BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 916
AUTHOR: V. Manuel Pérez
AMENDED: June 21, 2012
HEARING DATE: June 27, 2012
CONSULTANT: Orr
SUBJECT : Health: underserved communities.
SUMMARY : Requires federally qualified health centers (FQHCs),
as described, operated by a county to file a specified report
with the Office of Statewide Health Planning and Development
(OSHPD) reflecting patient demographic data, among other
information. Establishes the Task Force on the Health Care Needs
of Farmworkers (Task Force) to develop a comprehensive agenda of
programs and public policy initiatives designed to address the
health care needs of farmworkers in California.
Existing law:
1.Establishes FQHCs, under federal law, to include all
organizations receiving grants under Section 330 of the Public
Health Service Act, and makes FQHCs eligible to qualify for
enhanced reimbursement from Medicare and Medicaid, as well as
other benefits.
2.Allows individual counties to establish systems to provide for
the health of their indigent populations, including licensing
their own county-run clinics.
3.Establishes the Licensing and Certification (L&C) Division of
the California Department of Public Health (CDPH) to license
health facilities and non-county clinics, with certain
exceptions.
4.Requires all clinics licensed by CDPH to file a verified
report with OSHPD showing specified information for the
previous calendar year. This information includes: 1) number
of patients served and descriptive information, including age,
gender, race, and ethnic background of patients; 2) number of
patient visits by type of service, including child health and
disability prevention screenings, medical and dental services,
among others; 3) total clinic operating expenses; 4) gross
patient charges by payer category; 5) deductions from revenue;
and 6) additional information as may be required by OSHPD or
Continued---
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CDPH L&C.
5.Establishes the California State Office of Rural Health
(CalSORH) within the Department of Health Care Services (DHCS)
to collaborate with public and private entities statewide, and
at the regional and national levels to increase rural access
to health care. Establishes the Seasonal Agricultural and
Migratory Workers (SAMW) Advisory Committee within DHCS to
advise DHCS on the level of resources, priorities, criteria,
and guidelines necessary to address the health of seasonal and
migratory agricultural workers.
This bill:
1.Requires FQHCs operated by a county, as described, to file a
report with OSHPD showing patient demographic and payer
information, as specified. Exempts clinics conducted, operated
or maintained as outpatient departments of hospitals, and
licensed health facilities, as defined, from this requirement.
2.Establishes the Task Force to develop a comprehensive agenda
of programs and public policy initiatives designed to address
the health care needs of farmworkers in California. Stipulates
the Task Force will only be in effect until January 1, 2014.
3.Requires that the Task Force:
a. Be composed of 11 members, with the Governor appointing
5 and the Speaker of the Assembly and the President pro
Tempore of the Senate appointing 3 members each.
b. Include farmworkers, growers, representatives of
nonprofit community health centers with established records
of serving farmworker communities, representatives of
philanthropic foundations, representatives from county
hospital-owned or affiliated clinics, and representatives
of county health organizations.
c. Issue a report to DHCS and to the Governor by December
31, 2013, which includes: 1) strategies to create new
initiatives to provide health insurance or equivalent
coverage for farmworkers who will not be covered under the
federal Affordable Care Act (ACA); 2) a plan to coordinate
county health care delivery systems to integrate FQHCs and
to target farmworkers; 3) a plan to increase the number of
culturally competent health professionals in underserved
rural areas; 4) a plan to expand access to telehealth where
these services are not locally available; 5) a plan to
coordinate providers to ensure continued health care for
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migrant farmworkers; 6) long term strategies for educating,
training, and preparing workers for other industries
including, but not limited to green technology; and 7)
viable strategies for enabling farmworkers to purchase
affordable housing.
FISCAL EFFECT : This version of the bill has not been analyzed
by a fiscal committee.
PRIOR VOTES : Not relevant.
