BILL ANALYSIS Ó
AB 1177
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1177
(Gomez) - As Introduced February 27, 2015
SUBJECT: Primary care clinics: written transfer agreements
SUMMARY: Requires the Department of Public Health (DPH) to
repeal the regulation requiring primary care clinics to enter
into a written transfer agreement with a nearby hospital as a
condition of licensure, no later than July 1, 2016.
EXISTING STATE LAW:
1)Licenses and regulates clinics, including primary care clinics
and specialty clinics, such as surgical clinics, by DPH.
2)Defines a primary care clinic as a clinic operated by a
tax-exempt nonprofit corporation that is supported and
maintained in whole or in part by donations, bequests, gifts,
grants, and government funds or contributions. In a community
clinic, any charges to the patient must be based on the
patient's ability to pay, utilizing a sliding fee scale.
3)Permits DPH to issue a permit to authorize a clinic to offer
one or more special services, which is a type of care for
which DPH has established special standards for ensuring the
quality of care, including birth services and abortion
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services.
4)Provides for exemptions from licensing requirements for
certain types of clinics, including federally operated
clinics, local government primary care clinics, clinics
affiliated with an institution of higher learning, clinics
conducted as outpatient departments of hospitals, and
community or free clinics.
5)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.
EXISTING STATE REGULATIONS: Require primary care clinics, as a
condition of licensure, to have a written transfer agreement
with a nearby hospital. Allows all licensed clinics, except for
those providing abortion services or birthing services, to
request that DPH waive the requirement to maintain a written
transfer agreement, if the clinic can show that no hospital
would agree to enter into a transfer agreement.
EXISTING FEDERAL LAW: The Emergency Medical Treatment and
Active Labor Act, (EMTALA) is an act of the United States
Congress, passed in 1986 as part of the Consolidated Omnibus
Budget Reconciliation Act. It requires hospitals that accept
payments from Medicare to provide emergency health care
treatment to anyone needing it regardless of citizenship, legal
status, or ability to pay. There are no reimbursement
provisions. Participating hospitals may not transfer or
discharge patients needing emergency treatment except with the
informed consent or stabilization of the patient or when their
condition requires transfer to a hospital better equipped to
administer the treatment. EMTALA applies to "participating
hospitals." The statute defines participating hospitals as
those that accept payment from the Department of Health and
Human Services, Centers for Medicare and Medicaid Services under
the Medicare program. Because there are very few hospitals that
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do not accept Medicare, the law applies to nearly all hospitals.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, under current
California law, clinics are obliged to obtain a hospital
transfer agreement (HTA) from a nearby hospital as a condition
of licensure in order to begin performing services. DPH
regulations allow clinics who cannot get an HTA from a nearby
hospital to apply for a waiver to this requirement. However,
clinics that provide abortions or birthing services are not
allowed to apply for a waiver, even if a local hospital won't
agree to enter into an HTA. The author states that this
effectively allows a hospital that does not want to enter into
an HTA to prevent an abortion clinic from opening. The author
notes that if this bill is enacted, this regulation will be
repealed and unenforceable, and will give Californians equal
access to reproductive services and the ability to choose.
2)BACKGROUND. As required by Title 22, Division 5, Chapter 7,
Article 6 of the California Code of regulations, primary care
clinics must have an HTA with a local hospital as a condition
of licensure. Should a patient undergoing a procedure at a
clinic require transport to the hospital, an HTA facilitates
the timely transfer of the patient between the hospital and
the facility. The agreements delineate the responsibilities
of both the clinic and the hospital, including the required
sharing of vital information such as the current medical
findings regarding the patient, diagnoses, transfer of medical
records, and the patients' personal effects.
When a patient goes to the emergency department it is critical
for emergency physicians to understand the condition and what
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treatment the patient has received which has led them to be
brought into the emergency department. It is also very
helpful when the physician from the clinic speaks to the
emergency physician as many times notations in medical records
are not clear. This can all be built into an HTA.
3)SUPPORT. Planned Parenthood Affiliates of California (PPAC)
are the sponsors of this bill and they state by requiring
hospital transfer agreements as a condition of licensure, DPH
has essentially delegated some of its licensure authority to
the hospitals, because any hospital corporation with either a
moral objection or desire to secure a competitive edge can
refuse to sign a transfer agreement and bring a clinic's
license application to a halt. PPAC notes they believe the
decision of whether to grant a clinic a license should rest
exclusively with the state. PPAC also notes the existing
transfer agreement requirement acts as a targeted restriction
on abortion providers, or TRAP law, because only abortion
clinics and birthing centers are ineligible to receive a
waiver from the requirement, even in the event that they are
unable to secure a transfer agreement.
The California Primary Care Association is also in support of
this bill, noting, some of their members have found it
difficult to secure these agreements, and patient safety is
already protected by standards of care.
4)OPPOSITION. The California Chapter of the American College of
Emergency Physicians is opposed to this bill unless it is
amended to make all clinics equal by allowing community
clinics providing birthing or abortion services to apply for
an exemption.
The California Right to Life Committee, Inc. (CRCL), is
opposed to this bill because it would remove the necessity of
having a written transfer agreement with one or more nearby
hospital when a primary care clinic seeks licensure. CRLC
believes this would be a very serious regulation change and
would threaten the physical safety of patients at these
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primary care clinics. It would seem to be a logical
requirement for any facility performing surgery or any
treatment with potential medical complications.
5)RELATED LEGISLATION. AB 941 (Wood) expands the exemption from
licensure by DPH to certain clinics operated by a federally
recognized tribe or tribal organization.
6)PREVIOUS LEGISLATION. AB 980 (Pan), Chapter 663, Statutes of
2013, required the California Building Standards Commission to
adopt emergency regulations to delete a provision of the 2013
California Building Standards Code that establishes building
standards for primary care clinics that provide abortion
services, and prohibited the Commission from adopting any
building code standards for clinics providing medication or
aspiration abortion services that differ from construction
standards applicable to other primary care clinics.
REGISTERED SUPPORT / OPPOSITION:
Support
Planned Parenthood Affiliates of California
California Family Health Council
California Primary Care Association
Planned Parenthood of Los Angeles County
Planned Parenthood of the Pacific Southwest
Planned Parenthood of Santa Barbara, Ventura, & San Luis Obispo
Counties
Planned Parenthood of Orange and San Bernardino Counties
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Opposition
California Chapter of the American College of Emergency
Physicians (unless amended)
California Right to Life Committee, Inc.
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097