BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2053
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|AUTHOR: |Gonzalez |
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|VERSION: |March 31, 2016 |
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|HEARING DATE: |June 15, 2016 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Primary care clinics
SUMMARY : Requires the Department of Public Health to issue a single
consolidated license to a primary care clinic that includes more
than one physical plant operated on separate premises.
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 30 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.
5)Permits a primary care clinic that has held a license for at
AB 2053 (Gonzalez) Page 2 of ?
least five years with no history of repeated or uncorrected
violations to file an affiliate clinic application to
establish a primary care clinic at an additional site or a
mobile health care unit. Requires DPH to approve the license
for the affiliate clinic, without the necessity of first
conducting an initial onsite survey, if certain conditions are
met.
6)Requires DPH to issue a single consolidated license to a
general acute care hospital that includes more than one
physical plant maintained and operated on separate premises or
that has multiple licenses for a single health facility on the
same premises if the general acute care hospital meets certain
criteria and applicable requirements of licensure.
This bill:
1)Requires DPH to issue a single consolidated license to a
primary care clinic that includes more than one physical plant
maintained and operated on separate premises, upon written
notification by the primary care clinic that includes evidence
that the primary care clinic is licensed in good standing and
otherwise meets the criteria for licensure.
2)Permits a primary care clinic that is issued a single
consolidated license to operate, at its option, under a single
National Provider Identification number or separate National
Provider Identification numbers for one or more of the
facilities subject to the single consolidated license.
3)Requires the issuance of a single consolidated license to be
based on there being a single governing body, a single
administration, and a single medical director, for all the
facilities under the consolidated license, and that the
physical plants maintained and operated under the consolidated
license are located no more than 15 miles apart.
4)Exempts a licensed primary care clinic from the requirement to
file a license application with DPH when it adds an additional
physical plant, maintained and operated on separate premises,
to an existing primary care clinic site. Requires the primary
care clinic, however, to notify DPH no less than 60 days prior
to adding an additional physical plant maintained and operated
on separate premises.
FISCAL
AB 2053 (Gonzalez) Page 3 of ?
EFFECT : According to the Assembly Appropriations Committee:
1)Any costs to DPH to issue consolidated licenses are expected
to be minor and absorbable (Licensing and Certification Fund).
2)This bill is also expected to be cost-neutral to Medi-Cal,
based on the assumption that if clinics who pursue a
consolidated license experience an associated significant
change in costs or service mix, the clinic seeks a
recalculation of their facility-specific Medi-Cal prospective
payment rate pursuant to existing law.
PRIOR
VOTES :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
1)Author's statement. According to the author, the 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. AB 2053 offers health centers a
streamlined option to consolidate multiple facilities or open
new space near an existing facility under one license. This is
a common-sense way to help health centers increase access,
which is essential to the successful implementation of
increased health coverage.
2)Intermittent clinics. Under existing law, a licensed primary
care clinic is permitted to operate an off-site clinic, for up
to 30 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 has historically
AB 2053 (Gonzalez) Page 4 of ?
not tracked the number of intermittent clinics. 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. 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)Affiliate licensing. In 2009, SB 442 (Ducheny, Chapter 502,
Statutes of 2010), was introduced with provisions similar in
concept to this bill to allow for a primary care clinic to be
issued a consolidated license to operate facilities at
separate locations. However, it was later amended to
streamline provisions related to primary care clinic affiliate
licensure. Under existing law, as amended by SB 442, a primary
care clinic that has held a license for five years with no
history of repeated or uncorrected violations can apply for an
"affiliate clinic" license to establish a primary care clinic
at an additional site. An affiliate license application does
not require an initial onsite survey, and is a more simplified
and streamlined process than applying for a new stand-alone
license. Additionally, primary care clinics operating under a
single corporation utilizing the affiliate licensing option
are entitled to consolidate certain administrative functions
such as billing and related financial functions, purchasing
functions, and offsite storage and maintenance of certain
patient and personnel records.
