BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                       AB 2053|
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                                   THIRD READING 


          Bill No:  AB 2053
          Author:   Gonzalez (D) and Gray (D), et al.
          Amended:  3/31/16 in Assembly
          Vote:     21 

           SENATE HEALTH COMMITTEE:  9-0, 6/22/16
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 8/1/16
           AYES:  Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

           ASSEMBLY FLOOR:  79-0, 4/21/16 (Consent) - See last page for  
            vote

           SUBJECT:   Primary care clinics


          SOURCE:    California Health + Advocates

          DIGEST:  This bill 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.


          ANALYSIS:  


          Existing law:


          1)Licenses and regulates clinics, including primary care clinics  








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            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  
            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. 







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          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.


          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  







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            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  
            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.







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          4)Author-provided example of need for consolidated license. The  
            author's office provided an example in Fortuna, California, 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  
            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.


          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  







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          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.


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes


          According to the Senate Appropriations Committee, one-time costs  
          of $110,000 to adopt regulations by DPH (Licensing and  
          Certification Fund). 


          SUPPORT:   (Verified8/2/16)


          California Health + Advocates (source)
           AltaMed Health Services Corporation 
           APLA - AIDS Project Los Angeles Health & Wellness 
           California Family Health Council 
           Capital Impact Partners 
           Community Clinic Association of Los Angeles County 
           Community Clinic Consortium of Contra Costa & Solano
           Community Health Partnership
           East Cliff Family Health Center 
           Family Healthcare Network 
           Mendocino Coast Clinics 
           North Coast Clinics Network 
           Omni Family Health 







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           Open Door Community Health Centers 
           Planned Parenthood Action Fund of Santa Barbara, Ventura, & San  
            Luis Obispo Counties
           Planned Parenthood Action Fund of the Pacific Southwest 
           Planned Parenthood Advocacy Project Los Angeles 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


          OPPOSITION:   (Verified8/2/16)


          None received


          ARGUMENTS IN SUPPORT:     This bill is sponsored by the  
          California Health + Advocates, 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. California Health + Advocates 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 California Health + Advocates, 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, California Health +  
          Advocates 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  







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          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. 


          ASSEMBLY FLOOR:  79-0, 4/21/16
          AYES:  Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,  
            Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,  
            Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,  
            Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth  
            Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,  
            Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,  
            Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,  
            Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,  
            Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,  
            O'Donnell, Olsen, Patterson, Quirk, Rodriguez, Salas,  
            Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner,  
            Waldron, Weber, Wilk, Williams, Wood, Rendon
          NO VOTE RECORDED:  Ridley-Thomas

          Prepared by:Vince Marchand / HEALTH / (916) 651-4111
          8/4/16 14:32:16


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