Bill Text: CA SB442 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Clinic corporation: licensing.

Spectrum: Strong Partisan Bill (Democrat 10-1)

Status: (Passed) 2010-09-29 - Chaptered by Secretary of State. Chapter 502, Statutes of 2010. [SB442 Detail]

Download: California-2009-SB442-Amended.html

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BILL NUMBER: SB 442	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 28, 2009
	AMENDED IN SENATE  APRIL 15, 2009

INTRODUCED BY   Senator Ducheny
    (   Coauthor:   Senator   Wiggins
  ) 
    (   Coauthors:  Assembly Members  
Block,   Chesbro,   and Monning   ) 

                        FEBRUARY 26, 2009

   An act to amend Sections 1200, 1213, 1214, 1219, 1229, and 1266
of, and to add Section 1212.5 to, the Health and Safety Code,
relating to clinics.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 442, as amended, Ducheny. Clinic corporation: licensing.
   Under existing law, the State Department of Public Health is
responsible for the licensing and regulation of clinics, as defined.
A violation of these provisions is a crime.
   This bill would define "clinic corporation" as a nonprofit
organization that owns one or more primary care clinics,  or
mobile health care units  as defined, and would provide for a
single, consolidated license for corporation clinics, as specified.
   Existing law provides for a fee to be paid for an initial license,
renewal license, license upon change of ownership, or special permit
set at specified amounts.
   This bill would require the department to annually set the fee for
a clinic corporation. The bill would also make conforming changes to
the licensing provisions. Because this bill would create a new
crime, it imposes a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1200 of the Health and Safety Code is amended
to read:
   1200.  (a) As used in this chapter, "clinic" means an organized
outpatient health facility that provides direct medical, surgical,
dental, optometric, or podiatric advice, services, or treatment to
patients who remain less than 24 hours, and that may also provide
diagnostic or therapeutic services to patients in the home as an
incident to care provided at the clinic facility. Nothing in this
section shall be construed to prohibit the provision of nursing
services in a clinic licensed pursuant to this chapter. In no case
shall a clinic be deemed to be a health facility subject to the
provisions of Chapter 2 (commencing with Section 1250). A place,
establishment, or institution that solely provides advice,
counseling, information, or referrals on the maintenance of health or
on the means and measures to prevent or avoid sickness, disease, or
injury, where that advice, counseling, information, or referral does
not constitute the practice of medicine, surgery, dentistry,
optometry, or podiatry, shall not be deemed a clinic for purposes of
this chapter.
   (b) For purposes of this chapter:
   (1) "Primary care clinics" means all the types of clinics
specified in subdivision (a) of Section 1204, including community
clinics and free clinics.
   (2) "Specialty clinics" means all the types of clinics specified
in subdivision (b) of Section 1204, including surgical clinics,
chronic dialysis clinics, and rehabilitation clinics.
   (3) "Clinic corporation" means a nonprofit organization that
operates one or more primary care clinics, as defined in 
paragraphs (1) and (2)   paragraph (1)  of
subdivision (a) of Section 1204, that are required to be licensed
under Section 1205,  that may include  one or more
mobile health care units required to be licensed or approved pursuant
to the Mobile Health Care Services Act (Chapter 9 (commencing with
Section 1765.101)) and operated as primary care clinics, or one or
more primary care clinics and one or more mobile health care units.
   (4) "Department" means the Licensing and Certification Division of
the State Department of Public Health, or its successor.
  SEC. 2.  Section 1212.5 is added to the Health and Safety Code, to
read:
   1212.5.  (a) Upon application of a clinic corporation that
operates more than one primary care clinic, as defined in 
paragraphs (1) and (2)   paragraph (1)  of
subdivision (a) of Section  1240   1204  ,
the department shall issue a single consolidated license to the
clinic corporation if the clinics included in the single consolidated
license application meet the requirements of Section 1212 and other
applicable requirements for licensure.
   (b) In addition to primary care clinics, as described in
subdivision (a), a clinic corporation may include, in its application
for a single consolidated license, one or more mobile health care
units that meet the requirements under the Mobile Health Care
Services Act (Chapter 9 (commencing with Section 1765.101)).
   (c) Upon application of a clinic corporation that operates more
than one mobile health care unit and only operates mobile health care
units, the department shall issue a single consolidated license to
the clinic corporation if the mobile health care units included in
the single consolidated license application meet the requirements
under the Mobile Health Care Services Act (Chapter 9 (commencing with
Section 1765.101)).
   (d) Eligibility for a single consolidated license shall be based
on the following criteria: 
   (1) The clinic corporation applying for the consolidated license
is required to have held a valid, unrevoked, and unsuspended license
for, at a minimum, the immediately preceding five years, with no
demonstrated history of repeated or uncorrected violations of this
chapter, or any regulation adopted pursuant to this chapter, that
pose immediate jeopardy to a patient, as defined in subdivision (d)
of Section 1218.1, and have no pending action to suspend or revoke
its license.  
   (1) 
    (2)  A completed application for a single consolidated
license has been submitted and the associated license fee has been
paid. 
   (2) 
    (3)  The corporate officers, as specified in Section
5213 of the Corporations Code, are the same for each primary care
clinic or mobile unit included in the single consolidated license.

