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AB-899 Clinic licensing.(2019-2020)

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Date Published: 09/07/2019 04:00 AM
AB899:v95#DOCUMENT

Enrolled  September 06, 2019
Passed  IN  Senate  September 03, 2019
Passed  IN  Assembly  September 05, 2019
Amended  IN  Senate  July 11, 2019
Amended  IN  Senate  June 28, 2019
Amended  IN  Assembly  March 12, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 899


Introduced by Assembly Member Wood

February 20, 2019


An act to amend Sections 1212, 1218.1, 1226, and 1226.2 of the Health and Safety Code, relating to health care facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 899, Wood. Clinic licensing.
(1) Existing law provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, as defined. Existing law authorizes a primary care clinic that meets identified requirements, including specified minimum construction standards of adequacy and safety for clinics, to add a physical plant under a consolidated license or an affiliate clinic license.
This bill would exempt an additional physical plant under a consolidated license or an affiliate clinic license from the above-specified minimum construction standards if the physical plant was, prior to being acquired, an outpatient setting or a previously licensed primary care clinic that was actively seeing patients within the previous 18 months.
(2) Existing law establishes the Community Clinics Advisory Committee, which is required to be comprised of at least 15 individuals who are employed by, or under contract to provide service to, a community clinic on a full-time basis, as specified. Existing law requires that committee members be appointed by the 3 statewide primary care clinic associations in California that represent the greatest number of community or free clinic sites. Existing law requires the Office of Statewide Health Planning and Development, in consultation with the Community Clinics Advisory Committee, to prescribe minimum construction standards of adequacy and safety for the physical plant of clinics, as specified.
This bill would require the Community Clinics Advisory Committee to be empaneled on or before July 1, 2020. The bill would also require that the minimum construction standards of adequacy and safety prescribed for primary care clinics be developed in consideration of the unique and distinct needs of clinics in contrast to health facilities, as defined.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NO   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1212 of the Health and Safety Code is amended to read:

