BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2053|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2053
Author: Gonzalez (D) and Gray (D), et al.
Amended: 8/18/16 in Senate
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.
Senate Floor Amendments of 8/18/16 require primary care clinics
adding an additional physical plant to pay a license fee for
each physical plant added, and limit the addition of physical
plants to only those within one-half of a mile of the licensed
primary care clinic, rather than those within 15 miles, among
other changes that are more clarifying and technical in nature.
AB 2053
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ANALYSIS:
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
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.
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Page 3
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 amend a primary care clinic's license to
include a new physical plant as part of a single consolidated
license, within 30 days of receiving written notification and
certain specified information submitted by the primary care
clinic, and upon receiving payment of a licensing fee for each
additional physical plant added.
2)Limits the ability of a primary care clinic or affiliate
clinic to add additional physical plants pursuant to this bill
to only those that are no more than one-half mile from the
licensed clinic adding the additional physical plant.
3)Requires the written notification to include evidence that the
primary care clinic is licensed in good standing and otherwise
meets the criteria for licensure.
4)Requires the written notification to demonstrate compliance
with having a single governing body, a single administration,
and a single medical director, for all the facilities under
the consolidated license.
5)Requires the new physical plant to meet minimum construction
standards for adequacy and safety, pursuant to the OSHPD 3
requirements, as specified, and to meet fire clearance
standards.
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6)Requires the written notification submitted by the primary
care clinic wishing to add a new physical plant to include
specified documentation, including the hours of operation and
services provided by the new physical plant, and a copy of any
document confirming the corporation's authority to control the
new physical plant.
7)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.
8)Requires a license renewal for a consolidated license to
include a licensing fee for each physical plant approved on
the primary care clinic license.
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
not tracked the number of intermittent clinics. There are no
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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, 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
AB 2053
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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
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
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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: (Verified8/19/16)
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
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
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OPPOSITION: (Verified8/19/16)
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
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,
AB 2053
Page 9
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
8/19/16 18:49:15
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