   (3) 
    (4)  The clinic corporation's nonprofit board of
directors both owns and operates each primary care clinic or mobile
unit included in the single consolidated license. 
   (4) 
    (5)  The clinic corporation has submitted evidence to
the department establishing compliance with the minimum construction
standards of adequacy and safety for physical plant, pursuant to
subdivision (b) of Section  1126   1226  ,
for each primary care clinic included in the single consolidated
license. 
   (5) 
    (6)  There are one or more medical directors operating
under a single set of policies, procedures, and standards for all the
primary care clinics  and mobile health care units 
maintained and operated by the licensee. 
   (e) A single consolidated license issued by the department shall
specify the name, location, hours of operation, and services of each
clinic included in the license.  
   (e) 
    (f)  For purposes of this section there is a presumption
that all primary care clinics included in the application for the
single consolidated license that are separately licensed and in good
standing at the time of application for a single consolidated
license, meet the requirements of subdivision (a) and paragraph
 (4)   (5)  of subdivision (d). 
   (f) 
    (g)  For purposes of this section there is a presumption
that all mobile units included in the application for the single
consolidated license that are separately licensed or approved by the
department and in good standing at the time of application for a
single consolidated license, meet the requirements of subdivision
(b). 
   (g) 
    (h)  The department shall issue a single consolidated
license under this section within 30 days of receipt of a completed
application or within seven days of the date the central application
unit approves the application for a single consolidated license,
whichever is sooner. If the department determines that an applicant
does not meet the criteria for a single consolidated license as set
forth in subdivision (d), it shall identify, in writing and with
particularity, the grounds for that determination and shall, instead,
process the application under this chapter as if the application was
submitted on the date the denial  was released 
 of the consolidated license was issued  . 
   (h) 
    (i)  Upon application to the department,  a 
clinic corporation that is issued a single consolidated license
pursuant to this section may add a clinic, including a mobile health
care unit, to the single consolidated license, or remove a clinic,
including a mobile health care unit, from the single consolidated
license, at any time during the license period. For every primary
care clinic or mobile health care unit added to the single
consolidated license before the next renewal date, the clinic
corporation shall pay a license fee, if applicable, equivalent to the
fee for one primary care clinic included in a single consolidated
license set pursuant to subdivision (d) of Section 1266, prorated
based on the effective date of the addition of the clinic. 
   (i) 
    (j)  The department shall develop a single-page
application form for adding  or removing  a clinic between
renewal periods that includes all of the following information:
   (1) The name and address of the clinic corporation.
   (2) The name and address of the clinic or mobile health unit to be
added or removed.
   (3) The days and hours of operation and the services provided at
each clinic site added.
   (4) A self-attestation that each clinic site added meets the
requirements of Section 1212, including minimum construction
standards for adequacy and safety of physical plant, pursuant to
subdivision (b) of Section 1226.
   (5) Evidence of appropriate and sufficient fire clearance.