COMMENTS :
1.Author's statement. Farmworkers provide an indispensable role
to California's economy contributing mightily to the $37
billion a year agricultural industry but continue to live well
below the poverty level and suffer from chronic medical
conditions. AB 916 focuses on insuring accountability of
federal funds to serve farmworker and other working poor
populations while creating a Task Force on the Health Care
Needs of Farmworkers (funded from non-General Fund sources) to
provide, for the first time, a strategic and comprehensive
plan to address the issues confronting farmworkers in
California. Hundreds of millions of dollars are allocated to
California counties who have federally designated community
clinics. These clinics are required to provide medical
services to farmworker communities and other targeted
populations under a program that receives 50 percent federal
funds and 50 percent state General Fund. However, there is no
accountability to the State of California for how these funds
are expended. While nonprofit clinics are required to provide
annual reports on the total funds received, patients served,
medical services provided, and charity care/bad debt, county
clinics designated by the federal government provide no such
information to the state.
2.Farmworker health. A policy brief from the Central Coast
Health Network on the status of farmworkers claims that
despite the fact that California's agricultural industry
continues to generate well over $20 billion annually ($27
billion in 2000), farmworkers continue to lag well behind the
rest of society in terms of income, health, housing,
education, and other socio-economic conditions. Farmworkers
continue to live in poverty or near poverty, suffer from
chronic health conditions at higher rates than the general
public, have little access to health insurance, and are often
undereducated and speak little English. Data from 2000 show
that 18 percent of male farmworkers had at least 2 of 3 risk
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factors for chronic disease, 81 percent of men and 76 percent
of women had unhealthy weight, men suffer from iron deficiency
anemia at a rate of 4 times greater than U.S. men. Also,
nearly 70 percent lacked any form of health insurance, 32
percent of males reported they'd never been to a doctor or
clinic in their lives, 50 percent of males and 40 percent of
females had never been to a dentist, and over two-thirds never
had an eye-care visit.
Farms present many unique health and safety hazards for
workers, including: exposure to chemicals and pesticides;
machinery, tools and equipment that can be dangerous;
hazardous areas, such as grain bins, silos and wells; and
livestock that can spread diseases or cause injuries.
Farmworkers are also likely to be exposed to extreme heat, and
many have suffered heat strokes. United Farm Workers claims
that at least 16 farmworkers have died due to heat illness
since 2005, including the widely known 2008 death of
17-year-old Maria Isabel Vasquez Jimenez.
3.State actions related to farmworker health. The SAMW Program
was developed to study the health and health services for
seasonal agricultural and migratory workers and their families
throughout the state; provide financial and technical
assistance to primary care clinics serving this target
population; and, coordinate similar programs of the federal
government and other state and voluntary agencies. The SAMW
Advisory Committee was also established to advise DHCS on
guidelines necessary to address the health of seasonal and
migratory workers. The SAMW Program awarded grants to
community-based, private, nonprofit, licensed primary health
care clinics throughout California for the provision of
comprehensive primary and preventive health care services.
During Fiscal Year 1997-2000, the SAMW Program funded 45
clinics to support or enhance the delivery of primary health
care to seasonal agricultural workers, migratory workers, and
their families. CalSORH was established in statute in 1995 to
promote a relationship between state government and local and
federal agencies, universities, private and public interest
groups, rural consumers, health care providers, foundations,
and other offices of rural health, as well as to develop
health initiatives and maximize the use of existing resources
without duplicating existing effort.
4.FQHCs. FQHCs are expected to focus on providing care to the
populations whose needs are not met by private providers such
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as uninsured or publicly insured individuals. Each FQHC
tailors its services and patient base according to the unmet
need in its community. FQHCs are strongly encouraged to
collaborate with other health care providers in the area and
to focus on filling service gaps rather than duplicating
services. FQHC funding must be used for the purpose of
increasing access to the underserved patients in the
community.
In order to become an FQHC, a clinic has to:
be located in an area designated as a Medically
Underserved Area/Population;
be or become a 501(c)3 nonprofit organization or a public
entity;
have a governing board with at least 51percent of members
being consumers;
provide comprehensive primary care including dental health
and mental health; and
serve patients without regard to their ability to pay
(using a sliding fee scale).
FQHCs can be nonprofits or county-run. Unlike nonprofit
clinics in California, county-run FQHCs are licensed by their
respective counties, and are therefore excluded from the
requirement on clinics in existing law to report data to
OSHPD.
5.Related legislation. AB 2346 (Butler) would enact various
provisions related to heat illness and outdoor places of
agricultural employment, including provisions related to civil
and criminal liability and enforcement. AB 2346 is currently
pending before the Senate Labor and Industrial Relations
Committee.
