BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1130| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1130 Author: Gray (D), et al. Amended: 8/26/15 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.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. Senate Floor Amendments of 8/26/15 incorporate provisions from AB 941 (Wood) in order to avoid chaptering-out problems. ANALYSIS: AB 1130 Page 2 Existing law: 1)Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (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. 3)Incorporates provisions from AB 941 (Wood), which pertains to tribal clinics, to avoid chaptering-out conflicts. Comments AB 1130 Page 3 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 seven days a week) and continue to adapt in order to meet the 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 1130 Page 4 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 Com.:YesLocal: Yes SUPPORT: (Verified8/27/15) 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 AB 1130 Page 5 The Children's Partnership United Health Centers of the San Joaquin Valley Venice Family Clinic Wellspace Health West County Health Centers OPPOSITION: (Verified8/27/15) 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. AB 1130 Page 6 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, 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 / 8/27/15 13:49:09 **** END ****