   (j) 
    (k)  A clinic corporation that is issued a single
consolidated license may consolidate the administrative functions, as
specified in Section 1218.2, for all clinics that are subject to the
single consolidated license. 
   (k) 
    (l)  Upon written notice to the department, a clinic
corporation that has been issued a single consolidated license may
apply for one or more special permits pursuant to Section 1202. A
clinic corporation that is issued one or more special permits may
transfer  , with approval from the department,  the special
permits from one clinic site to another site that is included in the
single consolidated license. 
   (l) 
    (m)  The department shall transmit to the clinic
corporation that is issued a single consolidated license a renewal
fee invoice at least 45 days prior to the expiration date of the
single consolidated license. Failure by the clinic corporation to
make timely payment of the renewal fee shall result in the expiration
of  any licenses   its consolidated license
 and special permits. Timely application for renewal shall be
deemed equivalent to renewal of the license and special permits, if
any, where the department is unable to issue a renewal license or
special permit on or before the expiration date. 
   (m) 
    (n)  If the department issues a single consolidated
license pursuant to this section, the department, except as limited
by Section 1229 and Article 5 (commencing with Section 1240), may
take any action authorized by this chapter, including, but not
limited to, action specified in Article 5 (commencing with Section
1240 with respect to a primary care clinic  ,   a mobile
health care unit,  or special services provided in a clinic
that is included in the consolidated license.  An action
against one or more clinics included in the consolidated license
shall not be deemed an action against the clinic corporation as a
whole.  
   (n) 
    (o)  Nothing is this section shall require the business
office of a clinic corporation to enroll in the Medi-Cal program,
pursuant to subdivision (c) of Section 14043.15 of the Welfare and
Institutions Code, or a program specified in Section 1222, as a
clinic location subject to the single consolidated license. Each
primary care clinic included in the single consolidated license shall
be deemed to be licensed for purposes of enrollment as a provider in
any health care program. Each primary care clinic, including a
mobile health care unit, may separately enroll as a provider in the
Medi-Cal program or other health care program using the business
address of the primary care clinic. 
   (o) 
    (p)  Nothing in this section shall affect prospective
payment rate calculations made under Section 14132.100 of the Welfare
and Institutions Code for individual rural health clinics and
federally qualified health centers included in a single consolidated
license. 
   (p) 
    (q)  Nothing in this section shall affect the
requirements for obtaining a permit or license from the Board of
Pharmacy pursuant to Chapter 9 (commencing with Section 1480) of
Division 2 of the Business and Professions Code. Each primary care
clinic that is included in the single consolidated license shall be
deemed to be licensed as a primary care clinic for purposes of
obtaining a pharmacy license or permit. 
   (q) 
    (r)  Nothing in this section shall affect the
requirements for obtaining a clinic laboratory registration or
license pursuant to Section 1265 of the Business and Professions
Code. Each primary care clinic, including a mobile health care unit,
that is included in the single consolidated license shall be deemed
to be licensed as a primary care clinic for the purpose of obtaining
a clinic laboratory license or registration. 
   (r) 
    (s)  Nothing in this section shall require a clinic
corporation to apply for a single consolidated license.
  SEC. 3.  Section 1213 of the Health and Safety Code is amended to
read:
   1213.  A person, firm, association, partnership, corporation, or
other legal entity desiring a license for a clinic shall be exempt
from the requirements of Chapter 2 (commencing with Section 16000) of
Division 12.5.
  SEC. 4.  Section 1214 of the Health and Safety Code is amended to
read:
   1214.  Each application under this chapter for an initial license,
renewal license, license upon change of ownership, or special permit
shall be accompanied by a Licensing and Certification Program fee,
as follows:
   (a) For all primary care clinics licensed pursuant to this
chapter, the annual fee shall be set in accordance with Section 1266.

