BILL ANALYSIS Ó
AB 941
Page 1
ASSEMBLY THIRD READING
AB
941 (Wood)
As Introduced February 26, 2015
Majority vote
----------------------------------------------------------------
|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Patterson, | |
| | | | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+---------------------+------------------|
|Appropriations |16-0 |Gomez, Bigelow, | |
| | |Bloom, Bonta, | |
| | |Calderon, Chang, | |
| | |Daly, Eggman, | |
| | |Eduardo Garcia, | |
| | |Holden, Jones, | |
AB 941
Page 2
| | |Quirk, Rendon, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
----------------------------------------------------------------
SUMMARY: Exempts clinics operated by a tribe or tribal
organization, regardless of location, from obtaining a license
from the Department of Public Health (DPH), and requires, to
qualify for the exemption, the clinic operate under a contract
with the United States pursuant to the Indian Self Determination
and Education Assistance Act.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, minor annual revenue loss to DPH, to the extent tribal
clinics no longer pay approximately $700 per facility in licensing
fees. DPH oversight workload will be reduced commensurately with
any reduction in licensure fees.
COMMENTS: According to the author, the majority of California
tribal health clinics (tribal clinics) are located in rural areas
of the state and oftentimes, it is challenging to meet unmet needs
when providing healthcare services over large geographic areas.
Tribal clinics cannot always establish new clinics on Indian land,
as oftentimes, the Indian land in question is not available in an
area where many tribal clinic patients may reside. This results
in opening new tribal clinics on non-Indian land in order to
provide adequate access of care to patients. The author notes,
tribal clinics may only place new sites within the federal
statutorily defined service areas based on the population of the
tribal communities they serve. The federal, tribal, and state
standards requirements have to be met in order to create a new
tribal clinic; and these standards are comprehensive and coherent.
When abiding by the federal, tribal, and state standards, the
administrative process becomes very duplicative when applying for
a license to operate a tribal clinic on non-Indian land. The
author concludes, this bill will streamline the state clinic
licensing exemptions and exempt tribal clinics on non-Indian land
AB 941
Page 3
from DPH's state facility license.
Background. There are approximately 1,000 primary care clinics
currently licensed in California. In order to obtain a license, a
primary care clinic must submit an application and fee to DPH and
pass an initial licensure survey conducted by DPH. Clinics exempt
from state licensing do have to apply to the Department of Health
Care Services (DHCS) if they want to enroll as a Medi-Cal
provider. DHCS has a specific application process for exempt
clinics, including obtaining a certification by DPH or a specified
nonprofit entity that inspects the clinics and ensures they meet
minimum requirements.
Tribal Health Services. The Indian Health Service (IHS) oversees
health programs over portions of the state. By federal law, the
area is limited to the 38 counties with American Indian trust
lands, generally meaning a reservation or rancheria. Within the
included counties there is a service population of approximately
130,000 eligible American Indians. The IHS divides their service
area in California into smaller administrative units called
services units. These services units have responsibility for
planning, managing, and evaluating the health programs in its
jurisdiction. They are focused on a specific geographic area and
are usually centered on a single federal reservation. It is
within these services units that a tribe or consortium of tribes
can operate clinics under contract with the federal government.
Although the clinics are established to provide services to
specified American Indians they are open to all. The proportion
of non-Indians using these clinics varies dramatically. In some
smaller rural areas without many health care facilities, the
proportion of non-Indians can be quite significant accounting for
about half the patients seen. In other clinics, Indians comprise
the overwhelming majority. According to the California Rural
Indian Health Board, of the 30 existing tribal health clinics in
the state, this bill will apply to approximately five. All
IHS-funded health care is tied to American Indian and Alaska
Native user populations. In California there are eight urban
AB 941
Page 4
Indian clinics in cities. The exemption proposed by this bill
would not apply to them, and their funding and federal statutory
authority is distinct and separate from the funding and authority
for tribal health programs.
Support. The California Rural Indian Health Board, Inc., numerous
Tribes and Rancherias, and the California Pan-Ethnic Health
Network support this bill stating it will create a much needed
single standard for clinic licensure for federal Tribal Health
Programs (THP). Supporter's note, regardless of where a THP is
located, it is required to adhere to all federal IHS operating
requirements in order to maintain its status as a federal
contractor. Supporters also contend the THPs' governing bodies
have established compliance services that detect, prevent, and
appropriately respond to violations of law or company policy, and
many THPs are accredited by the Accreditation Association for
Ambulatory Health Care or the Joint Commission on Accreditation of
Health Care Organizations.
Opposition. The California Nurses Association (CNA) is opposed to
this bill because it will exclude Tribal Health Clinics from
California licensing and safety provisions outside of federally
designated tribal lands. CNA notes, without licensing, clinics
would not have to comply with state building or state professional
standards which assure minimal protections for employees working
in clinics who may or may not be tribal members. CNA concludes
the exemption proposed by this bill does not assure any state
minimum standards of care for tribal clinics operating within
California but not on tribal land.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN: 0000355
AB 941
Page 5