BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 2053| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 AB 2053 Page 2 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. AB 2053 Page 3 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 AB 2053 Page 4 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. AB 2053 Page 5 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 AB 2053 Page 6 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 AB 2053 Page 7 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 AB 2053 Page 8 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 **** END ****