   (b) For all specialty clinics licensed pursuant to this chapter,
the annual fee shall be set in accordance with Section 1266.
   (c) For all rehabilitation clinics, the annual fee shall be set in
accordance with Section 1266.
   (d) For all clinic corporations issued a single consolidated
license pursuant to this chapter, the annual fee shall be set in
accordance with Section 1266.
  SEC. 5.  Section 1219 of the Health and Safety Code is amended to
read:
   1219.  (a) Except for an affiliate clinic, as defined in Section
1218.1, or a  clinic corporation that includes, in its
application for a single consolidated license, one or more primary
care clinics, including one or more mobile health care units, that
were   primary care clinic or mobile health care unit
that was  licensed and in good standing as of December 31, 2009,
 and was included in an application by a clinic corporation for
a single consolidated license  if a clinic or an applicant for a
license has not been previously licensed, the department may only
issue a provisional license to the clinic as provided in this
section.
   (b) A provisional license to operate a clinic shall terminate six
months from the date of issuance.
   (c) Within 30 days prior to the termination of a provisional
license, the department shall give the clinic a full and complete
inspection, and, if the clinic meets all applicable requirements for
licensure, a regular license shall be issued. If the clinic does not
meet the requirements for licensure but has made substantial progress
towards meeting those requirements, as determined by the department,
the initial provisional license shall be renewed for six months.
   (d) If the department determines that there has not been
substantial progress towards meeting licensure requirements at the
time of the first full inspection provided by this section, or, if
the department determines upon its inspection made within 30 days of
the termination of a renewed provisional license that there is a lack
of full compliance with those requirements, no further license shall
be issued.
   (e) If an applicant for a provisional license to operate a clinic
has been denied by the department, the applicant may contest the
denial by filing a statement of issues, as provided in Section 11504
of the Government Code. The proceedings to review the denial shall be
conducted pursuant to the provisions of Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.
  SEC. 6.  Section 1229 of the Health and Safety Code is amended to
read:
   1229.  (a) The state department shall notify, in writing, a clinic
of all deficiencies in its compliance with the provisions of this
chapter, or the rules and regulations adopted hereunder, that are
discovered or confirmed by inspection, and the clinic shall agree
with the department on a plan of correction that shall give the
clinic a reasonable time to correct the deficiencies. During the
allotted time, a list of deficiencies and the plan of correction
shall be conspicuously posted in a clinic location accessible to
public view. If, at the end of the allotted time provided in the plan
of correction, the clinic has failed to correct the deficiencies,
the department shall assess the licensee a civil penalty not to
exceed fifty dollars ($50) per day, until the state department finds
the clinic in compliance. In that case, the department may also
initiate action against the clinic to revoke or suspend the license.
Nothing in this chapter shall be deemed to prohibit a clinic that is
unable to correct the deficiencies specified in a plan of correction
for reasons beyond its control from voluntarily surrendering its
license pursuant to Section 1245 prior to the assessment of a civil
penalty or the initiation of a revocation or suspension proceeding.
   (b) Notwithstanding subdivision (a), the department shall notify,
in writing, a clinic corporation of all deficiencies in compliance
with the provisions of this chapter, or the rules and regulations
adopted hereunder, that are discovered or confirmed by inspection, in
one or more clinics included in a single consolidated license issued
pursuant to Section 1212.5, and the clinic corporation shall agree
with the department on a plan of correction that gives the clinic
corporation a reasonable time to correct the deficiencies. If, at the
end of the time provided in the plan of correction, the clinic
corporation has failed to correct the deficiencies, the department
shall assess the licensee a civil penalty not to exceed fifty dollars
($50) per day per clinic cited as deficient, until the department
finds the clinic corporation in compliance. The department may also
initiate action against the clinic corporation to remove or suspend
the clinic or clinics that are the subject of the deficiencies from
the single consolidated license. Nothing in this chapter shall be
deemed to prohibit a clinic corporation that is unable, for reasons
beyond its control, to correct the deficiencies specified in the plan
of correction from voluntarily removing a clinic or clinics from its
single consolidated license prior to the assessment of a civil
penalty or the initiation of a removal or suspension proceeding. In
no case shall the department initiate an action to revoke or suspend
the single consolidated license for uncorrected deficiencies outlined
in a written notice of deficiencies, in one or more clinics included
in a single consolidated license, unless each clinic, including a
mobile health care unit, that is included in the single consolidated
license is cited in the notice of deficiencies and the clinic
corporation failed to correct the deficiencies in every clinic within
the allotted time period according to the plan of correction.
  SEC. 7.  Section 1266 of the Health and Safety Code is amended to
read:
   1266.  (a) The Licensing and Certification Division shall be
supported entirely by federal funds and special funds by no earlier
than the beginning of the 2009-10 fiscal year unless otherwise
specified in statute, or unless funds are specifically appropriated
from the General Fund in the annual Budget Act or other enacted
legislation. For the 2007-08 fiscal year, General Fund support shall
be provided to offset licensing and certification fees in an amount
of not less than two million seven hundred eighty-two thousand
dollars ($2,782,000).
   (b) The Licensing and Certification Program fees for the 2006-07
fiscal year shall be as follows:


