BILL ANALYSIS
AB 1544
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CONCURRENCE IN SENATE AMENDMENTS
AB 1544 (Jones and Fletcher)
As Amended September 4, 2009
Majority vote
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|ASSEMBLY: |79-0 |(June 1, 2009) |SENATE: |38-0 |(September 9, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Establishes timeframes and procedures for the
Department of Public Health (DPH) to act on applications by
general acute care (GAC) hospitals to add a new, or modify an
existing, outpatient clinic service (OPCS) as a supplemental
service. Specifies that an onsite inspection is not required
prior to approving the application.
The Senate amendments :
1)Change the author from the Health Committee to Assembly
Members Jones and Fletcher, with the remaining committee
members as co-authors.
2)Narrow the bill to apply only to GAC hospitals by removing
acute psychiatric and special hospitals as eligible entities.
3)Delete requirements that an applicant hospital hold a valid,
unrevoked or unsuspended license in the five years prior to
application; not have repeated or uncorrected state licensing
or federal certification violations that pose immediate
jeopardy to a patient; and, not have any pending actions
against it to suspend or revoke its license or terminate
Medicare or Medi-Cal certification.
4)Apply the 30-day deadline for DPH to act on a completed
application to only applications from hospitals previously
approved for an OPCS, and require DPH to approve or deny
applications from first-time applicants within 100 days of a
complete application being filed.
5)Require DPH to deny an application for specified reasons,
including applicant failure to provide additional information
within 30 days of DPH's request.
AB 1544
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6)Delete a list of specified services that may not be provided
under the OPCS, and instead limit the OPCS to non-emergency
primary health care services in a clinical environment.
7)Define "outpatient clinic services" to mean the same as
services provided by a primary care clinic, but specify that
supplemental outpatient services established by a GAC hospital
shall not be considered primary care clinics for licensing,
regulatory, or enforcement purposes.
8)Make minor and technical amendments.
EXISTING LAW :
1)Requires the licensure of health facilities, including GAC
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.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, one-time costs to DPH of $70,000 in fiscal year (FY)
2009-10 and $120,000 in FY 2010-11, funded by the DPH Licensing
and Certification Program Fund, to promulgate regulations
related to this bill. Ongoing costs would be absorbable since
hospitals may currently add supplemental services at any time.
COMMENTS : According to the author, this bill 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 author, will speed the
opening of new primary care clinics, reduce the workload of DPH,
and avoid unnecessary costs to hospitals by facilitating
transfers between primary, emergency, and acute care.
AB 1544
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Primary care clinics faced a similar problem of long delays in
obtaining DPH approval of new or ancillary operations. This led
to enactment of measures in 2003 [SB 937 (Ducheny), Chapter 602,
Statutes of 2003] and again in 2008 [AB 2010 (DeSaulnier),
Chapter 90, Statutes of 2008] to streamline 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 (CHA) 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.
Recent Senate amendments reflect a compromise reached between
the author, CHA, and DPH, and remove DPH opposition.
Analysis Prepared by : Joyce Iseri / HEALTH / (916) 319-2097
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