BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1130
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|AUTHOR: |Gray |
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|VERSION: |February 27, 2015 |
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|HEARING DATE: |June 24, 2015 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Clinics: licensing: hours of operation
SUMMARY : Expands the licensure exemption for intermittent clinics that
are operated by licensed clinics on separate premises by
permitting these intermittent clinics to be open for up to 30
hours per week, instead of only 20 hours per week.
Existing law:
1)Licenses and regulates clinics, including primary care clinics
and specialty clinics, by the Department of Public Health
(DPH)
2)Defines a primary care clinic as either a "community clinic,"
which is required to be operated by a non-profit corporation
and to use a sliding fee scale to charge patients based on
their ability to pay, or a "free clinic," which is also
required to be operated by a non-profit but is not allowed to
directly charge patients for services rendered or for any
drugs, medicines, or apparatuses furnished.
3)Exempts various types of clinics from licensure and regulation
by DPH, including clinics operated by the United States or by
a federally recognized Indian tribe on tribal land.
4)Exempts from licensure by DPH an intermittent clinic that is
operated by a licensed primary care community clinic on
separate premises from the licensed clinic and is only open
for limited services of no more than 20 hours each week.
However, an intermittent clinic operated under this exemption
is still required to meet all other requirements of law,
including administrative regulations and requirements,
pertaining to fire and life safety.
AB 1130 (Gray) Page 2 of ?
This bill: Expands the licensure exemption for intermittent
clinics that are operated by licensed clinics on separate
premises by permitting these intermittent clinics to be open for
up to 30 hours per week, instead of only 20 hours per week.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill has negligible state fiscal effect.
PRIOR
VOTES :
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|Assembly Floor: |77 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS :
1)Author's statement. According to the author, the existing
limit of hours of operation for intermittent clinics of a
maximum of 20 hours was placed in statute 37 years ago, and
based on a typical 40 hour work week. Today, full time
healthcare centers are open much longer hours, (in some cases
7 days a week) and continue to adapt in order to meet the
needs of every community. Given the increase in patient
population thanks to the Medi-Cal expansion and the Affordable
Care Act, this bill simply increases the hours an intermittent
clinic may operate so that they may keep up with the demand
for service in all areas of California, but particularly in
the most underserved regions.
2)Intermittent clinics. Under existing law, a licensed primary
care clinic is permitted to operate an off-site clinic, for up
to 20 hours per week, without obtaining a separate license for
these off-site locations. While there are a little more than
1,000 licensed primary care clinics, because no license is
required for these off-site locations, DPH does not track the
number of intermittent clinics. The sponsors of this bill
estimate there are approximately 200 intermittent clinics
across the state, ranging from a small one-provider clinic
inside a homeless shelter that is open 4 hours per week, to
AB 1130 (Gray) Page 3 of ?
the larger school-based health centers that may operate up to
20 hours per week. There are no regulations specific to
intermittent clinics, and under California statute, these
clinics are only required to meet fire and life safety
requirements of law, which are established by the State Fire
Marshall. As stated by the many supporting organizations,
primary care clinics use these satellite locations to offer
services in communities that might not otherwise support a
full-time licensed clinic, such as school-based health
centers, or in rural or underserved communities.
3)Related legislation. AB 941 (Wood) expands a licensure
exemption for tribal clinics, which are currently exempted if
they are located on tribal land, by exempting tribal clinics
regardless of the location of the clinic, if the clinic is
operated under a contract with the United States pursuant to
the Indian Self-Determination and Education Assistance Act. AB
941 is currently pending in this committee.
4)Prior legislation. AB 2787 (Arambula, 2008), was identical to
this bill. AB 2787 was held on the Assembly Appropriations
Committee suspense file.
5)Support. This bill is co-sponsored by the California Primary
Care Association (CPCA) and the Central Valley Health Network
(CVHN). According to CPCA and CVHN, by increasing the number
of operating hours for intermittent clinics, community health
centers can meet the growing need for care, especially among
special populations that may not have the ability to access
care in traditional full time health centers. According to
CPCA and CVHN, many intermittent clinics are operated on
school campuses and address the unique needs of school age
children and their families. Others are operated in short and
long-term shelters designed to help people experiencing
homelessness, or are embedded in affordable housing
communities. The California School-Based Health Alliance
states in support that since the introduction of this bill,
many school-based health centers have shared that increasing
the hours they can provide health care services means greater
access to care and increased support for children and their
families. Camarena Health states in support that it is
currently partnering with the largest school district in
Madera County to begin the development of two new school based
health center sites that will deliver medical, dental,
behavioral health and health education services, and is also
AB 1130 (Gray) Page 4 of ?
partnering with a local grower to establish an on-site clinic
that would provide primary care services to agricultural
employees during their work day. WellSpace Health states in
support that just blocks away from the Capitol there is an
intermittent clinic operated in the Salvation Army shelter,
and another embedded in an affordable housing community, and
that increasing the maximum operating hours will improve a
clinic's ability to get services and resources in the most
underserved areas quickly.
6)Suggested amendment on reporting intermittent clinics.
According to the sponsors, based on a survey of their licensed
clinic members, there are approximately 200 intermittent
clinics. However, according to DPH, while some licensed
clinics do report when they open an intermittent clinic, it is
inconsistent, and they do not keep track of this information.
Committee staff has worked with the author's office and
sponsors on an amendment to require licensed clinics, as part
of their biennial license renewal, to report to DPH as to
whether they are currently operating any intermittent clinics,
the location of these clinics, and the estimated hours of
operation.
SUPPORT AND OPPOSITION :
Support: California Primary Care Association (co-sponsor)
Central Valley Health Network (co-sponsor)
Alameda Health Consortium
California Family Health Council
California School-Based Health Alliance
Camarena Health
Chinatown Service Center
Clinica Sierra Vista
Clinicas de Salud del Pueblo, Inc.
Coastal Health Alliance
Community Clinic Association of Los Angeles County
Council of Community Clinics
Dos Palos Memorial Hospital Skilled Nursing Facility
El Dorado Community Health Centers
Family HealthCare Network
Family Purpose
Golden Valley Health Centers
Harmony Health Medical Clinic and Family Resource
Center
Hill Country Community Clinic
Inland Behavioral and Health Services, Inc.
AB 1130 (Gray) Page 5 of ?
James Morehouse Project
La Maestra Community Health Centers
Livingston Community Health
Los Angeles Trust for Children's Health
People Assisting the Homeless (PATH)
Planned Parenthood Affiliates of California
Santa Rosa Community Health Centers
The Children's Partnership
United Health Centers of the San Joaquin Valley
Venice Family Clinic
Wellspace Health
West County Health Centers
Oppose: None received
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