report to HCAI. In addition, HRSA requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a specific set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients’ use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). However, when licensed clinics file the AUR with HCAI, the data regarding intermittent clinics associated with that “parent” clinic is aggregated into the licensed clinic data.
      
      Currently HCAI produces two files using the PCC AUR data that can be downloaded from the CHHSA Portal. One is the full PCC AUR dataset, which contains all of the information that each clinic submitted in their AUR, and the other is a “pivot profile” table that uses select data from the PCC AUR to produce a more user friendly display and aggregation of the data. For example, in the pivot table one can see a summary of the clinic data at the statewide, county, or legislative district level.
      
      According to HCAI the clinic data on intermittent clinics is only reported in aggregate; HCAI currently has no way to distinguish the data of intermittent clinics from the parent clinic.
      
   4. FQHCs and Medi-Cal PPS. FQHCs are federally designated clinics that provide primary care services to serve medically underserved populations. Pursuant to federal requirements, health centers must meet specified requirements, including being located in or serving a medically underserved area or population, provide comprehensive primary care services furnished regardless of ability to pay, and governance by a community-based board that meets certain composition requirements (including a board composed of a majority of individuals who are served by the health center) that exercises specified authorities. FQHCs are reimbursed by Medi-Cal on a per-visit rate which is known as PPS rate for services provided by specific providers listed in statute. Under PPS, FQHCs are paid a predetermined rate that encompasses reimbursement for all services provided during a single visit, and it is adjusted annually for inflation. In California, these rates are in a publicly available fee schedule on the DHCS web site.
      
   5. Other health facility data reporting requirements. Under existing law, HCAI is designated as the single state agency to collect specified health facility or clinic data for use by all state agencies. All licensed health facilities are required to file annual financial reports detailing assets and liabilities, income and expenses, and patient revenue by payer, among other data elements. Additionally, licensed acute care hospitals are required to file the Hospital Discharge Abstract Data Record that includes 19 specified data elements for each admission, including date of birth, sex, admission date, discharge date, principal diagnosis, other diagnoses, principal procedures, and disposition of the patient. In addition to this discharge report, hospitals are required to file an Emergency Care Data Record for each patient encounter in a hospital emergency department, and hospitals and freestanding ambulatory surgery clinics are required to file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed.
      
   6. New clinic data collected under this bill. For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported elsewhere, or (in the case of the PPS rate) public disclosure of something already collected. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item, including information on the number of staff vacancies by job classification, and the percentage of all revenue spent on workforce expenditures.
      
      This bill also adds the requirement that all licensed clinics report on patients’ ethnicity, preferred language spoken, disability status, sexual orientation, gender identity, and payor category. Existing law currently only requires age, gender, race and the ethnic background of patients to be reported on the AUR. However, the additional patient data required by this bill data is currently collected by FQHCs submitting to HRSA at the corporate level. If a patient does not want to provide the information there are options for “don't know, chose not to disclose or unknown," to report patients whose sexual orientation is not known because the clinic did not have systems in place to routinely ask about sexual orientation, or the patient left that section blank. HRSA notes that this data can be used to identify and reduce health disparities and promote culturally competent care.
      
   7. Workforce. In 2021 the Legislature established the Health Workforce Research Data Center at HCAI as the state's central source of health care workforce and education data. HCAI is responsible for collecting, analyzing, and distributing information on the educational and employment trends for health care occupations and distribution in the state. The statute requires HCAI to produce an annual report to the Legislature that: i) Identifies education and employment trends in the health care professions; ii) Reports the current supply and demand for health care workers in California and gaps in the educational pipeline producing workers in specific occupations and geographic areas; iii) Recommends state policy to address issues of health workforce shortage and distribution; and, iv) Describes the health care workforce program outcomes and effectiveness. However, the effort has primarily been focused on licensed professionals. However these efforts have focused on licensed health professionals such as physicians, nurses, social workers, therapists and nurse practitioners. Currently, there is no detailed workforce data for the primary care clinic workforce that is unlicensed.
      
3. SUPPORT. SEIU California is the sponsor of this bill and notes that intermittent clinic sites do not report data directly to HCAI, but under the licensed clinic they are affiliated with. This means data across two or more physical locations is aggregated under one licensed clinic site. There is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This is resulting in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders.
   
   SEIU California states that According to DPH Licensed and Certified Healthcare Facility data, the number of clinic sites, inclusive of licensed and intermittent sites, has grown from roughly 1,500 sites in 2012 to 2,700 sites in 2021. In 2012, just over 1,000 licensed sites reported data or 70% of all DPH listed sites. Fast forward to 2021, and just under 1,200 licensed sites reported data or just 43% of all DPH listed sites– less than half of all DPH recognized sites are now reporting. The total number of licensed sites completing the AUR is decreasing drastically. SEIU California also states that this is not just because clinic corporations are choosing to open more intermittent sites, but also because they are converting previously licensed sites to be intermittent sites. Less data means a less complete picture of primary care in underserved communities. SEIU California notes that this bill gets us back on track by requiring data collection of intermittent sites. SEIU California contends that the Primary Care Clinic AUR is a vital tool that must be modernized to better reflect the role clinics plays in our health care delivery system. With Medi-Cal recipients representing 60% of all patients, and Medi-Cal representing a bigger share of their funding, it is crucial for the state to better track the critical interplay between primary care clinic finances, workforce, and quality of care. SEIU California concludes that this bill does this by building upon currently collected workforce data, incorporating quality data, and expanding financial data reporting.
   
   The California Labor Federations supports this bill and states that it will require the collection of more robust data on primary care clinics including information on workforce, workforce development, financial and patient care quality, and equity data. This data is essential to inform decisions on funding and policy to ensure clinics are properly staffed and funded to ensure health care equity, quality, and access.
   
