BILL ANALYSIS                                                                                                                                                                                                    



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          SENATE THIRD READING
          SB 442 (Ducheny)
          As Amended August 2, 2010
          Majority vote 

           SENATE VOTE  :35-0  
           
           HEALTH              19-0        APPROPRIATIONS      17-0        
           
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          |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.








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          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  








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            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  








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               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  








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          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