BILL ANALYSIS SB 442 Page 1 SENATE THIRD READING SB 442 (Ducheny) As Amended August 2, 2010 Majority vote SENATE VOTE :35-0 HEALTH 19-0 APPROPRIATIONS 17-0 ----------------------------------------------------------------- |Ayes:|Monning, Fletcher, |Ayes:|Fuentes, Conway, | | |Ammiano, Carter, Conway, | |Bradford, | | |De La Torre, De Leon, | |Charles Calderon, Coto, | | |Eng, Gaines, Hayashi, | |Davis, | | |Hernandez, Jones, Bonnie | |De Leon, Gatto, Hall, | | |Lowenthal, Nava, | |Harkey, Miller, Nielsen, | | |V. Manuel Perez, Salas, | |Norby, Skinner, Solorio, | | |Smyth, Audra Strickland, | |Torlakson, Torrico | | |Silva | | | | | | | | ----------------------------------------------------------------- SUMMARY : Amends the administrative requirements for a clinic corporation to apply for licensure for an affiliate primary care clinic or a mobile health care unit operated as a primary care clinic (collectively affiliate clinics). Specifically, this bill : 1)Makes findings and declarations regarding the current system for licensing affiliate clinics and the need to streamline administrative processes through paperwork reduction and elimination of duplication in the application process. 2)Clarifies that a clinic corporation can apply to establish affiliate clinics on behalf of a primary care clinic, as specified. Defines "clinic corporation" as a nonprofit organization that operates one or more affiliate clinics. Makes other definitions, as specified. 3)Adds to the conditions already in existing law under which the Department of Public Health (DPH) is required to approve a license for an affiliate clinic without first conducting an initial onsite survey, that the clinic corporation and affiliate clinic have the same medical director or directors and medical policies, procedures, protocols, and standards. SB 442 Page 2 4)Requires the affiliate clinic licensure application to consist solely of a simple form and supporting documents relating to: the contact information of the clinic corporation and affiliate clinic's administrative officers; the affiliate clinic location and hours of operation; evidence of compliance with minimum safety standards related to the affiliate clinic's physical plant; and, other pertinent information, as specified. 5)Permits the affiliate clinic application to be signed by an officer of the clinic corporation's board of directors or the clinic corporation's chief executive officer or executive director. 6)Requires the clinic corporation, in order to reduce paperwork, eliminate errors, and streamline communications between DPH and a clinic corporation that operates one or more affiliate clinics, on behalf of all of the licensed clinics it operates, to act as the administrative headquarters for purposes of receiving from and submitting to DPH communications, as specified. 7)Requires DPH to maintain a complete corporate file containing information about each clinic corporation operating one or more affiliate clinics, and for the file to include specified information. 8)Prohibits a clinic corporation from being required to resubmit information, materials, or documents, as specified, as part of an affiliate clinic application, unless the information, materials, or documents are necessary to complete the corporate file. 9)Requires a clinic corporation to submit to DPH, on behalf of all licensed affiliate clinics operated by the clinic corporation, a single report of change that is applicable to all affiliate 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. 10)Permits a clinic corporation to submit to DPH, on behalf of all licensed affiliate clinics operated by the clinic corporation that are within the same license renewal month, a SB 442 Page 3 single payment for all affiliate clinic licensure. 11)Makes other technical and clarifying changes. EXISTING LAW : 1)Defines a primary clinic as an outpatient health facility, operated by a nonprofit corporation, which provides direct medical, surgical, dental, optometric, or podiatric advice, services, or treatment to patients who remain less than 24 hours. Requires that primary care clinics be licensed by DPH and approved for operation by DPH prior to obtaining a Medi-Cal provider number or providing services. 2)Requires DPH to issue a provisional license, upon approval of a primary clinic's initial licensure application, which is good for six months from the date of issuance. DPH is then required to conduct an on-site survey of the clinic within 30 days prior to the expiration of the provisional license and, if the clinic meets all licensure requirements, issue a regular license. 3)Permits a primary care clinic that has held a valid and unsuspended license for at least the preceding five years, with no history of repeated or uncorrected violations of law or regulation that pose immediate jeopardy to a patient and has no pending suspensions or revocation actions, to apply to establish an affiliate primary care clinic (affiliate clinic) at an additional site. 4)Requires DPH to issue a regular license to an affiliate clinic within 30 days without the necessity of first conducting an on-site survey, if: a) The parent primary care clinic has submitted a completed application for licensure for the affiliate clinic; b) The parent and affiliate clinics' corporate officers are the same and the clinics are owned and operated by the same nonprofit organization; c) The parent affiliate clinic's operational policies and procedures and staff training are substantially the same; and, d) The parent clinic has submitted evidence to DPH SB 442 Page 4 establishing compliance with the minimum construction standards of adequacy and safety of the affiliate's physical plant as prescribed by the Office of Statewide Health Planning and Development (OSHPD). 5)Authorizes DPH to conduct a licensing inspection at any time after receipt of the affiliate clinic licensing application. 6)Defines a mobile health care unit, commonly referred to as a "mobile clinic," as a commercial coach that is licensed by DPH as an independent freestanding clinic, or approved by DPH as an adjunct of a licensed parent health facility or clinic, and that provides medical, diagnostic, and treatment services in order to ensure the availability of quality health care services for patients in remote or underserved areas, and patients who need specialized types of medical care. 7)Authorizes DPH to issue a special permit to a clinic approved to provide one or more specified special services, such as birthing services, for which the state has established separate standards. 8)Authorizes DPH to take various types of enforcement actions against a primary care clinic that has violated state law or regulation, including imposing fines, sanctions, civil or criminal penalties, and suspension or revocation of the clinic's license. FISCAL EFFECT : According to the Assembly Appropriations Committee analysis, minor absorbable workload to DPH to continue oversight of licensing and certification of health clinics and the requirement of this bill. COMMENTS : According to the author, primary care clinics are at the core of the state's health care safety net and primary care delivery systems. The author states that, among the top concerns for clinics in their day-to-day administration and long-term planning are difficulties associated with state licensing and certification. The author asserts that the current system for licensing and certification of clinics is outdated and inefficient, which causes providers and the state to waste scarce financial and human resources. The author states that most clinic organizations operate multiple SB 442 Page 5 clinic sites, ranging in numbers from two to 25, under the governance of a single board of directors and medical directorship, using common business practices, policies, and procedures, as well as medical oversight. The author states that despite this, under current law, each clinic site must be separately licensed, which requires clinics to often submit the same information on separate licensing applications, even when the information is identical or unchanged. The author states that this process is not only administratively burdensome and duplicative, it does not account for the role of the governing clinic organization. The author states that delays in the processing of licensing applications often inhibit clinics from providing and/or billing for much-needed services in their communities. The author states that, to avoid the state licensing process, many clinics are opting to open "intermittent clinics," which operate at or less than 20 hours per week, and do not require state licensure. Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916) 319-2097 FN: 0005764