4. OPPOSITION. The San Diego Regional Chamber of Commerce (the Chamber) is opposed to this bill and notes that the Chamber supports the reporting of necessary health information by primary care and intermittent clinics, which increases transparency for patients and holds bad actors accountable. However, the Chamber contends that this bill creates duplicative reporting requirements, that almost all of the information that the bill requires is already publicly available; and, requesting it again only serves to catalyze a subset of special interest groups.
5. OPPOSE UNLESS AMENDED. CaliforniaHealth+ Advocates (CPCA) opposed this bill unless it is amended and notes that under current law, Community Health Clinics (CHCs) report the following information: PPS rates, full income statement including operating revenue and expenses, and major capital expenditures, including any building projects commenced during the reporting period. Additionally, CHCs already report patient data broken down by preferred language spoken, sexual orientation, gender identity, and payor status category. As it relates to workforce data, CHCs provide a detailed labor report broken down by salaried, contract, and volunteer staff along with their respective number of encounters. CHCs also provide workforce development information delineated by pre-graduate and post-graduate training. Between the reporting to HRSA and HCAI alone, CHCs report over 500 data points for the sake of transparency, accountability, and to improve patient outcomes. CPCA contends that while CHCs may need to improve the standardization of the data provided, the amount of data already submitted on an annual basis is robust, and with any effort to increase data reporting requirements, their members are particularly concerned about patient and staff privacy protections. In particular, a portion of their membership provides sensitive services to patients where privacy is of utmost interest and importance. The proposed changes in this bill that may compromise the safety and privacy of its patients and staff must be balanced with the utility of increased data reporting.

CPCA also notes that intermittent sites are small and operate on very thin staff such as school-based health centers; these intermittent sites may have to hire another person or devote a portion of a Full Time Equivalent just to meet the reporting requirements of this bill. These smaller intermittent sites would need more time and resources to implement these provisions. Additionally, CHCs may not currently organize their data in a manner that is easily reportable or can easily meet the newly required data requirements. Furthermore, the detailed workforce data may be challenging for smaller sites because staff may work at different sites every day during their workweek. CHCs are concerned that they may have to pull staff from providing care to fulfill the requirements of this legislation. At a time where the state is expanding coverage for the 26-49 aged people, CHCs will need to devote their workforce to providing care, not to meet data reporting requirements where the public policy benefit remains unclear.

CPCA states that the current annual reporting deadline of February 15 will be challenging to meet considering the increased reporting requirements. CPCA has offered the following amendment to remove their opposition: strike all new data reporting requirements and extend existing reporting requirements to every intermittent clinic exempt from licensure.

RELATED LEGISLATION.

• 1. AB 616 (Rodriguez) establishes the Medical Group Financial Transparency Act and authorizes the disclosure of audited financial reports and comprehensive financial statements of physician organizations of 50 or more physicians and physician organizations that are part of a fully integrated delivery system, collected OHCA, and financial and other records of risk-bearing organizations made available to the Department of Managed Health Care. AB 616 is pending in the Senate Health Committee.
  2. AB 1612 (Pacheco) authorizes a licensed PCC with a license in good standing with DPH for the preceding five years to construct a new outpatient clinic, acquire ownership or control of an outpatient setting, or acquire ownership or control of a previously licensed PCC. Authorizes a facility constructed or acquired by a licensed PCC under these provisions to be deemed compliant with the minimum construction standards of adequacy and safety required for the PCC constructing or acquiring the facility. Requires DPH to immediately approve a license for these facilities without the necessity of first conducting an initial onsite survey upon receipt of a written notice, as specified. AB 1612 is pending in the Senate Health Committee.

1. PREVIOUS LEGISLATION.
   1. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, establishes OHCA within HCAI. Identifies OHCAs’ three primary responsibilities: managing spending targets, monitoring system performance, and assessing market consolidation. Requires OHCA to collect, analyze, and publicly report data on total health care expenditures, and enforce spending targets set by a Health Care Affordability Board.
   2. SB 1014 (Hertzberg) of 2022, would have required DHCS to authorize a new optional supplemental payment program for FQHCs to be named the Enhanced Clinically Integrated Program (ECIP). Requires the supplemental funding under ECIP to be provided in addition to all other funding received by FQHCs. SB 1014 would have required DHCS to make funding, if appropriated, available for the purpose of direct compensation of health center workers on the condition that FQHCs meet certain standards relating to wage thresholds and participation in bona fide labor-management cooperation committees. Additionally, SB 1014 would have required DHCS to establish a statewide 15-member board to develop eligibility criteria, an application process, a fund distribution process, reporting requirements, and a methodology for adjusting funding allocations based on health care inflation. SB 1014 was not taken up on the Assembly Floor.
      
   3. AB 1204 (Wicks), Chapter 751, Statutes of 2021, requires HCAI to develop and administer a hospital equity report program to collect and post hospital equity reports. These annual reports are required to include measures on patient access, quality, and outcomes by race, ethnicity, language, disability status, sexual orientation, gender identity, and payor as recommended by the newly created Hospital Equity Measures Advisory Committee (Advisory Committee). The reports are also required to include a plan to prioritize and address disparities for vulnerable populations identified in the data and as specified by the Advisory Committee.
   4. AB 973 (Jackson), Chapter 363, Statutes of 2020, requires private employers with 100 or more employees to submit a report annually to the Department of Fair Employment and Housing (now the Civil Rights Department) with pay data for specified job categories broken down by race, ethnicity, and sex.
      
   5. AB 2204 (Gray) 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.
   6. 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.
   7. 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.
   8. 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.
   9. SB 442 (Ducheny), Chapter 502, Statutes of 2010, streamlined the administrative requirements for a clinic corporation to apply for licensure for an affiliate PCC.
   10. 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.
2. AMENDMENTS.
   1. As noted in the Background discussion, there has been a large increase in the number of unlicensed “intermittent clinics” and there does not appear to be accurate data on their hours of operation. The Committee may wish to amend this bill to require licensed and intermittent clinics to report their locations and weekly hours of operations on the AUR. This would allow the Legislature to clearly identify how many intermittent clinics are operating at 40 hours a week.
   2. In order to address concerns raised by the California Association of Public Hospitals, the author has agreed to amend this bill to clarify that this bill does not apply to unlicensed public sector clinics.
      
