BILL ANALYSIS                                                                                                                                                                                                    Ó






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                                   THIRD READING 


          Bill No:  AB 1130
          Author:   Gray (D), et al.
          Amended:  6/29/15 in Senate
          Vote:     21  

           SENATE HEALTH COMMITTEE:  8-0, 6/24/15
           AYES:  Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan,  
            Roth, Wolk
           NO VOTE RECORDED:  Hall

           SENATE APPROPRIATIONS COMMITTEE:  Senate Rule 28.8

           ASSEMBLY FLOOR:  77-0, 4/30/15 (Consent) - See last page for  
            vote

           SUBJECT:   Clinics: licensing: hours of operation


           SOURCE:    California Primary Care Association 
                                Central Valley Health Network

          DIGEST:   This bill expands the licensure exemption for  
          intermittent clinics that are operated by licensed clinics on  
          separate premises by permitting these intermittent clinics to be  
          open for up to 30 hours per week, instead of only 20 hours per  
          week.

          ANALYSIS: 
          
          Existing law:

          1)Licenses and regulates clinics, including primary care clinics  
            and specialty clinics, by the Department of Public Health  








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            (DPH).

          2)Defines a primary care clinic as either a "community clinic,"  
            which is required to be operated by a non-profit corporation  
            and to use a sliding fee scale to charge patients based on  
            their ability to pay, or a "free clinic," which is also  
            required to be operated by a non-profit but is not allowed to  
            directly charge patients for services rendered or for any  
            drugs, medicines, or apparatuses furnished.

          3)Exempts various types of clinics from licensure and regulation  
            by DPH, including clinics operated by the United States or by  
            a federally recognized Indian tribe on tribal land.

          4)Exempts from licensure by DPH an intermittent clinic that is  
            operated by a licensed primary care community clinic on  
            separate premises from the licensed clinic and is only open  
            for limited services of no more than 20 hours each week.  
            However, an intermittent clinic operated under this exemption  
            is still required to meet all other requirements of law,  
            including administrative regulations and requirements,  
            pertaining to fire and life safety.

          This bill: 

          1)Expands the licensure exemption for intermittent clinics that  
            are operated by licensed clinics on separate premises by  
            permitting these intermittent clinics to be open for up to 30  
            hours per week, instead of only 20 hours per week.

          2)Requires licensed primary care clinics to report to DPH, when  
            renewing its license, whether it is currently operating an  
            intermittent clinic, the location of any intermittent clinic,  
            and the estimated hours of operation of any intermittent  
            clinic.

          Comments
          
          1)Author's statement.  According to the author, the existing  
            limit of hours of operation for intermittent clinics of a  
            maximum of 20 hours was placed in statute 37 years ago, and  
            based on a typical 40 hour work week. Today, full time  
            healthcare centers are open much longer hours, (in some cases  
            7 days a week) and continue to adapt in order to meet the  







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            needs of every community. Given the increase in patient  
            population thanks to the Medi-Cal expansion and the Affordable  
            Care Act, this bill simply increases the hours an intermittent  
            clinic may operate so that they may keep up with the demand  
            for service in all areas of California, but particularly in  
            the most underserved regions. 

          2)Intermittent clinics. Under existing law, a licensed primary  
            care clinic is permitted to operate an off-site clinic, for up  
            to 20 hours per week, without obtaining a separate license for  
            these off-site locations. While there are a little more than  
            1,000 licensed primary care clinics, because no license is  
            required for these off-site locations, DPH does not track the  
            number of intermittent clinics. The sponsors of this bill  
            estimate there are approximately 200 intermittent clinics  
            across the state, ranging from a small one-provider clinic  
            inside a homeless shelter that is open four hours per week, to  
            the larger school-based health centers that may operate up to  
            20 hours per week. There are no regulations specific to  
            intermittent clinics, and under California statute, these  
            clinics are only required to meet fire and life safety  
            requirements of law, which are established by the State Fire  
            Marshall. As stated by the many supporting organizations,  
            primary care clinics use these satellite locations to offer  
            services in communities that might not otherwise support a  
            full-time licensed clinic, such as school-based health  
            centers, or in rural or underserved communities.

