BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 442|
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THIRD READING
Bill No: SB 442
Author: Ducheny (D), et al
Amended: 1/26/10
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 4/22/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 9-0, 1/21/10
AYES: Kehoe, Cox, Corbett, Denham, Leno, Liu, Price,
Walters, Yee
SUBJECT : Clinic corporation: licensing
SOURCE : California Family Health Council
California Primary Care Association
Planned Parenthood Affiliates of California
DIGEST : This bill requires the Department of Public
Health 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.
ANALYSIS :
Existing law:
1. Provides for the licensing and regulation of health
CONTINUED
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clinics, including community and free clinics, by the
Department of Public Health (DPH).
2. Provides for a fee to be paid for an initial and annual
renewal license, as specified. Estimated fees are
published every February 1 by DPH.
3. 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.
4. Provides that the DPH 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:
1. Requires DPH's centralized application unit to issue a
single consolidated license to a clinic corporation upon
submission of a complete application, as specified.
2. Requires 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.
3. Requires 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
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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.
4. Requires 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 requires that it
would identify the reasons in writing.
5. Provides 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.
6. Requires 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
will do so within 30 days of receipt of the form.
7. Specifies that a licensed clinic corporation could add
or relocate a clinic or mobile health care unit to its
single consolidated license without the DPH first
conducting an initial onsite survey.
8. Requires the DPH 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 requires the DPH to
assess a civil penalty at no more than $50 per day of
noncompliance and permits the DPH to take action against
the licensee.
9. Provides that, in the case of a deficient clinic, a
clinic corporation could voluntarily remove that clinic
from its consolidated license.
10.Provides that any clinic or mobile health care unit that
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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.
11.Provides that a clinic or mobile health care unit
included on a single consolidated license will 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.
12.Permits DPH 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
DPH or the Board of Pharmacy would be against the
individual clinic or mobile health care unit, not
against the clinic corporation.
13.Requires the DPH, commencing February 1, 2011, and every
February thereafter, to publish the estimated fee for a
single consolidated license. The licensing fees will be
based on DPH workload and will offset program costs.
Comments
According to the Senate Appropriations Committee analysis:
"CDPH [California Department of Public Health] 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
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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."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
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DPH administration up to $800 up to $1,300up to
$1,200 Special*
Initial clinic licensing/ unknown, but likely to
provide sufficient Special*
annual renewal fee revenue funds to cover ongoing
program costs
* DPH Licensing and Certification Program Fund
SUPPORT : (Verified 1/25/10)
California Family Health Council (co-source)
California Primary Care Association (co-source)
Planned Parenthood Affiliates of California (co-source)
Alliance Medical Center
Alliance for Rural Community Health
Alta Med Health Services
Anderson Valley Health Center
Central Valley Health Network
Chinatown Service Center
Clinicas del Camino Real, Incorporated
Clinica de Salud del Valle de Salinas
Clinica Sierra Vista
Community Clinic Association of Los Angeles County
East Community Health Center, Inc.
Eisner Pediatric and Family Medical Center
Family HealthCare Network
Family Health Centers of San Diego
Imperial Beach Health Center
LifeLong Medical Care
Long Valley Health Center
MayView Community Health Center
Mendocino Coast Clinics, Inc.
Mendocino Community Health Clinics, Inc.
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
Open Door Community Health Centers
Petaluma Health Center
Planned Parenthood Mar Monte
Planned Parenthood of San Diego and Riverside Counties
Planned Parenthood of Santa Barbara, Ventura and San Luis
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Obispo
Planned Parenthood: Shasta-Diablo
Potter Valley Community Health Center
Redwood Coast Medical Services
Saban Free Clinic
Salud Para La Gente
Shasta Community Health Center
Shasta Consortium of Community Health Centers
Shingletown Medical Center
Six Rivers Planned Parenthood
Southern Trinity Health Services
UMMA Community Clinic
Venice Family Clinic
West County Health Centers, Inc.
ARGUMENTS IN SUPPORT : The California Primary Care
Association (CPCA) states that this bill eliminates
unnecessary administrative barriers to increasing access to
care by allowing primary care clinics to operate multiple
sites under one consolidated license. CPCA states that
moving to a consolidated licensure will streamline the
licensing process, reduce duplication, and promote
administrative efficiency, and thereby maximize the ability
of safety net providers to meet the growing health care
needs of individuals and families in their communities.
Planned Parenthood Affiliates of California (PPAC) states
that each time a clinic corporation applies for a new
clinic, numerous documents must be submitted to DPH, many
of which are duplications of paperwork already filed with
the department. PPAC states that significant time and
money is expended on these cumbersome licensing activities
that take away from the critical services clinic staff
should be providing. PPAC states that this bill
streamlines and modernizes the current overly burdensome
processes and eliminate duplication.
CTW:mw 1/26/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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