BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
442 (Ducheny)
Hearing Date: 5/11/2009 Amended: 5/6/2009
Consultant: Katie Johnson Policy Vote: Health 11-0
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BILL SUMMARY: SB 442 would require the California Department of
Public Health (CDPH) to issue a single, consolidated license to
a clinic corporation, or an entity that operates multiple
clinics under a single governing board with a universal
administrative and operative structure.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Regulations $69 $117 $0 Special*
Fee Development $55 $96 $96 Special*
Data system modification $62 $108 $0
Special*
Additional licensure $2,063 $2,739 $2,739 Special*
survey staff
Initial clinic licensing and unknown, but likely to provide
sufficient Special*
annual renewal funds to cover ongoing program costs
fee revenue
*State Department of Public Health Licensing and Certification
Program Fund
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STAFF COMMENTS: This bill meets the criteria for referral to
the Suspense File.
Existing law provides for the licensing and regulation of health
clinics by the CDPH. Existing law provides for a fee to be paid
for an initial and renewal license, as specified.
Existing law permits a primary care clinic that has held a
valid, unrevoked, and unsuspended license for at least the
preceding five years to apply to establish another primary care
clinic at an additional site, which is referred to as an
affiliate clinic. Existing law provides that the CDPH approve an
affiliate clinic without the necessity of first conducting an
initial onsite survey if specified conditions are met.
This bill would provide for a single, consolidated license for
corporation clinics. This bill would require that clinics
included in the consolidated license meet applicable
requirements for licensure, as specified. This bill would
require that for a clinic corporation to receive a consolidated
license, it must have held a valid, unrevoked, and unsuspended
license for at least the preceding five years. This bill would
require that a clinic corporation meet specified requirements
pertaining to the clinics that would be
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SB 442 (Ducheny)
included in its consolidated license, including that the
corporate officers are the same for each clinic, the
corporation's nonprofit board of directors owns and operates the
clinics, and that there are medical directors operating under a
single set of policies and procedures for all the clinics
included in the license. It is estimated that the CDPH would
need $69,000 in FY 2009-2010 and $117,000 in FY 2010-2011 to
promulgate regulations to implement this new licensing category.
This bill would require the CDPH to annually set the fee for a
clinic corporation, defined in this bill as a nonprofit
organization that owns one or more primary care clinics and/or
one or mobile health care units that operate as primary care
clinics. It is estimated that the CDPH would require an
additional Fee Development Analyst at $55,000 in FY 2009-2010
and $96,000 ongoing to set the fee annually. Additionally, the
CDPH would need an additional information technology staff
person to modify the department's data systems to include this
new licensure category at $62,000 in FY 2009-2010 and $108,000
in FY 2010-2011.
This bill would require that the CDPH issue a consolidated
license within 30 days of the receipt of a completed application
or within seven days of the date the central application unit
approves the application, whichever is sooner. Existing law
allows the department 100 days to review and approve new clinic
applications. Preliminary analysis indicates that the CDPH would
need more survey staff to accommodate approximately 80 annual
initial surveys in this new, shorter timeframe at an estimated
cost of $2,063,000 in FY 2009-2010 and $2,739,000 ongoing.
This bill would require the CDPH, commencing February 1, 2010,
and every February thereafter, to publish the estimated fee for
a single consolidated license. This bill would require that the
estimated fee for primary care clinics and for each primary care
clinic included in a consolidated license be included in the
report and list of estimated fees that the CDPH reports to the
Legislature and posts on its Internet Web site each February 1.
Since the licensing fees would not be published until February
1, 2010, and it would be unlikely that the regulations process
would be completed, the effective date of this bill, January 1,
2010, when the CDPH would be required to issue consolidated
licenses, could be premature. Staff recommends that the bill be
amended to require the CDPH to commence issuing a single,
consolidated license no later than January 1, 2011.
This bill would provide that a clinic corporation with a
consolidated license may, at any time during the license period,
add or remove a clinic. This bill would require the department
to develop a single-page application form for the addition or
removal of a clinic, as specified. For every clinic added, this
bill would require that the clinic corporation pay a license fee
equivalent to the fee for one primary care clinic included in a
consolidated license. The proposed licensing fee for FY
2009-2010 for a community clinic is $600. Staff recommends that
the bill be amended to require the CDPH to set the clinic
corporation licensing and renewal fees and the fee per clinic
included in a consolidated license at an amount sufficient to
cover the annual costs of the program related to this licensure
category.
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SB 442 (Ducheny)
This bill would require the CDPH to notify a clinic corporation
of all deficiencies in its compliance with the provisions
relating to its licensure and regulation that are discovered or
confirmed by inspection and to work with the clinic on a plan of
correction. If the issue remains unresolved at the conclusion of
the plan of correction timeline, this bill would require the
CDPH to assess a civil penalty at no more than $50 per day of
noncompliance and would permit the department to take action
against the licensee.
This bill would prohibit the department from revoking or
suspending a single, consolidated license unless all clinics on
a license were found to be deficient. This bill would provide
that, in the case of a deficient clinic, a clinic corporation
could voluntarily remove that clinic from its consolidated
license.