BILL NUMBER: SB 442	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 26, 2010
	PASSED THE ASSEMBLY  AUGUST 16, 2010
	AMENDED IN ASSEMBLY  AUGUST 12, 2010
	AMENDED IN ASSEMBLY  AUGUST 2, 2010
	AMENDED IN ASSEMBLY  JUNE 22, 2010
	AMENDED IN SENATE  JANUARY 26, 2010
	AMENDED IN SENATE  JANUARY 12, 2010
	AMENDED IN SENATE  MAY 6, 2009
	AMENDED IN SENATE  APRIL 28, 2009
	AMENDED IN SENATE  APRIL 15, 2009

INTRODUCED BY   Senator Ducheny
   (Principal coauthor: Assembly Member Chesbro)
   (Coauthor: Senator Wiggins)
   (Coauthors: Assembly Members Block, Blumenfield, Evans, Fletcher,
Bonnie Lowenthal, Monning, V. Manuel Perez, and Salas)

                        FEBRUARY 26, 2009

   An act to amend Sections 1200, 1213, and 1218.1 of, and to add
Section 1218.3 to, the Health and Safety Code, relating to clinics.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 442, Ducheny. Clinic corporation: licensing.
   Under existing law, the State Department of Public Health is
responsible for the licensing and regulation of clinics, as defined.
A violation of these provisions is a crime.
   This bill would define "clinic corporation" as a nonprofit
organization that operates one or more primary care clinics or mobile
health care units as defined.
   Existing law allows specified primary care clinics to apply for a
license to establish a primary care clinic, known as an affiliate
clinic, at an additional site and allows the department to approve a
license for the affiliate clinic, without the necessity of first
conducting an initial onsite survey in specified conditions.
   This bill would allow a clinic corporation, on behalf of an
eligible primary care clinic, to submit an affiliate clinic
application, as specified, to license a primary care clinic or a
mobile health care unit as an affiliate clinic if certain conditions
are met. The bill would designate the clinic corporation as the
administrative headquarters for specified purposes for all of the
affiliated clinics operated by that clinic corporation and would
allow the clinic corporation to submit a single report of change and
a single payment for all clinic license renewal fees that are due
within the same license renewal month for all of the primary care
clinics operated by the clinic corporation. The bill would also
require the department to create a complete corporate file for each
clinic corporation that includes specified information.
   Because this bill would create a new crime, it 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.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) California's primary care clinics are essential partners with
the state in providing a health care safety net for underserved,
uninsured, and underinsured populations in a cost-effective manner.
   (b) California's primary care clinics generate significant savings
to the state and to local communities in both of the following ways:

   (1) By providing primary and preventive care that responds to
patients' needs before medical problems become serious or life
threatening.
   (2) By reducing the reliance of patients, including uninsured and
underinsured patients, on costly emergency room care, inpatient
treatment, and specialty care.
   (c) The need for primary care clinics continues to grow
dramatically due to the continuing increase of uninsured and
underinsured patients in California, the escalating unemployment
rate, and a severely depressed economy.
   (d) The current system for licensing primary care clinics is
inefficient and results in a significant waste of taxpayer and
community resources that could otherwise be devoted to patient care.
Requiring a nonprofit clinic corporation that operates primary care
clinics to submit a full application package for each affiliate
clinic license every time the clinic corporation wishes to open a new
site results in the repeated submission of a significant amount of
information and documentation that is already in the department's
possession. This places a significant burden both on the primary care
clinics that must compile the information and on regulators who must
process it. The mandate under current law that each clinic
separately submit notices to the department for any change in the
clinic's administration, medical director, or board members further
burdens clinic corporations that operate multiple clinic sites under
a centralized administration. This requirement also results in the
submission of unnecessary duplicate notices to the department.
   (e) Streamlining administrative processes through a paperwork
reduction process that eliminates duplication in the application
requirements for new affiliate clinics will result in substantial
cost savings to the state and improved access to health care for
underserved populations.
  SEC. 2.  Section 1200 of the Health and Safety Code is amended to
read:
   1200.  (a) As used in this chapter, "clinic" means an organized
outpatient health facility that provides direct medical, surgical,
dental, optometric, or podiatric advice, services, or treatment to
patients who remain less than 24 hours, and that may also provide
diagnostic or therapeutic services to patients in the home as an
incident to care provided at the clinic facility. Nothing in this
section shall be construed to prohibit the provision of nursing
services in a clinic licensed pursuant to this chapter. In no case
shall a clinic be deemed to be a health facility subject to the
provisions of Chapter 2 (commencing with Section 1250). A place,
establishment, or institution that solely provides advice,
counseling, information, or referrals on the maintenance of health or
on the means and measures to prevent or avoid sickness, disease, or
injury, where that advice, counseling, information, or referral does
not constitute the practice of medicine, surgery, dentistry,
optometry, or podiatry, shall not be deemed a clinic for purposes of
this chapter.
   (b) For purposes of this chapter:
   (1) "Primary care clinics" means all the types of clinics
specified in subdivision (a) of Section 1204, including community
clinics and free clinics.
   (2) "Specialty clinics" means all the types of clinics specified
in subdivision (b) of Section 1204, including surgical clinics,
chronic dialysis clinics, and rehabilitation clinics.
   (3) "Clinic corporation" means a nonprofit organization that
operates one or more primary care clinics, as defined in paragraph
(1) of subdivision (a) of Section 1204, that are required to be
licensed under Section 1205, one or more mobile health care units
required to be licensed or approved pursuant to the Mobile Health
Care Services Act (Chapter 9 (commencing with Section 1765.101)) and
operated as primary care clinics, or one or more primary care clinics
and one or more mobile health care units.
   (4) "Department" means the Licensing and Certification Division of
the State Department of Public Health, or its successor.
   (5) "Centralized applications unit" means the centralized
applications unit in the Licensing and Certification Division of the
department, or a successor entity.
  SEC. 3.  Section 1213 of the Health and Safety Code is amended to
read:
   1213.  A person, firm, association, partnership, corporation, or
other legal entity desiring a license for a clinic shall be exempt
from the requirements of Chapter 2 (commencing with Section 16000) of
Division 12.5.
  SEC. 4.  Section 1218.1 of the Health and Safety Code is amended to
read:
   1218.1.  (a)  A clinic corporation on behalf of a primary care
clinic that has held a valid, unrevoked, and unsuspended license for
at least the immediately preceding five years, with no demonstrated
history of repeated or uncorrected violations of this chapter or a
regulation adopted under this chapter that pose immediate jeopardy to
a patient, as defined in subdivision (f), and that has no pending
action to suspend or revoke its license, may file an affiliate clinic
application under this section to establish a primary care clinic at
an additional site or a mobile health care unit, either of which
shall hereafter be referred to as the affiliate clinic. The
department, upon receipt of the completed affiliate clinic
application submitted by the clinic corporation, shall approve a
license for the affiliate clinic, without the necessity of first
conducting an initial onsite survey, if all of the following
conditions are met:
   (1)  The clinic corporation that operates the existing licensed
primary care clinic, which shall hereafter be referred to as the
parent clinic, has submitted a completed affiliate clinic application
and the associated application fee.
   (2)  The parent and affiliate clinics' corporate officers, as
specified in Section 5213 of the Corporations Code, are the same.
   (3)  The parent and affiliate clinics are owned and operated by
the same nonprofit organization with the same board of directors.
