BILL ANALYSIS
AB 1544
Page 1
ASSEMBLY THIRD READING
AB 1544 (Committee on Health)
As Introduced March 4, 2009
Majority vote
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De La Torre, De | |Charles Calderon, Davis, |
| |Leon, Emmerson, Hall, | |Duvall, Fuentes, Hall, |
| |Hayashi, Hernandez, | |Harkey, Miller, |
| |Bonnie Lowenthal, Nava, | |John A. Perez, Price, |
| |V. Manuel Perez, Salas, | |Skinner, Solorio, Audra |
| | Audra | |Strickland, Torlakson, |
| |Strickland | |Krekorian |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Permits a hospital in good standing to operate an
outpatient clinic without a prior onsite survey and requires the
Department of Public Health (DPH) to approve a specified license
within 30 days of receipt. Specifically, this bill :
1)Authorizes a hospital that meets specified criteria to
establish an outpatient clinic without the necessity of DPH
first conducting an initial onsite survey. In order to submit
an application a hospital must meet both of the following:
a) Hold a valid license for a minimum of five years without
repeated or uncorrected violations; have no pending actions
for suspension or revocation of Medicare or Medi-Cal
certification; and, meet all applicable federal and state
certifications; and,
b) Own and operate the outpatient service that is the
subject of the application.
2)Requires the outpatient service that is the subject of the
application to provide primary care to patients who remain in
the clinic less than 24 hours.
3)Specifies that outpatient services may not include chronic
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dialysis treatment, outpatient surgeries, or alternative
birthing services.
4)Specifies the information to be included in the DPH
application.
5)Requires DPH to approve an application to add or modify an
outpatient service as a supplemental service, add it to the
hospital license, and issue a new license within 30 days, if
the hospital meets the specified requirements.
EXISTING LAW :
1)Requires the licensure of health facilities, including general
acute care hospitals, acute psychiatric hospitals, and special
hospitals, and requires approval for specified supplemental
and outpatient services.
2)Permits primary care clinics to operate an affiliate clinic
without DPH having first conducted an onsite survey, if
certain conditions are met.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time fee-supported special fund costs of $200,000
to promulgate regulations and establish processes contained in
this bill. Ongoing fee-supported special fund costs of $50,000.
This bill increases hospitals' ability to care for patients in
a less costly environment and in a more timely way than under
current law.
COMMENTS : According to the Assembly Committee on Health
(Committee), authors of this bill, it is intended to expedite
expansion of hospital based outpatient clinics in order to
improve access to primary care and reduce the demand on
emergency departments. This bill speeds the approval process
for hospital based clinics by specifying a time frame for
application approvals and elimination of the requirement for a
DPH survey prior to initiating services in primary care clinics.
Hospitals routinely experience months long delays waiting for
DPH surveys. This bill, notes the Committee, will speed the
opening of new primary care clinics, reduce the workload of DPH,
and avoid unnecessary costs to hospitals.
Timely access to primary and preventive care is a critical
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element in reducing health care costs and improving health
access. Yet, both insured and uninsured patients now experience
delays in accessing regular and timely primary care. The health
delivery system works best when appropriate levels of care are
accessible and transfers between primary, emergency, and acute
care can be facilitated. At this point in time, additional
outpatient clinic services need to be expanded, yet the current
system of approving new hospital-based outpatient clinics is
often lengthy and slow, making it more costly and difficult for
hospitals to offer additional primary care services.
Primary care clinics faced a similar problem in recent years.
Clinics also faced long delays in obtaining DPH approval of new
or ancillary operations, and in 2003 [SB 937 (Ducheny), Chapter
602, Statutes of 2003] and again in 2008 [AB 2010, (DeSaulnier)
Chapter 90, Statutes of 2008] successfully passed measures which
streamlined the approval process by eliminating the necessity of
an onsite survey and requiring DPH application approval within
specified timeframes. This bill is very similar to the primary
care clinic statutes.
The California Hospital Association supports this bill and
reports several examples demonstrating the frustrations of
hospitals whose clinic operations were delayed by the wait for
DPH approval. In the city of Reedley, the Fresno Department of
Public Health District Office required seven months to complete
their survey. The Reedley clinic lost 2,800 patient visits
waiting for the survey. In Modesto, a new and expanded facility
building has remained empty for six months while the clinic
waits for a surveyor. Similar experiences are reported from
Fairfield, Clearlake, and Lodi hospitals.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
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