6.Support. The National Association of Social Workers,
California Chapter (NASW-CA) supports this bill, which NASW-CA
believes will address the ongoing health disparities
afflicting California farmworkers by creating an entity to
take a leadership role in identifying viable strategies for
improving their health status. NASW-CA advocates for the
implementation and improvement of programs and policies
designed to enhance human well-being and help meet the basic
needs of all people. NASW-CA states that under this bill, the
key stakeholders in California's agricultural industry would
come together to form the Task Force to develop these
partnerships to coordinate resources for new initiatives for
health services to farmworkers.
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7.Opposition. The California Right to Life Committee, Inc.
(CRLC) opposes this bill and considers it as one additional
bureaucracy dependent on federal and private dollars, not one
which would significantly increase health care services in the
long run to those farmworkers in our state. Also, CRLC claims
the formation of this Task Force will involve nonprofit
agencies as a significant aspect of providing health care.
CRLC believes this will include agencies like Planned
Parenthood, which they oppose.
8.Policy comments.
a. Duplicative reporting. FQHCs are required to report to
the U.S. Health Resources and Services Administration
(HRSA) quarterly financial status reports, annual project
reports, and submit data on patient demographics and
services provided called the Uniform Data System (UDS)
annually. The UDS requires similar demographic data as the
OSHPD report, but incompatibility between their two
electronic reporting systems would prohibit data sharing.
This means clinics captured by this bill will likely report
duplicative data to both HRSA and OSHPD.
b. SAMW Advisory Committee versus the Task Force. As
mentioned above, there is already an advisory committee
authorized in statute to address farmworker health issues,
although the level of activity of that committee is
unknown. Given that the authority to convene SAMW still
remains, the Task Force in this bill may be duplicative and
therefore unnecessary.
c. Task Force report. This bill lists several plans it
intends for the Task Force to create that are either
tangentially related to the health outcomes of farmworkers
or that could be addressed through other means. Given the
relatively short timeline that the Task Force would be
expected to develop their plans for submission to the
Governor and to DHCS, it may be more prudent to narrow the
scope of plans the Task Force is mandated to create.
Suggested amendments would be to delete (c), (f) and (g) of
Section 127646 (page 5, lines 38-39, and page 6, lines
4-8).
d. Task Force timing. Should this bill become law, it will
not be effective until January 1, 2013. However, the bill
sunsets the Task Force on January 1, 2014, leaving only one
year to secure the necessary funding to start the Task
Force, appoint members, convene, and develop the required
report. The author may wish to provide a more workable
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implementation timeline and sunset date for the Task Force.
e. Task Force composition. The bill describes the Task
Force as being composed of 11 members, with the Governor
appointing 5 members, and the Speaker of the Assembly and
the President pro Tempore of the Senate appointing 3
members each. The Task Force is to include farmworkers,
growers, representatives of nonprofit community health
centers with an established record of serving farmworker
communities, representatives of philanthropic foundations,
representatives from county hospital-owned or affiliated
clinics, and representatives of county health
organizations. The bill does not, however, specify how many
people from each of these representative groups should be
appointed to the Task Force. The author may wish to provide
further guidance on the specific appointment authority for
each appointing entity, to ensure the intended entities are
sufficiently represented on the Task Force.
f. Task Force funding. The bill calls for the Task Force to
be funded by federal or private funds, but does not specify
who will collect those funds. The author may wish to amend
the bill to create a fund in the State Treasury for this
purpose and to specify that no state funds be used to
implement these provisions.
9.Placement in statute. The current code reference for the Task
Force falls under a code section under OSHPD's jurisdiction.
Existing statutes and programs pertaining to the health of
agricultural workers fall under the jurisdiction of DHCS. The
author may wish to amend the bill to relocate this section to
either within Chapter 3 of Part 4 of Division 106 of the
Health and Safety Code, within the SAMW authorizing statute,
or to Part 5 of Division 1 within the CalSORH authorizing
statute.
10.Gut and amend. When this bill was first voted on in the
Assembly, it required the California Department of Public
Health (CDPH) to assess the grants available pursuant to the
ACA for funding opportunities related to the use of
promotores. The current version of the bill has not been heard
in either house of the Legislature.
SUPPORT AND OPPOSITION :
Support: National Association of Social Workers, California
Chapter
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Oppose: California Right to Life Committee, Inc.
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