BILL ANALYSIS Ó
AB 2053
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Date of Hearing: March 29, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2053
(Gonzalez) - As Introduced February 17, 2016
SUBJECT: Primary care clinics.
SUMMARY: Requires the Department of Public Health (DPH), upon
written notification by a licensed primary care clinic (PCC)
that it is adding an additional physical plant maintained and
operated on separate premises, to issue a single consolidated
license to the PCC. Specifically, this bill:
1)Requires DPH, upon written notification by a PCC, to issue a
single consolidated license that includes more than one
physical plant maintained and operated on separate premises.
2)Requires the written notification to be provided no less than
60 days prior to adding the additional physical plant, and to
include evidence that the PCC is licensed in good standing and
meets all necessary requirements.
3)Requires DPH, when issuing the license to specify the location
of each physical plant.
4)Allows a PCC that is issued a consolidated license to operate
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under a single National Provider Identification (NPI) number,
or separate NPI's for one or more of the facilities subject to
the consolidated license.
5)Requires the issuance of a consolidated license to be based on
all of the following criteria:
a) There is a single governing body for all the facilities
maintained and operated by the licensee;
b) There is a single administration for all the facilities
maintained and operated by the licensee;
c) There is a single medical director for all the
facilities maintained and operated by the licensee, with a
single set of bylaws, rules, and regulations; and,
d) Separate physical plants maintained and operated by the
licensee covered by a single consolidated license are
located not more than 15 miles apart.
6)Exempts from existing application requirements a PCC that
modifies or adds a physical plant maintained and operated on
separate premises.
7)Applies existing notification and building permit requirements
to a PCC that modifies or adds an additional physical plant.
EXISTING LAW:
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1)Licenses and regulates clinics, including primary care clinics
and specialty clinics, by DPH.
2)Requires a person, firm, association, partnership, or
corporation desiring a license for a clinic or a special
permit for special services, to file an application with DPH
on forms furnished by DPH which contain, among other things:
a) Evidence satisfactory to DPH that the applicant is of
reputable and responsible character, and has the ability to
comply with rules and regulations promulgated by DPH;
b) The class of clinic to be operated, the character and
scope of advice and treatment to be provided, and a
complete description of the building, its location,
facilities, equipment, apparatus, and appliances to be
furnished and used in the operation of the clinic;
c) The name and address of the professional licentiate
responsible for the professional activities of the clinic
and the licentiate's license number and professional
experience; and,
d) The initial license fee to be charged and any other
information DPH deems necessary, including, but not limited
to, evidence that the clinic has a written policy relating
to the dissemination of information to patients regarding
current laws requiring child passenger restraint systems.
3)Specifies that no application is required where a PCC adds a
service that is not a special service, or remodels an existing
PCC site. Requires a clinic to notify DPH in writing of a
change in service or physical plant no less than 60 days prior
to adding the service or remodeling an existing PCC site.
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4)Requires, when city, county or state law obligates a PCC to
obtain a building permit with respect to remodeling or
modification of a PCC, that the PCC must provide DPH a signed
certificate or statement from a licensed architect or a
written statement from a local building department that the
applicable construction, remodeling, alteration, or
modification of the physical plant is in compliance with
required standards.
5)Specifies that nothing in existing law limits DPH's authority
to conduct an inspection at any time in order to ensure
compliance with, or to prevent a violation of PCC licensing
requirements.
6)Requires all clinics to maintain compliance with licensing
provisions, and also specifies that licensing requirements
must not prohibit the use of alternate concepts, methods,
procedures, techniques, space, equipment, personnel
qualifications, or the conducting of pilot projects, provided
these exceptions are carried out with provision for safe and
adequate patient care and with prior written approval from
DPH.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
1)PURPOSE OF THIS BILL. According to the author, the Patient
Protection and Affordable Care Act and California's expansion
of Medi-Cal provide a great opportunity for health coverage,
but more work must be done to ensure access for communities of
color and the working poor throughout our state. The author
states this bill offers health centers a streamlined option to
consolidate multiple facilities, or open new space near an
existing facility, under one license. The author concludes,
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this is a commonsense way to help health centers increase
access, which is essential to the successful implementation of
increased health coverage.
2)BACKGROUND.
a) Community clinics. Community clinics and health centers
are nonprofit, tax-exempt clinics that are licensed as
community or free clinics, and provide services to patients
on a sliding fee scale basis or, in the case of free
clinics, at no charge to the patients. These include
federally designated community health centers, migrant
health centers, rural health centers, and frontier health
centers. California is home to nearly 1,000 community
clinics serving more than 5.6 million patients (or one in
seven Californians) annually through over 17 million
patient encounters. More than 50% of these patients are
Hispanic and 43% speak a primary language other than
English.
b) Clinic licensing requirements. Clinic licensing
requirements vary widely in California depending on the
type of clinic and contain many exceptions. Examples of
some of the types of clinics exempt from licensure by DPH
include:
i) Any establishment that is owned and operated as a
clinic by one or more licensed health care practitioners
and used as an office for the practice of their
profession, with the exception of surgical clinics and
specialty clinics;
ii) Clinics operated as outpatient departments of
hospitals;
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iii) A clinic operated by, or affiliated with, any
institution of learning that teaches a recognized healing
art and is approved by the state board or commission
vested with responsibility for regulation of the practice
of that healing art;
iv) An intermittent clinic that is open for no more than
20 hours per week, and that is operated by a licensed
primary care clinic; and,
v) Student health centers operated by public
institutions of higher education.