   3. In order to help address concerns raised by CPCA regarding the potential burden the new reporting requirements might place on small clinics, the author has agreed to amend this bill to stagger the implementation timeline to require intermittent clinics to begin filing the AUR as required under existing law by February 15, 2025, and for all reporting clinics, the new reporting requirements to take effect by February 15, 2026.
      
   4. This bill requires clinics to report additional demographic information regarding patients, including their sexual orientation and gender identity: information which some patients may not wish to disclose. In order to address concerns raised by CPCA, the author has also agreed to amend this bill to hold a clinic harmless if a patient does not wish to provide certain information required to be reported under this bill.

REGISTERED SUPPORT / OPPOSITION:

Support

SEIU California (sponsor)

California Alliance for Retired Americans
California Black Health Network
California Labor Federation, AFL-CIO
California League of United Latin American Citizens
California School Employees Association
California Teachers Association
Clergy and Laity United for Economic Justice

Council on American-Islamic Relations, California (CAIR-CA)
Fresno, Madera, Tulare, Kings Counties, Central Labor Council, AFL-CIO
LAANE (Los Angeles Alliance for A New Economy)

North Valley Labor Association
SEIU - United Healthcare Workers

Opposition

Calexico Wellness Center
California Advocacy LLC
California Human Development
Center for Employment and Training
Central Valley Opportunity Center (CVOC)
Farmworkers Institute of Education & Leadership Development
Inland Coalition for Immigrant Justice
LA Cooperativa Campesina De California
Los Amigos De LA Comunidad, INC.
San Diego Regional Chamber of Commerce

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 779

Author: Stern (D), et al.

Amended: 4/17/23

Vote: 21

SENATE HEALTH COMMITTEE: 9-2, 4/12/23

AYES: Eggman, Gonzalez, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

NOES: Nguyen, Glazer

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/23

AYES: Portantino, Ashby, Bradford, Wahab, Wiener

NOES: Jones, Seyarto

SUBJECT: Primary Care Clinic Data Modernization Act

SOURCE: SEIU California

DIGEST:

This bill adds intermittent clinics that are exempt from licensure to an existing requirement that clinics file an annual report to the Department of Health Care Access and Information (HCAI) with specified information. This bill creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including mergers and acquisitions, a labor report, a workforce development report, and a report of quality and equity measures.

ANALYSIS:

Existing law:

1. Licenses and regulates clinics, including primary care and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
2. Defines a primary care clinic as either a “community clinic,” which is operated by a non-profit corporation and uses 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 charge patients. [HSC §1204]
3. Exempts various types of clinics from licensure by CDPH, including clinics operated by the federal government or by a federally recognized Indian tribe on tribal land, any primary care clinic operated by the state, counties, or cities, a clinic operated by any institution of learning that teaches a healing art, medical foundation clinics, and the offices of physicians in group practice who provide the preponderance of their services to members of a health plan. [HSC §1206]
4. Exempts from licensure by CDPH 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 no more than 40 hours each week. An intermittent clinic operated under this exemption is still required to meet other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. [HSC §1206(h)]
5. Requires every clinic holding a license to file with HCAI an annual report (known as the annual utilization report, or AUR) showing the following information relating to the previous calendar year:
   1. Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients;
   2. Number of patient visits by type of service, including child health and disability prevention screens, treatment, and follow-up services, medical services, dental services, and other health services;
   3. Total clinic operating expenses;
   4. Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county programs, private insurance, self-paying patients, nonpaying patients, and other payers;
   5. Deductions from revenue by payer category, bad debts, and charity care charges; and,
   6. Additional information as required by HCAI or CDPH. [HSC §1216]
6. Permits CDPH, in the event a clinic fails to file a timely report as required in 5) above, to suspend the license of the clinic until the report is completed and filed with HCAI. [HSC §1216(b)]

This bill:

1. Adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report with certain specified information for the previous calendar year, known as the AUR.
2. Revises the AUR to require clinics to report more detailed demographic information on patients served, including preferred language spoken, disability status, sexual orientation, gender identity, and payer category.
3. Revises the AUR to require primary care clinics participating in the Medi-Cal program to include the number of members per Medi-Cal managed care plan and county indigent program, and the number of assigned members per Medi-Cal managed care plan and county indigent program that had clinic visits.
4. Requires an organization that operates or owns a primary care clinic or intermittent clinic to file with HCAI, for each primary care clinic and each intermittent clinic that it operates, by February 15^th each year, the following:
   1. The Medi-Cal FQHC/RHC prospective payment system rate, if applicable;
   2. A report of all mergers and acquisitions, including, but not limited to, whether the clinic has been purchased, acquired, or merged with any other clinic parent corporation since the prior reporting period; and, information identifying all purchased, acquired or merged clinics, including all applicable clinic sites;
   3. A detailed labor report, including the following information:
      1. The actual number, not full-time equivalents (FTEs), of employees, as well as contracted or registry staff, by job classification, including nonlicensed and noncredentialed positions at the beginning and end of the reporting period;
      2. The number of staff vacancies by job classification;
      3. The average base hourly wages and hourly base wage ranges by job classification for each classification with three or more employees; and,
      4. Workforce demographic information, including age, sex, race, ethnicity, languages spoken, disability status, sexual orientation, and gender identity. Prohibits workers from being required to provide this information or from being disciplined for not providing the information. Requires data to be reported separately for licensed persons, and for nonlicensed persons. Requires this information to be reported in an aggregate form that cannot be used to identify an individual.
   4. A detailed workforce development report, including the following:
      1. Participation in any local, regional, or statewide labor-management cooperation committee (LMCC) , and the identity of all partners; and,
      2. Data about the nature and extent of participation in allied health care professional degrees and certificate programs, including, but not limited to, the number of clinical placements for each program;
   5. A report of quality and equity measures. Requires HCAI to coordinate with the Department of Health Care Services, in consultation with stakeholders, on quality measure data and other information necessary to include.
5. Requires HCAI to maintain a file of all reports under this bill and under existing law at its Sacramento office, and subject to any rules HCAI may prescribe, requires these reports to be produced and made available for inspection upon the demand of any person, and to also be posted on HCAI’s website.
6. Revises a provision of law that permits CDPH to suspend the license of a clinic until its AUR report is filed by applying this provision to the new reporting requirements in this bill, and also permitting CDPH to suspend the license of any clinic who does not file a report for any intermittent clinic it operates.
7. Requires HCAI, on or before March 1^st of each year, to send a written notice of violation to every clinic that fails to file a timely report under this bill or under specified provisions of existing law, either for itself or for any intermittent clinic it operates, and to also provide CDPH with a list of every clinic that receives a written notice of violation. Requires these notices to be available on HCAI’s internet website.

