BILL ANALYSIS
SB 442
Page 1
SENATE THIRD READING
SB 442 (Ducheny)
As Amended August 12, 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.
4)Requires the affiliate clinic licensure application to consist
SB 442
Page 2
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)Requires 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 single payment
for all affiliate clinic licensure.
11)Makes other technical and clarifying changes.
SB 442
Page 3
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
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.
5)Authorizes DPH to conduct a licensing inspection at any time
SB 442
Page 4
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, this bill will result in 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
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
SB 442
Page 5
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: 0005849