BILL ANALYSIS Ó
AB 941
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
941 (Wood)
As Amended August 26, 2015
Majority vote
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|ASSEMBLY: | 77-0 | (May 11, |SENATE: |38-0 | (August 31, |
| | |2015) | | |2015) |
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Original Committee Reference: HEALTH
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.
The Senate amendments clarify that clinics operated by a tribe
or tribal organization may apply for a license from DPH should
they choose to do so, and incorporate additional changes to
Health and Safety Code Section 1206 proposed by AB 1130 that
would become operative if this bill and AB 1130 are chaptered
and this bill is chaptered last.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
AB 941
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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 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
AB 941
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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
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.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0001851