Comments

1. Author’s statement. According to the author, community clinics are integral to our state’s health care system, but we are facing a crisis exacerbated by the pandemic and its aftermath. Recent events have brought into sharp focus the workforce shortages faced by our clinics, exposing vulnerabilities in California’s social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. Accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.
2. Background on primary care clinics and intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics, and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics. In 2018, which is the year AB 2204 (Gray, Chapter 279, Statutes of 2018) extended the number of hours an intermittent clinic could operate from 30 to 40 hours, CDPH reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics. Clearly, the expansion of the number of hours an intermittent clinic could operate has led to an increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics.
3. Background on existing data collection for clinics. There are a number of existing data reporting obligations for clinics. As noted in existing law, a primary reporting requirement is the AUR report to HCAI. In addition, the federal Health Resources and Services Administration (HRSA) requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a core set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients’ use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported in some fashion, or (in the case of the PPS rate) public disclosure of something already collected. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item.
4. Clinic workforce shortage. According to a 2016 report by National Association of Community Health Centers, workforce challenges are one of the primary barriers to health center patient growth. If all health center clinical vacancies were filled today, health centers could serve two million more patients. At that time, prior to COVID-19’s impact on the health care workforce, 95% of health centers had at least one clinical vacancy, and were averaging a vacancy rate for clinical positions of 13%. The number one challenge in recruitment and retention named was the ability to offer competitive salaries. According to the Kaiser Family Foundation, California has 643 areas with a Health Professional Shortage Area designation for primary care, meaning one-third of Californians live in an area with a primary care provider shortage.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee:

• HCAI estimates costs to be $2,037,000 in 2024-25, $1,064,000 in 2025-26, $1,186,000 in 2026-27, and $1,186,000 ongoing thereafter (California Health Data and Planning Fund), which includes costs for staff, contracting resources, and enhancements to existing information systems and data infrastructure.
• CDPH estimates minor and absorbable costs.

SUPPORT: (Verified 5/25/23)

SEIU California (source)

Buen Vecino

California Alliance for Retired Americans
California Black Health Network
California Labor Federation

California School Employees Association

California Teachers Association

Los Angeles Alliance for a New Economy

OPPOSITION: (Verified 5/19/23)

AltaMed Health Services

Altura Centers for Health

APLA Health & Wellness

Calexico Wellness Center

California Health+ Advocates

California Human Development

California Medical Association

Center for Employment Training

Central City Community Health Center

Central Valley Opportunity Center

Clinica Sierra Vista

CommuniCare Health Centers

Community Health Association Inland Southern Region

Community Medical Centers

El Proyecto del Barrio, Inc.

Farmworkers Institute of Education and Leadership Development

First Day Foundation

Fresno American Indian Health Project

Gardner Health Services

Golden Valley Health Centers

Health Alliance of Northern California

Health Center Partners of Southern California

Hill Country Health & Wellness

Inland Coalition for Immigrant Justice

La Clinica de la Raza

La Cooperativa Campesina de California

Lifelong Medical Care

Los Amigos de la Comunidad

Neighborhood Healthcare

North Coast Clinics Network

North East Medical Services

Northeast Valley Health Corporation

OLE Health

Proteus

San Diego Regional Chamber of Commerce

San Francisco Community Clinic Consortium

San Ysidro Health

Shasta Community Health Center

St. Jude Neighborhood Health Center

TCC Family Health

To Help Everyone Health and Wellness Centers

Valley Community Healthcare

Venice Family Clinic

Westside Family Health Center

ARGUMENTS IN SUPPORT: This bill is sponsored by the SEIU California to increase accountability, quality, and transparency in health care by updating annual data reporting for California’s licensed primary care clinics. According to SEIU California, over the past decade, the number of clinics in California have grown significantly with much of this growth being in intermittent clinic sites. Today, intermittent clinic sites do not report data directly, but under the licensed clinic they are affiliated with, which means data across two or more physical locations is aggregated under one licensed clinic site. SEIU California states there is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This results in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders. SEIU California points to data that indicate the number of clinic sites, inclusive of licensed and intermittent sites, has grown from roughly 1,500 sites in 2012 to 2,700 sites in 2021. In 2012, just under over 1,000 licensed sites reported data, or 70% of all CDPH listed sites. In 2021, on the other hand, just under 1,200 licensed sites reported data, or just 43% of all CDPH listed sites. The total number of licensed sites completing the AUR is decreasing, and not just because clinic corporations are choosing to open more intermittent sites, but also because they are converting previously licensed sites to be intermittent sites. Additionally, SEIU California states that we need to modernize the data we collect by building upon currently collected workforce data, incorporating quality data, and expanding financial data reporting.

ARGUMENTS IN OPPOSITION: Calexico Wellness Center opposes this bill, stating that it creates unnecessary burdensome data reporting requirements on community clinics and exposes these community clinics to civil penalties. Such burdensome requirements and penalties should not be places on clinics at a time when hospitals are closing their doors due to financial strains. Rural, low-income communities are facing many challenges, including food shortage, unemployment, violence and health disparities, and these communities are mainly served by FQHCs. This legislation will have a negative impact on undocumented communities, and California should not place additional requirements on community clinics that have limited financial resources to serve patients. The Farmworker Institute of Education and Leadership Development (FIELD) makes similar arguments in opposition, and states that the Central Valley, Imperial Valley and rural areas have historically experienced a shortage of healthcare facilities and workers, and California must prioritize these communities in investing job training funds for health care worker, not create burdens. California Health+ Advocates, the advocacy affiliate of the California Primary Care Association, opposes this bill unless amended, stating that this bill is a solution in search of a problem, and that clinics already report to multiple entities such as the Health Resource and Services Administration, HCAI, and various payors. Additionally, just last session the Legislature created the Office of Health Care Affordability, with responsibilities to manage spending targets, monitor system performance, and assess market consolidation. According to California Health+ Advocates, under current law, clinics report PPS rates, a full income statement, and patient data, among other data. While improving data standardization is an on-going and worthy effort, the amount of data clinics already submit on an annual basis is robust.