  Type of Facility                Fee
General Acute Care Hospitals   $ 134.10  per bed
Acute Psychiatric Hospitals    $ 134.10  per bed
Special Hospitals              $ 134.10  per bed
Chemical Dependency Recovery
Hospitals                      $ 123.52  per bed
Skilled Nursing Facilities     $ 202.96  per bed
Intermediate Care Facilities   $ 202.96  per bed
Intermediate Care Facilities
- Developmentally Disabled     $ 592.29  per bed
Intermediate Care Facilities
- Developmentally Disabled -             per
Habilitative                   $1,000.00 facility
Intermediate Care Facilities
- Developmentally Disabled -             per
Nursing                        $1,000.00 facility
Home Health Agencies                     per
                                $2,700.00 facility
Referral Agencies                        per
                                $5,537.71 facility
Adult Day Health Centers                 per
                                $4,650.02 facility
Congregate Living Health
Facilities                     $ 202.96  per bed
Psychology Clinics                       per
                                $ 600.00  facility
Primary Clinics - Community              per
and Free                       $ 600.00  facility
Specialty Clinics - Rehab
Clinics                                  per
  (For profit)                  $2,974.43 facility
  (Nonprofit)                             per
                                $ 500.00  facility
Specialty Clinics - Surgical             per
and Chronic                    $1,500.00 facility
Dialysis Clinics                         per
                                $1,500.00 facility
Pediatric Day Health/Respite
Care                           $ 142.43  per bed
Alternative Birthing Centers             per
                                $2,437.86 facility
Hospice                                  per
                                $1,000.00 facility
Correctional Treatment Centers $ 590.39  per bed