          Related Legislation
          
          AB 941 (Wood, 2015) expands a licensure exemption for tribal  
          clinics, which are currently exempted if they are located on  
          tribal land, by exempting tribal clinics regardless of the  
          location of the clinic, if the clinic is operated under a  
          contract with the United States pursuant to the Indian  
          Self-Determination and Education Assistance Act. AB 941 is  
          currently pending in the Senate Appropriations Committee.

          Prior Legislation
          
          AB 2787 (Arambula, 2008) was identical to this bill. AB 2787 was  
          held on the Assembly Appropriations Committee suspense file.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  







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          Com.:YesLocal:   Yes


          SUPPORT:   (Verified7/14/15)


          California Primary Care Association (co-source)
          Central Valley Health Network (co-source)
          Alameda Health Consortium
          Bienvenidos Community Health Center 
          California Family Health Council
          California School-Based Health Alliance
          Camarena Health
          Chinatown Service Center
          Clinica Sierra Vista
          Clinicas de Salud del Pueblo, Inc.
          Coastal Health Alliance
          Community Clinic Association of Los Angeles County
          Council of Community Clinics
          Dos Palos Memorial Hospital Skilled Nursing Facility
          El Dorado Community Health Centers
          Family HealthCare Network
          Family Purpose
          Golden Valley Health Centers
          Harmony Health Medical Clinic and Family Resource Center
          Hill Country Community Clinic
          Inland Behavioral and Health Services, Inc.
          James Morehouse Project
          La Clinica de la Raza
          La Maestra Community Health Centers
          Livingston Community Health
          Los Angeles Trust for Children's Health
          Northeast Valley Health Corporation 
          Omni Family Health
          People Assisting the Homeless 
          Petaluma Health Center 
          Planned Parenthood Affiliates of California
          Santa Rosa Community Health Centers
          The Children's Partnership
          United Health Centers of the San Joaquin Valley
          Venice Family Clinic
          Wellspace Health
          West County Health Centers








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          OPPOSITION:   (Verified7/14/15)


          None received


          ARGUMENTS IN SUPPORT:     This bill is co-sponsored by the  
          California Primary Care Association (CPCA) and the Central  
          Valley Health Network (CVHN). According to CPCA and CVHN, by  
          increasing the number of operating hours for intermittent  
          clinics, community health centers can meet the growing need for  
          care, especially among special populations that may not have the  
          ability to access care in traditional full time health centers.  
          According to CPCA and CVHN, many intermittent clinics are  
          operated on school campuses and address the unique needs of  
          school age children and their families. Others are operated in  
          short and long-term shelters designed to help people  
          experiencing homelessness, or are embedded in affordable housing  
          communities. The California School-Based Health Alliance states  
          in support that since the introduction of this bill, many  
          school-based health centers have shared that increasing the  
          hours they can provide health care services means greater access  
          to care and increased support for children and their families.  
          Camarena Health states in support that it is currently  
          partnering with the largest school district in Madera County to  
          begin the development of two new school based health center  
          sites that will deliver medical, dental, behavioral health and  
          health education services, and is also partnering with a local  
          grower to establish an on-site clinic that would provide primary  
          care services to agricultural employees during their work day.  
          WellSpace Health states in support that just blocks away from  
          the Capitol there is an intermittent clinic operated in the  
          Salvation Army shelter, and another embedded in an affordable  
          housing community, and that increasing the maximum operating  
          hours will improve a clinic's ability to get services and  
          resources in the most underserved areas quickly.
           

          ASSEMBLY FLOOR:  77-0, 4/30/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau,  
            Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,  
            Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,  







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            Eduardo Garcia, Gatto, Gipson, Gonzalez, Gordon, Gray, Grove,  
            Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,  
            Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Campos, Chávez, Gomez

          Prepared by:Vince Marchand / HEALTH / 
          7/14/15 16:53:49


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