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

5/25/23 10:22:55

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

SB 779 (Stern) - Primary Care Clinic Data Modernization Act

Bill Summary:

SB 779 would revise and expand the data reporting requirements for health clinics, as specified.

Fiscal Impact:

• The Department of Health Care Access and Information (HCAI) estimates costs to be $2,037,000 in 2024-25, $1,064,000 in 2025-26, $1,186,000 in 2026-27, and $1,186,000 ongoing thereafter (California Health Data and Planning Fund), which includes costs for staff, contracting resources, and enhancements to existing information systems and data infrastructure.
• The California Department of Public Health estimates minor and absorbable costs.

Background:

The California Department of Public Health (CDPH) licenses and regulates various clinics, including primary care clinics and specialty clinics. Current law exempts from licensure by CDPH 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 40 hours each week.

Existing law requires every clinic holding a license to file with HCAI an annual report (known as the annual utilization report, or AUR) showing the following information relating to the previous calendar year:

a) Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients;

b) Number of patient visits by type of service, including child health and disability prevention screens, treatment, and follow-up services, medical services, dental services, and other health services;

c) Total clinic operating expenses;

d) Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county program, private insurance, self-paying patients, nonpaying patients, and other payers;

e) Deductions from revenue by payer category, bad debts, and charity care charges; and,

f) Additional information as may be required, as specified.

The CDPH may, in the event a clinic fails to file a timely report as required above, suspend the license of the clinic until the report is completed and filed with HCAI.

Proposed Law:

Specific provisions of the bill would:

• Add intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an AUR and expand the data required as part of the AUR.
• Require a primary care clinic or intermittent clinic to file reports, as specified, with the HCAI on or before the 15th day of February each year, including, but not limited to:
  • Medi-Cal prospective payment system rates, if applicable.
  • A report of all mergers and acquisitions.
  • A detailed labor report.
  • A detailed workforce development report.
  • A report of quality and equity measures.
• Require HCAI, subject to any rules the department may prescribe, to produce and make available these reports for inspection upon the demand of any person, and post the reports on the department’s internet website.
• Require HCAI to adopt all regulations necessary to implement the provisions of the bill.

-- END --

ENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: SB 779

SUBJECT: Primary Care Clinic Data Modernization Act

SUMMARY:

Adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report to the Department of Health Care Access and Information (HCAI) with certain specified information for the previous calendar year. Creates new reporting requirements for all primary care clinics, including intermittent clinics, to report various types of data to HCAI, including all mergers and acquisitions, a detailed labor report, a detailed workforce development report, and a report of quality and equity measures. Establishes a penalty for failure to report of $100 per day a report is delayed.

Existing law:

1. Licenses and regulates clinics, including primary care clinics and specialty clinics, by the California Department of Public Health (CDPH). [HSC §1200, et seq.]
2. 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]
3. Exempts various types of clinics from licensure and regulation by CDPH, including clinics operated by the federal government or by a federally recognized Indian tribe on tribal land, any primary care clinic operated by the state, counties, or cities, a clinic operated by any institution of learning that teaches a healing art, medical foundation clinics, and the offices of physicians in group practice who provide the preponderance of their services to members of a health plan. [HSC §1206]
4. Exempts from licensure by CDPH 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 40 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)]
5. Requires every clinic holding a license to file with HCAI an annual report (known as the annual utilization report, or AUR) showing the following information relating to the previous calendar year:
   1. Number of patients served and descriptive information, including age, gender, race, and ethnic background of patients;
   2. Number of patient visits by type of service, including child health and disability prevention screens, treatment, and follow-up services, medical services, dental services, and other health services;
   3. Total clinic operating expenses;
   4. Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county program, private insurance, self-paying patients, nonpaying patients, and other payers;
   5. Deductions from revenue by payer category, bad debts, and charity care charges; and,
   6. Additional information as may be required by HCAI or CDPH. [HSC §1216]
6. Permits CDPH, in the event a clinic fails to file a timely report as required in 5) above, to suspend the license of the clinic until the report is completed and filed with HCAI. [HSC §1216(b)]
7. Requires federally qualified health center (FQHC) and rural health clinic (RHC) services to be covered benefits under the Medi-Cal program and requires these services to be reimbursed on a per-visit basis, as defined. [WIC §14132.100]

This bill:

1. Adds intermittent clinics that are exempt from licensure to an existing requirement that licensed clinics file an annual report with certain specified information for the previous calendar year, known as the AUR.
2. Revises the AUR to require clinics to report more detailed demographic information on patients served, including preferred language spoken, disability status, sexual orientation, gender identity, and payer category.
3. Revises the AUR to require primary care clinics participating in the Medi-Cal program to include the number of members per Medi-Cal managed care plan and county indigent program, and the number of assigned members per Medi-Cal managed care plan and county indigent program that had one or more clinic visits.
4. Requires an organization that operates or owns a primary care clinic or intermittent clinic, and the officers thereof, to file with HCAI, for each primary care clinic and each intermittent clinic that it owns or operates, on or before the 15^th day of February each year, in conjunction with existing required reports, the following:
   1. The Medi-Cal FQHC/RHC prospective payment system (PPS) rate, if applicable;
   2. The percentage of all revenue spent on workforce expenditures, including, but not limited to, salaries, wages, benefits, and associated payroll taxes;
   3. A report of all mergers and acquisitions, including, but not limited to, whether the clinic has been purchased, acquired, or merged with any other clinic parent corporation since the prior reporting period; information identifying all purchased, acquired or merged clinics, including all applicable clinic sites; and, a summary of costs related to the mergers and acquisitions;
   4. A detailed labor report, including, but not limited to, the following information:
      1. The actual number, not full-time equivalents (FTEs), of employees by job classification, including nonlicensed and noncredentialed positions;
      2. The actual number, not FTEs, of contracted, registry, and temporary staff by job classification, including nonlicensed and noncredentialed positions;
      3. Staff retention and turnover information for total employees and key job classifications, including the number of employees at the beginning and end of the reporting period; the average number of employees throughout the reporting period; the total number of people employed during the reporting period; employee turnover and retention percentages during the reporting period; and, the number of employees with continuous service for the entire reporting period;
      4. The number of staff vacancies by job classification;
      5. The average base hourly wages and hourly base wage ranges (minimum and maximum base hourly wage) for all employees and by job classification;
      6. The average weekly hours worked and average weekly overtime hours worked for all employees and by job classification; and,
      7. Workforce demographic information by job classification, including, but not limited to, age, sex, race, ethnicity, languages spoken, disability status, sexual orientation, and gender identity. Prohibits workers from being required to provide this information or from being subject to discipline or any other adverse action for not providing the information listed. Requires this demographic information to be reported only in an aggregate form that cannot be used to identify an individual.
   5. A detailed workforce development report, including, but not limited to, the following:
      1. The number of residents participating in a residency program accredited by the Accreditation Council for Graduate Medical Education, per program, over the reporting period;
      2. The number of advanced practice clinicians participating in an advance practice clinician postgraduate training or fellowship program, per program, over the reporting period;
      3. Participation in any local, regional, or statewide labor-management cooperation committee (LMCC) , and for each LMCC, the identity of all partners;
      4. Participation in allied health care professional degrees and certificate programs, including the name of each program and affiliated school, the number of clinical placements for each program over the reporting period, and the number of students participating in each program over the reporting period;
      5. Participation in behavioral health professional degree and certificate programs, including the name of each program and affiliated school, the number of clinical placements for each program over the reporting period, and the number of students participating in each program over the reporting period.
   6. A report of quality and equity measures, which are required to include the quality measures selected for the FQHC alternative payment methodology program, to assess performance for the Medi-Cal program or other programs administered by DHCS. Requires reported quality measures to include, at a minimum, quality measures in the following categories:
      1. Prevention-adults;
      2. Prevention-pediatrics;
      3. Access to care;
      4. Behavioral health integration;
      5. Chronic care;
      6. Maternity care;
      7. Patient experience of access and care;
      8. Hospital and emergency department utilization; and,
      9. Patient-reported outcome measures.
5. Requires, for purposes of the report on quality and equity measures required pursuant to 4) f) above, quality measure reporting to be clinic site specific and stratified by patient demographics, as specified. Requires HCAI to coordinate with DHCS on additional quality measure data and other information necessary to include in this report, and to align reporting with HCAI’s Health Equity Measures Advisory Committee, the Department of Managed Health Care Health Equity and Quality Committee Recommendations, and the Centers for Medicare and Medicaid Services Framework for Health Equity. Requires data to be reported for all assigned patients that visited the health center at least once during the reporting period.
6. Requires HCAI to maintain a file of all reports under this bill and under existing law at its Sacramento office, and subject to any rules HCAI may prescribe, requires these reports to be produced and made available for inspection upon the demand of any person, and to also be posted on HCAI’s website.
7. Subjects a primary care clinic or intermittent clinic that does not file a report with HCAI as required by this bill or specific reporting requirements in existing law (including the AUR) to a civil penalty of $100 per day for each day the filing of any report is delayed, unless an extension is granted by HCAI. Requires funds received by HCAI pursuant to this civil penalty, upon appropriation by the Legislature, to be allocated to health care workforce education and training programs, in consultation with the California Health Workforce Education and Training Council.
8. Permits a primary care clinic or intermittent clinic affected by any determination made by HCAI to petition HCAI for review of the decision, as specified, with judicial review of a final action permitted by any party to the proceedings. Establishes procedures for the judicial review, as specified.
9. Makes various findings and declarations, and states that it is in the internet of the state and consumers to collect greater information about primary care clinics.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, community clinics are integral to our state’s health care system, but we are facing a crisis exacerbated by the pandemic and its aftermath. Recent events have brought into sharp focus the workforce shortages faced by our clinics, exposing vulnerabilities in California’s social safety net and disparities in healthcare. Action must be taken to ensure safe and efficient care, without delays. It is crucial that the state better track the interplay between primary care clinic finances, workforce, and quality of care. Accurate, comprehensive data collection will enable better policymaking and more thoughtful investments that empower workers while fostering more equitable healthcare in historically marginalized communities.
2. Background on primary care clinics and intermittent clinics. Under existing law, a licensed primary care clinic is permitted to operate an off-site clinic for up to 40 hours per week, without obtaining a separate license for these offsite locations. Licensed primary care clinics include community clinics and free clinics, but do not include a number of clinic settings that are exempt from licensure, such as county-operate clinics or tribal clinics. According to CDPH, only clinics licensed by CDPH are captured by the Electronic Licensing Management System, so intermittent clinics are not tracked by CDPH. There are currently 1,388 licensed primary care clinics (1,339 community clinics, and 49 free clinics). However, intermittent clinics report to the Provider Enrollment Division at DHCS, which reports that there are currently 795 listed intermittent clinics. In 2018, which is the year AB 2204 (Gray, Chapter 279, Statutes of 2018) extended the number of hours an intermittent clinic could operate from 30 to 40 hours, CDPH reported 1,630 licensed primary care clinics, while there were just 171 intermittent clinics. Clearly, the expansion of the number of hours an intermittent clinic could operate has led to a significant increase in the number of intermittent clinics, and a commensurate drop in the number of licensed clinics.
3. Background on existing data collection for clinics and what is new in this bill. There are a number of existing data reporting obligations for clinics. As noted in existing law, a primary reporting requirement is the AUR report to HCAI. In addition, the federal Health Resources and Services Administration (HRSA) requires FQHC and FQHC look-alikes (clinics that meet the federal definition for an FQHC, but are not receiving grant funding as FQHCs) to report a core set of information, including data on patient characteristics, services provided, clinical processes and health outcomes, patients’ use of services, staffing, costs, and revenues as part of a standardized reporting system known as the Uniform Data System (UDS). For some of the data requirements in this bill, the sponsors state that it is a modification of a data item already reported in some fashion, or (in the case of the PPS rate) public disclosure of something already collected. An example of a modification of a data item is the detailed labor report, which is requiring actual workers rather than full-time equivalents, and for all workers rather than just some workers in the AUR. In other cases, it is a new data item for clinics, but something similar is collected for other types of facilities, such as mergers and acquisitions, which is reported in some form for hospitals and long-term care facilities. However, for many of the data items in this bill, the sponsor states that it is a new data item, including things like the number of staff vacancies by job classification, the percentage of all revenue spent on workforce expenditures, and the assigned members per Medi-Cal managed care program.
4. Background on data collection for hospitals and other health facilities. Under existing law, HCAI is designated as the single state agency to collect specified health facility or clinic data for use by all state agencies. All licensed health facilities are required to file annual financial reports detailing assets and liabilities, income and expenses, and patient revenue by payer, among other data elements. Additionally, licensed acute care hospitals are required to file a Hospital Discharge Abstract Data Record that includes 19 specified data elements for each admission, including date of birth, sex, admission date, discharge date, principal diagnosis, other diagnoses, principal procedures, and disposition of the patient. In addition to this discharge report, hospitals are required to file an Emergency Care Data Record for each patient encounter in a hospital emergency department, and hospitals and freestanding ambulatory surgery clinics are required to file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed.
5. Clinic workforce shortage. According to a 2016 report by National Association of Community Health Centers, workforce challenges are one of the primary barriers to health center patient growth. If all health center clinical vacancies were filled today, health centers could serve two million more patients. At that time, prior to COVID-19’s impact on the health care workforce, 95% of health centers had at least one clinical vacancy, and were averaging a vacancy rate for clinical positions of 13%. The number one challenge in recruitment and retention named was the ability to offer competitive salaries. According to the Kaiser Family Foundation, California has 643 areas with a Health Professional Shortage Area designation for primary care, meaning one-third of Californians live in an area with a primary care provider shortage.
6. FQHCs and PPS. FQHCs are clinics that meet federally defined qualifications and furnish federally specified services. FQHCs provide preventive and primary health care services to medically underserved populations. Payment rules for FQHCs differ from those for other providers. State and federal law requires that FQHCs are paid for each patient visit, a cost-based per-visit rate known as PPS. Medi-Cal managed care plans make their own payment to the FQHC for services to their enrollees. DHCS also makes a “wrap around” payment that makes up the difference between the managed care plan payment and the FQHC full per-visit PPS rate. DHCS conducts an audit process where the state reconciles payments made by plans to FQHCs for the purpose of determining the amount the state must pay for wrap around Medi-Cal payments.
7. The role of FQHCs post-Medi-Cal expansion. According to a recent market analysis by the California Health Care Foundation (CHCF), many FQHCs experienced rapid growth in the period immediately following the implementation of the federal Affordable Care Act (ACA) in 2014. In the post-ACA period, as more Californians gained health insurance under the state’s expanded Medi-Cal program, FQHCs have continued to add patients and clinic sites at a rapid pace in regions throughout the state, and many health centers have increased offerings of specialty services and care for elderly patients. The number of patients increased from 3.7 million in 2014 to 5.3 million in 2019. While the number of organizations (i.e., clinic networks) largely leveled off, the number of clinic sites has steadily increased each year as existing FQHCs expanded. In 2014, excluding county-run clinic networks, FQHC organizations operated 776 sites across the state. Over the following five years, 157 new sites opened, an increase of more than 20%. Although this expansion initially helped stabilize the revenues of FQHCs as more and more of their patients were covered by Medi-Cal rather than uninsured, not long after the implementation of the ACA, federal grants started to decline and staffing costs began to increase resulting in shrinking operating margins despite such growth.
8. Alternative Payment Methodology (APM) pilot program. SB 147 (Hernandez, Chapter 760, Statutes of 2015) authorized a three-year APM pilot program for county and community-based FQHCs. As proposed under the FQHC APM pilot, the PPS payment and wrap-around would be replaced by an upfront, clinic-specific capitation rate. The purpose was to move the clinics away from volume-based, PPS to a more flexible payment methodology that would enable “non-traditional” services like integrated primary and behavioral health visits on the same day, group visits, email visits, phone visits, community health worker contacts, case management, and case coordination across systems. In 2016, DHCS submitted a concept paper for the APM pilot program to CMS, but CMS indicated the proposal did not comply with federal APM requirements, thus the pilot has not been implemented.
   