Clinics exempt from licensure must comply with all local
building and fire safety standards.
c) DPH program flexibility. The DPH Licensing and
Certification Program (L&C) has no authority to waive laws
and regulations, regardless of whether or not they are
outdated or obsolete as a result of changes in technology,
or procedures. However, in order to serve patients in
health care facilities, L&C has a statutorily authorized
concept called Program Flexibility, which recognizes that
regulations cannot keep pace with modern technology and
that often new alternatives, approaches, and techniques
which meet the intent of the regulation is preferable to
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strict compliance. Program flexibility allows DPH to
provide an exception to regulation upon request and
supportive documentation.
d) Waivers granted and denied. The proponents of this bill
have provided Committee staff with three examples of
instances where DPH has approved clinics' requests for
waivers similar to what would be allowed under this bill.
For example, in 2008 Shasta Community Health Center in
Redding was granted a waiver and allowed to operate in
additional space across the street under one consolidated
license. However, in 2015, Open Door clinic in Fortuna was
denied a consolidated license for facilities that are
housed in the same shopping center. The clinic was told
that it could not have one license cover three separate
buildings, and DPH did not suggest they apply for Program
Flexibility.
It appears that there is no statewide policy on how to
approach requests for Program Flexibility with regard to
licensing clinics. In some regions, local DPH offices are
allowing consolidated licenses with buildings on separate
sites, and others are not. According to DPH, Program
Flexibility requests are unique and considered on a
case-by-case basis by each District Office.
3)SUPPORT. The California Primary Care Association (CPCA) is
the sponsor of this bill, and writes that, today, if a
licensed health center wants to expand the services it
provides and decides to open an additional facility that is
located next door, around the corner, or a few stops down the
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bus line, it is required to obtain a separate license to
operate the additional facility. CPCA notes because the new
facility is independently licensed, it must operate
independently, creating challenges related to patient
satisfaction, continuity of care, data analytics, billing,
supply management, logistics, and more. CPCA states this bill
will provide surety and guidance to DPH and its field offices
by allowing for a streamlined and consistent process for both
DPH and health centers to add facilities under the provisions
of this bill.
Planned Parenthood Affiliates of California supports this bill
stating it will help community health centers expand primary
care services and more easily adopt integrated care models by
allowing multiple facilities to operate on a single
consolidated license.
4)RELATED LEGISLATION. AB 1947 (Chiu) requires the centralized
application unit of L&C to publish current checklists and
instructions on how to complete an application for a new
affiliate clinic license, and how to report changes to an
existing affiliate clinic, on the DPH Website. AB 1947 is set
to be heard in this Committee on March 29, 2016.
5)PREVIOUS LEGISLATION.
a) AB 941 (Wood), Chapter 502, Statutes of 2015, expands
the exemption from DPH licensure to certain clinics
operated by a federally recognized tribe or tribal
organization.
b) AB 1130 (Gray) Chapter 412, Statutes of 2015, extends
the limit on the hours of operation for an intermittent
primary care community or free clinic, from 20 hours a week
to 30 hours a week; requires licensed clinics, as part of
their biennial license renewal, to report to DPH as to
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whether they are currently operating any intermittent
clinics, the location of these clinics, and the estimated
hours of operation.
c) AB 1177 (Gomez), Chapter 704, Statutes of 2015,
prohibits a primary care clinic, notwithstanding current
regulations or any other law, from being required to enter
into a written transfer agreement with a nearby hospital as
a condition of licensure, and requires DPH to repeal the
regulation requiring primary care clinics to enter into
transfer agreements, no later than July 1, 2016.
d) SB 937 (Ducheny), Chapter 602, Statutes of 2003, revises
provisions relating to the licensure and operation of
primary care clinics. Permits a primary care clinic to add
a service or remodel a site without first having to apply
for a new license from DPH. Authorizes a primary care
clinic with more than one site to consolidate certain
administrative functions. Requires DPH to issue a license
to a primary care clinic to allow it to open a clinic at an
additional site, under specified conditions.
6)TECHNICAL AMENDMENT. In order to correct a drafting error,
the bill should be amended as follows:
On page 4, line 26, strike "or that has multiple licenses
for a single health facility on the same premises"
REGISTERED SUPPORT / OPPOSITION:
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Support
AIDS Project Los Angeles Health & Wellness
AltaMed Health Services Corporation
California Primary Care Association (CPCA)
Capital Impact Partners
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Family Healthcare Network
Mendocino Coast Clinics
North Coast Clinics Network
Omni Family Health
Open Door Community Health Centers
Planned Parenthood Action Fund of the Pacific Southwest
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Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Northern California Action Fund
Planned Parenthood of Mar Monte
Ravenswood Family Health Center
Redwoods Rural Health Center
Santa Cruz Community Health Centers
Opposition
None on file.
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Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097