   (c) Commencing February 1, 2007, and every February 1 thereafter,
the department shall publish a list of estimated fees pursuant to
this section. The calculation of estimated fees and the publication
of the report and list of estimated fees shall not be subject to the
rulemaking requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
   (d) Commencing February 1, 2010, and every February thereafter,
the department shall publish the estimated fee for a single
consolidated license issued under Section 1212.5 pursuant to this
section. The  calculation of the estimated fee shall be based
on a percentage of the fee   estimated fee  for
primary care clinics, for each primary care clinic included in a
single consolidated  license, and   license
 shall be included in the report and list of estimated fees
required by subdivisions (c) and (e).
   (e) By February 1 of each year, the department shall prepare the
following reports and shall make those reports, and the list of
estimated fees required to be published pursuant to subdivision (c),
available to the public by submitting them to the Legislature and
posting them on the department's Internet Web site:
   (1) The department shall prepare a report of all costs for
activities of the Licensing and Certification Program. At a minimum,
this report shall include a narrative of all baseline adjustments and
their calculations, a description of how each category of facility
was calculated, descriptions of assumptions used in calculations, and
shall recommend Licensing and Certification Program fees in
accordance with the following:
   (A) Projected workload and costs shall be grouped for each fee
category.
   (B) Cost estimates, and the estimated fees, shall be based on the
appropriation amounts in the Governor's proposed budget for the next
fiscal year, with and without policy adjustments to the fee
methodology.
   (C) The allocation of program, operational, and administrative
overhead, and indirect costs to fee categories shall be based on
generally accepted cost allocation methods. Significant items of
costs shall be directly charged to fee categories if the expenses can
be reasonably identified to the fee category that caused them.
Indirect and overhead costs shall be allocated to all fee categories
using a generally accepted cost allocation method.
   (D) The amount of federal funds and General Fund moneys to be
received in the budget year shall be estimated and allocated to each
fee category based upon an appropriate metric.
   (E) The fee for each category shall be determined by dividing the
aggregate state share of all costs for the Licensing and
Certification Program by the appropriate metric for the category of
licensure. Amounts actually received for new licensure applications,
including change of ownership applications, and late payment
penalties, pursuant to Section 1266.5, during each fiscal year shall
be calculated and 95 percent shall be applied to the appropriate fee
categories in determining Licensing and Certification Program fees
for the second fiscal year following receipt of those funds. The
remaining 5 percent shall be retained in the fund as a reserve until
appropriated.
   (2) (A) The department shall prepare a staffing and systems
analysis to ensure efficient and effective utilization of fees
collected, proper allocation of departmental resources to licensing
and certification activities, survey schedules, complaint
investigations, enforcement and appeal activities, data collection
and dissemination, surveyor training, and policy development.
   (B) The analysis under this paragraph shall be made available to
interested persons and shall include all of the following:
   (i) The number of surveyors and administrative support personnel
devoted to the licensing and certification of health care facilities.

   (ii) The percentage of time devoted to licensing and certification
activities for the various types of health facilities.
   (iii) The number of facilities receiving full surveys and the
frequency and number of follow up visits.
   (iv) The number and timeliness of complaint investigations.
   (v) Data on deficiencies and citations issued, and numbers of
citation review conferences and arbitration hearings.
   (vi) Other applicable activities of the licensing and
certification division.
   (f) (1) The department shall adjust the list of estimated fees
published pursuant to subdivision (c) if the annual Budget Act or
other enacted legislation includes an appropriation that differs from
those proposed in the Governor's proposed budget for that fiscal
year.
   (2) The department shall publish a final fee list, with an
explanation of any adjustment, by the issuance of an all facilities
letter, by posting the list on the department's Internet Web site,
and by including the final fee list as part of the licensing
application package, within 14 days of the enactment of the annual
Budget Act. The adjustment of fees and the publication of the final
fee list shall not be subject to the rulemaking requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code.
                                                        (g) (1) No
fees shall be assessed or collected pursuant to this section from any
state department, authority, bureau, commission, or officer, unless
federal financial participation would become available by doing so
and an appropriation is included in the annual Budget Act for that
department, authority, bureau, commission, or officer for this
purpose. No fees shall be assessed or collected pursuant to this
section from any clinic that is certified only by the federal
government and is exempt from licensure under Section 1206, unless
federal financial participation would become available by doing so.
   (2) For the 2006-07 state fiscal year, no fee shall be assessed or
collected pursuant to this section from any general acute care
hospital owned by a health care district with 100 beds or less.
   (h) The Licensing and Certification Program may change annual
license expiration renewal dates to provide for efficiencies in
operational processes or to provide for sufficient cash flow to pay
for expenditures. If an annual license expiration date is changed,
the renewal fee shall be prorated accordingly. Facilities shall be
provided with a 60-day notice of a change in their annual license
renewal date.
  SEC. 8.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.