   More recently, as part of the California Advancing and Innovating Medi-Cal (CalAIM), initiative by DHCS, the FQHC APM model has been revisited. As one goal of CalAIM is to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility, DHCS aims to transform reimbursement methodologies for FQHCs in order to reduce complexity and increase flexibility. DHCS held a series of stakeholder meetings in 2021 and is now proposing to update SB 147 via trailer bill language for submission of a State Plan Amendment for federal approval of the APM with the intent of implementing the APM no sooner than January 1, 2024.
9. Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Judiciary Committee.
10. Prior legislation. SB 1014 (Hertzberg of 2022) would have required DHCS to authorize a new optional supplemental payment program for FQHCs to be named the Enhanced Clinically Integrated Program (ECIP).  Requires the supplemental funding under ECIP to be provided in addition to all other funding received by FQHCs. SB 1014 would have required DHCS to make funding, if appropriated, available for the purpose of direct compensation of health center workers on the condition that FQHCs meet certain standards relating to wage thresholds and participation in bona fide labor-management cooperation committees. Additionally, SB 1014 would have required DHCS to establish a statewide 15-member board to develop eligibility criteria, an application process, a fund distribution process, reporting requirements, and a methodology for adjusting funding allocations based on health care inflation. SB 1014 was not taken up on the Assembly Floor.
    