   (4)  The parent and affiliate clinics have the same medical
director or directors and medical policies, procedures, protocols,
and standards.
   (b) The affiliate clinic application shall consist solely of a
simple form and required supporting documents giving the following
information:
   (1) The name and address of the clinic corporation's
administrative office.
   (2) The name and contact information of the clinic corporation's
chief executive officer or executive director.
   (3) The name and address of the new affiliate primary care clinic
site or the location of the new affiliate mobile health care unit.
   (4) The name and contact information of the administrator of the
new affiliate primary care clinic site or mobile health care unit.
   (5) The expected days and hours of operation and the services to
be provided at the new affiliate primary care clinic site or mobile
health care unit.
   (6) Evidence that the new affiliate mobile health care unit meets
the requirements of the Mobile Health Care Services Act (Chapter 9
(commencing with Section 1765.101)).
   (7) The type and the manufacturer of the new affiliate mobile
health care unit and the proposed area or areas where the new
affiliate mobile health care unit will be providing services.
   (8) To the extent otherwise required by law, evidence of
compliance with the minimum construction standards for adequacy and
safety of the new affiliate clinic's physical plant, pursuant to the
OSHPD 3 requirements of the most recent version of the California
Building Code applicable to clinics and subdivision (b) of Section
1226. The compliance may be established in the form prescribed by
Section 1226.3.
   (9) Evidence of fire clearance for the new affiliate clinic site.
   (10) A copy of the lease or purchase agreement for the new
affiliate clinic site.
   (11) A copy of the transfer agreement between the new affiliate
clinic and a local hospital.
   (12) A current list of clinic corporation board members.
   (c) The affiliate clinic application shall be signed by an officer
of the clinic corporation's board of directors or the clinic
corporation's chief executive officer or executive director.
   (d) The department shall issue a clinic license under this section
within 30 days of receipt of a completed affiliate clinic
application. If approved, a clinic license shall be issued within
seven days of approval. If the department determines that an
applicant does not meet the conditions stated in subdivision (a), it
shall identify, in writing and with particularity, the grounds for
that determination, and shall instead process the application in
accordance with the time specified in Section 1218.
   (e) Nothing in this section shall prohibit the department from
conducting a licensing inspection of the affiliate clinic at any time
after receipt of the completed affiliate clinic application.
   (f) For purposes of this section, "immediate jeopardy to a patient"
means a situation in which the clinic's noncompliance with one or
more requirements of licensure has caused, or is likely to cause,
serious injury, harm, impairment, or death to a patient.
  SEC. 5.  Section 1218.3 is added to the Health and Safety Code, to
read:
   1218.3.  (a) In order to reduce paperwork, eliminate errors, and
streamline communications between the department and licensed primary
care clinics, a clinic corporation that operates one or more
affiliate clinics shall, on behalf of all licensed clinics it
operates, act as the administrative headquarters for purposes of
receiving from and submitting to the department communications
regarding primary care clinic license applications or license
renewals, primary care clinic operations, requests for prior
approval, additions of services, primary care clinic relocations,
required reports of changes in primary care clinic administration and
board of directors, notices of deficiencies, and all communications
from the department to primary care clinics licensed by the
department including communications by mail, e-mail, facsimile, or
any other electronic or telephonic means.
   (b) The department shall maintain a complete corporate file
containing information about each clinic corporation operating one or
more affiliate clinics, including all of the following:
   (1) A copy of the clinic corporation's articles of incorporation
and bylaws.
   (2) Unless exempt under paragraph (1) of subdivision (a) of
Section 1204, a copy of the determination letter to show the clinic
corporation's exempt status under paragraph (3) of subsection (c) of
the Internal Revenue Code of 1954, as amended.
   (3) A copy of the clinic corporation's organizational chart.
   (4) Information identifying the clinic corporation's governing
body, including the clinic corporation's board of directors and
corporate officers and required documents.
   (5) Information identifying the clinic corporation's
administrators, including the chief executive officer or executive
director and medical director.
   (c) A clinic corporation shall not be required to resubmit
information, materials, or documents identified in subdivision (b) as
part of an affiliate clinic application, unless the information,
materials, or documents are necessary to complete the corporate file.

   (d) A clinic corporation shall submit to the department, on behalf
of all licensed primary care clinics operated by the clinic
corporation, a single report of change that is applicable to all
primary care clinics operated by the clinic corporation, including a
change in a principal officer or general manager of the governing
body, the medical director, and the clinic administrator, as required
by law.
   (e) A clinic corporation may submit to the department, on behalf
of all licensed primary care clinics operated by the clinic
corporation that are within the same license renewal month, a single
payment for all primary care clinic licensure renewal fees.
  SEC. 6.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.