BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
442 (Ducheny)
Hearing Date: 1/21/2010 Amended: 1/12/2010
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, 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 2010-11 2011-12 2012-13 Fund
CDPH administration up to $800 up to $1,300 up to
$1,200 Special*
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: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Existing law provides for the licensing and regulation of health
clinics, including community and free clinics, by CDPH. Existing
law provides for a fee to be paid for an initial and annual
renewal license, as specified. Estimated fees are published
every February 1 by CDPH.
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 license an
affiliate clinic without the necessity of first conducting an
initial onsite survey if specified conditions are met and within
30 days of receipt of a completed application or within seven
days of approving it.
This bill would require CDPH's centralized application unit to
issue a single consolidated license to a clinic corporation upon
submission of a complete application, as specified. This bill
would require that for a clinic corporation to receive a single
consolidated license, it must have been a known entity to the
department, have been in existence for not less than five years,
and have operated at least one or more clinics or mobile health
units that hold a valid, unrevoked, and unsuspended license for
at least the preceding five years. Any clinics or mobile health
units placed on the single consolidated license at the time of
application that are not already individually licensed would be
deemed by the centralized application unit to meet the
requirements for an individually licensed clinic by virtue of
being included on the single consolidated license.
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SB 442 (Ducheny)
This bill would require that a clinic corporation meet specified
requirements pertaining to the clinics that would be included in
its consolidated license, including that the corporate officers
are the same for each clinic, the corporation's non-profit 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.
This bill would require that the centralized application unit
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. If the centralized application unit determines that an
applicant is ineligible for a single consolidated license, this
bill would require that it would identify the reasons in
writing.
This bill would provide that conducting an initial onsite survey
would not be necessary prior to licensure and that clinics
included on the single consolidated license would not be subject
to provisional licensure requirements. This bill would require
the centralized application unit to develop a one-page form to
add, relocate, or delete a clinic or mobile health unit on a
single consolidated license. It would do so within 30 days of
receipt of the form. This bill would also specify that a
licensed clinic corporation could add or relocate a clinic or
mobile health care unit to its single consolidated license
without the CDPH first conducting an initial onsite survey.
This bill would require the CDPH to notify a clinic and its
clinic corporation of any 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 provide that,
in the case of a deficient clinic, a clinic corporation could
voluntarily remove that clinic from its consolidated license.
This bill would provide that any clinic or mobile health care
unit that is included in a single consolidated license is deemed
to be licensed for the purposes of enrollment as a provider in
the Medi-Cal, Medi-Cal Presumptive Eligibility, Child Health and
Disability Prevention, Perinatal Services, and the Family
Planning, Access, Care, and Treatment programs. Such a clinic or
mobile health care unit may instead choose to separately enroll
as a provider in these programs.
This bill would provide that a clinic or mobile health care unit
included on a single consolidated license would be deemed to be
licensed as a primary care clinic for the purpose of obtaining a
pharmacy license and a clinical laboratory license or
registration.
This bill would permit CDPH to take regulatory action against
any clinic or mobile health care unit that is included on a
single consolidated license and that any action taken by the
department or the California State Board of Pharmacy would be
against the individual clinic or mobile health care unit, not
against the clinic corporation.
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SB 442 (Ducheny)
This bill would require the CDPH, commencing February 1, 2010,
and every February thereafter, to publish the estimated fee for
a single consolidated license. The licensing fees would be based
on CDPH workload and would offset program costs.
CDPH currently uses a system of 14 regional offices and a
contract with Los Angeles County and a database that tracks
licensees to oversee all of the health facilities, including
clinics that it licenses and certifies. The department would
likely need to modify the way in which it oversees clinics since
clinics and mobile health care units on a single consolidated
license would no longer be tracked by an individual license
number. Depending on the workload at a given regional office, an
additional program technician could be needed to oversee a
single consolidated license and to facilitate communication
amongst the regional office that oversees the single
consolidated license and the other regional offices that will
directly oversee each of the clinics on the license. If each of
the offices and LA County needed to hire an extra full-time
staff member, costs could be up to $600,000 in FY 2010-2011 and
$1,000,000 in FY 2011-2012 and ongoing.
This bill would state that regulations would not be necessary to
implement these provisions. However, it is likely that the CDPH
would need to promulgate regulations to implement these
provisions where the language is not explicit in its directions
to the department, clinics, mobile health care units, and clinic
corporations. If CDPH promulgates regulations, it would need
approximately $75,000 in FY 2010-2011 and $125,000 in FY
2011-2012.
This bill would require the CDPH to annually set the fee for a
single consolidated license. It is estimated that the CDPH would
require an additional Fee Development Analyst at $60,000 in FY
2009-2010 and $100,000 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 and create a system that
would accommodate the new way of tracking clinics at $60,000 in
FY 2010-2011 and $110,000 in FY 2011-2012.
In total, depending on department workload, costs for
regulations, ongoing district office administration, and
database management and clinic tracking would be up to
approximately $800,000 in FY 2010-2011 and $1,300,000 FY
2011-2012, and $1,200,000 ongoing. All costs would be offset by
initial and annual single consolidated license fees.
The proposed amendment would require CDPH to commence publishing
an estimated fee for a single consolidated license no later than
February 1, 2011, instead of the current deadline February 1,
2010.