    AB 2204 (Gray, Chapter 279, Statutes of 2018) 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.
    
    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.
11. Support. This bill is sponsored by the Service Employees International Union California (SEIU) to increase accountability, quality, and transparency in health care by updating annual data reporting for California’s licensed primary care clinics. According to SEIU, over the past decade, the number of clinics in California have grown significantly with much of this growth being in intermittent clinic sites. Today, intermittent clinic sites do not report data directly, but under the licensed clinic they are affiliated with, which means data across two or more physical locations is aggregated under one licensed clinic site. SEIU states there is no limit on how many intermittent clinics can be under a licensed clinic site and many serve distinct communities and populations. This results in an AUR dataset that no longer provides accurate information of local experience and can no longer meet the needs of policymakers and stakeholders. SEIU points to data that indicate the number of clinic sites, inclusive of licensed and intermittent sites, has grown from roughly 1500 sites in 2012 to 2700 sites in 2021. In 2012, just under over 1000 licensed sites reported data, or 70% of all CDPH listed sites. In 2021, on the other hand, just under 1200 licensed sites reported data, or just 43% of all CDPH listed sites. The total number of licensed sites completing the AUR is decreasing, and not just because clinic corporations are choosing to open more intermittent sites, but also beca7use they are converting previously licensed sites to be intermittent sites. Additionally, SEIU states that we need to modernize the data we collect by building upon currently collected workforce data, incorporating quality data, and expanding financial data reporting.
12. Oppose unless amended. California Health+ Advocates, the advocacy affiliate of the California Primary Care Association, opposes this bill unless amended, stating that this bill is a solution in search of a problem, and that clinics already report to multiple entities such as the Health Resource and Services Administration, HCAI, and various payors. Additionally, just last session the Legislature created the Office of Health Care Affordability, with responsibilities to manage spending targets, monitor system performance, and assess market consolidation. According to California Health+ Advocates, under current law, clinics report PPS rates, a full income statement, and patient data, among other data. While improving data standardization is an on-going and worthy effort, the amount of data clinics already submit on an annual basis is robust. Another area of concern is the enforcement mechanism under the proposed language, and California Health+ Advocates point out that under currently law, CDPH can suspend a clinic license until a report is submitted, and that adding a civil penalty of $100 per day for each day the report is delayed is excessive and unnecessary. California Health+ Advocates states as currently drafted, this bill is duplicative and overly broad, and looks forward to working with the author to find a reasonable solution to supplement the transparency currently provided under law. The California Medical Association, AltaMed Health Services, and Health Center Partners of Southern California also oppose unless amended, making similar arguments.
13. Opposition. Calexico Wellness Center opposes this bill, stating that it creates unnecessary burdensome data reporting requirements on community clinics and exposes these community clinics to civil penalties. Such burdensome requirements and penalties should not be places on clinics at a time when hospitals are closing their doors due to financial strains. Rural, low-income communities are facing many challenges, including food shortage, unemployment, violence and health disparities, and these communities are mainly served by FQHCs. This legislation will have a negative impact on undocumented communities, and California should not place additional requirements on community clinics that have limited financial resources to serve patients. The Farmworker Institute of Education and Leadership Development (FIELD) makes similar arguments in opposition, and states that the Central Valley, Imperial Valley and rural areas have historically experienced a shortage of healthcare facilities and workers, and California must prioritize these communities in investing job training funds for health care worker, not create burdens. FIELD states this legislation is detrimental to community clinics which are the only health care resource to the most underserved in California. The Inland Coalition for Immigrant Justice, La Cooperativa Campesina de California, Central Valley Opportunity Center, and other organizations all make similar arguments in opposition.
14. Policy comment. The author and sponsor state that there are two primary objectives with this bill: to ensure that the growing number of unlicensed intermittent clinics are required to report as individual clinic sites, and to expand and improve the data being collected. With respect to new reporting requirements, this bill is requiring an extensive amount of detailed data elements, many of which are not currently required of any other type of health care setting. Given the challenges facing many community clinics serving rural and underserved regions, the author may wish to consider narrowing the bill to reduce the burden of these reporting requirements.

SUPPORT AND OPPOSITION:

Support: SEIU California (sponsor)

California Alliance for Retired Americans

California Black Health Network

California Labor Federation

Oppose: AltaMed Health Services (unless amended)

Altura Centers for Health (unless amended)

APLA Health & Wellness (unless amended)

California Health+ Advocates (unless amended)

California Human Development

California Medical Association (unless amended)

Center for Employment Training

Central City Community Health Center (unless amended)

Central Valley Opportunity Center

Clinica Sierra Vista (unless amended)

CommuniCare Health Centers (unless amended)

Community Health Association Inland Southern Region (unless amended)

Community Medical Centers (unless amended)

El Proyecto del Barrio, Inc. (unless amended)

Farmworkers Institute of Education and Leadership Development

First Day Foundation

Fresno American Indian Health Project (unless amended)

Gardner Health Services (unless amended)

Golden Valley Health Centers (unless amended)

Health Alliance of Northern California (unless amended)

Health Center Partners of Southern California (unless amended)

Hill Country Health & Wellness (unless amended)

Inland Coalition for Immigrant Justice

La Clinica de la Raza (unless amended)

La Cooperativa Campesina de California

Lifelong Medical Care (unless amended)

Los Amigos de la Comunidad

Neighborhood Healthcare (unless amended)

North Coast Clinics Network (unless amended)

North East Medical Services (unless amended)

Northeast Valley Health Corporation (unless amended)

OLE Health (unless amended)

Calexico Wellness Center

Proteus

San Diego Regional Chamber of Commerce

San Francisco Community Clinic Consortium (unless amended)

San Ysidro Health (unless amended)

Shasta Community Health Center (unless amended)

St. Jude Neighborhood Health Center (unless amended)

TCC Family Health (unless amended)

To Help Everyone Health and Wellness Centers (unless amended)

Valley Community Healthcare (unless amended)

Venice Family Clinic (unless amended)

Westside Family Health Center (unless amended)