4)Author-provided example of need for consolidated license. The
author's office provided an example in Fortuna, CA, to
demonstrate why a consolidated license is important as opposed
to an affiliate license. In this example, two private
practices were acquired in the same shopping center as an
existing licensed primary care clinic in Fortuna. The existing
primary care clinic remodeled the facilities to meet building
requirements for a clinic and requested a consolidated license
from DPH. The request for a consolidated license was denied,
and according to the author, DPH stated that they needed to
license each facility. According to the author, having three
separate licenses for three buildings that function as one
clinic presents problems, including having to credential all
of their licensed staff with dozens of private insurance
companies, Medi-Cal and Medicare at all three locations
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instead of one. Additionally, they would have to keep track of
each medical supply and minute of staff time allocated to each
building, and if a patient needed to have services in two
different buildings, then two different bills would need to be
sent to the insurance company.
5)Related legislation. AB 1947 (Chiu), would require DPH to
publish current checklists and instructions on how to complete
an application for a new affiliate license, and how to report
changes to an existing affiliate clinic, on the DPH website.
AB 1947 is set for hearing on June 15, 2016 in this Committee.
6)Prior legislation. 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.
AB 1130 (Gray, Chapter 412, Statutes of 2015), extended 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. Additionally, AB 1130 required 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.
AB 1177 (Gomez, Chapter 704, Statutes of 2015), prohibited 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 required DPH to repeal the regulation requiring
primary care clinics to enter into transfer agreements, no
later than July 1, 2016.
SB 442 (Ducheny, Chapter 502, Statutes of 2010), streamlined the
administrative requirements for a clinic corporation to apply
for licensure for an affiliate primary care clinic.
SB 937 (Ducheny, Chapter 602, Statutes of 2003), revised
provisions relating to the licensure and operation of primary
care clinics. Permitted a primary care clinic to add a
service or remodel a site without first having to apply for a
new license from DPH. Required DPH to issue an affiliate
license to a primary care clinic to allow it to open a clinic
at an additional site, under specified conditions.
AB 2053 (Gonzalez) Page 6 of ?
7)Support. This bill is sponsored by the California Primary
Care Association (CPCA), which states that this bill is a
simple, yet effective way to help health centers expand their
ability to provide healthcare in California's most vulnerable
communities. CPCA states that that this bill does this by
providing licensed health centers the option to add an
additional facility to an existing license, so long as the new
facility is maintain and operated by the same health center.
According to CPCA, if a licensed health center wants to open
an additional facility that is located next door, around the
corner, or a few stops down the bus line, the licensed health
center is required to obtain a separate license to operate the
additional facility. Because the new facility is independently
licensed, CPCA states that it must operate independently
creating challenges related to patient satisfaction,
continuity of care, data analytics, billing, supply
management, logistics, and more. Planned Parenthood Affiliates
of California states in support that this bill will help
community health centers more easily adopt integrated care
models by allowing multiple facilities within 15 miles of each
other to operate in sync with a single consolidated license.
Numerous clinics also support this bill, many of which state
that in some limited circumstances, DPH has issued
consolidated licenses for community health centers under their
waiver authority, which has resulted in inconsistency and
confusion, and that this bill will allow for a consistent
process for health centers seeking to add facilities.
SUPPORT AND OPPOSITION :
Support: California Primary Care Association (sponsor)
AltaMed Health Services Corporation
APLA - AIDS Project Los Angeles Health & Wellness
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
Planned Parenthood Action Fund of Santa Barbara,
Ventura, & San Luis Obispo Counties
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Planned Parenthood Advocacy Project LA County
Planned Parenthood Advocates Pasadena and San Gabriel
Valley
Planned Parenthood Affiliates of California
Planned Parenthood Northern California Action Fund
Planned Parenthood of Mar Monte
Planned Parenthood Pasadena
Ravenswood Family Health Center
Redwoods Rural Health Center
Santa Cruz Community Health Centers
Oppose: None received
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