1212.
 (a) Any person, firm, association, partnership, or corporation desiring a license for a clinic or a special permit for special services under this chapter, shall file with the department a verified application on forms prescribed and furnished by the department, containing the following:
(1) Evidence satisfactory to the department that the applicant is of reputable and responsible character. If the applicant is a firm, association, partnership, trust, corporation, or other artificial or legal entity, like evidence shall be submitted as to the members, partners, trustees or shareholders, directors, and officers thereof and as to the person who is to be the administrator of, and exercise control, management, and direction of the clinic for which application is made.
(2) If the applicant is a partnership, the name and principal business address of each partner, and, if any partner is a corporation, the name and principal business address of each officer and director of the corporation and name and business address of each stockholder owning 10 percent or more of the stock thereof.
(3) If the applicant is a corporation, the name and principal business address of each officer and director of the corporation, and if the applicant is a stock corporation, the name and principal business address of each stockholder holding 10 percent or more of the applicant’s stock and, if any stockholder is a corporation, the name and principal business address of each officer and director of the corporate stockholder.
(4) Evidence satisfactory to the department of the ability of the applicant to comply with this chapter and rules and regulations promulgated under this chapter by the department.
(5) The name and address of the clinic, and if the applicant is a professional corporation, firm, partnership, or other form of organization, evidence that the applicant has complied with the requirements of the Business and Professions Code governing the use of fictitious names by practitioners of the healing arts.
(6) The name and address of the professional licentiate responsible for the professional activities of the clinic and the licentiate’s license number and professional experience.
(7) The class of clinic to be operated, the character and scope of advice and treatment to be provided, and a complete description of the building, its location, facilities, equipment, apparatus, and appliances to be furnished and used in the operation of the clinic.
(8) Sufficient operational data to allow the department to determine the class of clinic that the applicant proposes to operate and the initial license fee to be charged.
(9) Any other information as may be required by the department for the proper administration and enforcement of this chapter, including, but not limited to, evidence that the clinic has a written policy relating to the dissemination of the following information to patients:
(A) A summary of current state laws requiring child passenger restraint systems to be used when transporting children in motor vehicles.
(B) A listing of child passenger restraint system programs located within the county, as required by Section 27360 or 27362 of the Vehicle Code.
(C) Information describing the risks of death or serious injury associated with the failure to utilize a child passenger restraint system.
(b) (1) No application is required if a licensed primary care clinic adds a service that is not a special service, as defined in Section 1203, or any regulation adopted under that section, or remodels or modifies, or adds an additional physical plant maintained and operated on separate premises to, an existing primary care clinic site. However, the clinic shall notify the department, in writing, of the change in service or physical plant no less than 60 days prior to adding the service or remodeling or modifying, or adding an additional physical plant maintained and operated on a separate premises to, an existing primary care clinic site. Nothing in this subdivision shall be construed to limit the authority of the department to conduct an inspection at any time pursuant to Section 1227, in order to ensure compliance with, or to prevent a violation of, this chapter, or any regulation adopted under this chapter.
(2) If applicable city, county, or state law obligates the primary care clinic to obtain a building permit with respect to the remodeling or modification to be performed by the clinic, or the construction of a new physical plant, the primary care clinic shall provide a signed certification or statement as described in Section 1226.3 to the department within 60 days following completion of the remodeling, modification, or construction project covered by the building permit.
(c) In the course of fulfilling its obligations under Section 1221.09, the department shall ensure that any application form utilized by a primary care clinic, requiring information of the type specified in paragraph (1), (4), (8), or (9) of subdivision (a), is consistent with the requirements of Section 1225, including the requirement that rules and regulations for primary care clinics be separate and distinct from the rules and regulations for specialty clinics. Nothing in this section shall be construed to require the department to issue a separate application form for primary care clinics.
(d) (1) The department, upon written notification by a primary care clinic or an affiliate clinic of its intent to add an additional physical plant maintained and operated on separate premises, as described in paragraph (1) of subdivision (b) and upon payment of a licensing fee for each additional physical plant added, shall review the information provided in the notification, and if the information submitted is in compliance with the requirements specified in this subdivision, the department shall approve the additional physical plant within 30 days of all information being submitted and shall amend the primary care clinic or affiliate clinic’s license to include the additional physical plant as part of a single consolidated license. If the notification does not include the information required by this subdivision, the department shall notify the licensee of the need for additional information and shall not amend the license to add the additional physical plant until the additional information is received and reviewed by the department.
(2) Written notification shall include evidence that the primary care clinic or affiliate clinic is licensed in good standing and otherwise meets the criteria specified in this subdivision. In issuing the single consolidated license, the department shall specify the location of each physical plant.
(3) The written notification shall demonstrate compliance with all of the following criteria:
(A) There is a single governing body for all the facilities maintained and operated by the licensee.
(B) There is a single administration for all the facilities maintained and operated by the licensee.
(C) There is a single medical director for all the facilities maintained and operated by the licensee, with a single set of bylaws, rules, and regulations.
(D) Except as specified in subdivision (e), the additional physical plant meets minimum construction standards of adequacy and safety for clinics found in the most recent version of the California Building Standards Code and prescribed by the Office of Statewide Health Planning and Development, as required in subdivision (b) of Section 1226. Compliance with the minimum construction standards of adequacy and safety may be established as specified in Section 1226.3.
(E) The additional physical plant meets fire clearance standards.
(4) The written notification required to be submitted pursuant to this subdivision shall include all of the following documentation:
(A) The name and address of the licensee’s corporation administrative office, including the name and contact information for the corporation’s chief executive officer or executive director.
(B) The name and address of, and the hours of operation and services provided by, the additional physical plant.
(C) A copy of any document confirming the corporation’s authority to control the additional physical plant. Examples of acceptable documentation include, but shall not be limited to, a lease or purchase agreement, grant deed, bill of sale, sublease, rental agreement, or memorandum of understanding between the owner of the property and the proposed licensee.
(5) A primary care clinic or an affiliate clinic may add additional physical plants pursuant to this section that are no more than one-half mile from the licensed clinic adding the additional physical plant under a consolidated license.
(6) Upon renewal of a consolidated license approved pursuant to this subdivision, a licensee fee shall be required for each additional physical plant approved on the license.
(e) If a licensed primary care clinic adds an additional physical plant under a consolidated license pursuant to this section that was, prior to being acquired, an outpatient setting or a previously licensed primary care clinic that was actively seeing patients within the previous 18 months, that additional physical plant shall be exempt from the minimum construction standards of adequacy and safety as specified in subparagraph (D) of paragraph (3) of subdivision (d) and shall be deemed compliant with the minimum construction standards of adequacy and safety.

SEC. 2.

 Section 1218.1 of the Health and Safety Code is amended to read:

1218.1.
 (a) A clinic corporation on behalf of a primary care clinic that has held a valid, unrevoked, and unsuspended license for at least the immediately preceding five years, with no demonstrated history of repeated or uncorrected violations of this chapter or a regulation adopted under this chapter that pose immediate jeopardy to a patient, as defined in subdivision (f), and that has no pending action to suspend or revoke its license, may file an affiliate clinic application under this section to establish a primary care clinic at an additional site or a mobile health care unit, either of which shall hereafter be referred to as the affiliate clinic. The department, upon receipt of the completed affiliate clinic application submitted by the clinic corporation, shall approve a license for the affiliate clinic, without the necessity of first conducting an initial onsite survey, if all of the following conditions are met:
(1) The clinic corporation that operates the existing licensed primary care clinic, which shall hereafter be referred to as the parent clinic, has submitted a completed affiliate clinic application and the associated application fee.
(2) The parent and affiliate clinics’ corporate officers, as specified in Section 5213 of the Corporations Code, are the same.
(3) The parent and affiliate clinics are owned and operated by the same nonprofit organization with the same board of directors.
(4)  The parent and affiliate clinics have the same medical director or directors and medical policies, procedures, protocols, and standards.
(b) The affiliate clinic application shall consist solely of a simple form and required supporting documents giving the following information:
(1) The name and address of the clinic corporation’s administrative office.
(2) The name and contact information of the clinic corporation’s chief executive officer or executive director.
(3) The name and address of the new affiliate primary care clinic site or the location of the new affiliate mobile health care unit.
(4) The name and contact information of the administrator of the new affiliate primary care clinic site or mobile health care unit.
(5) The expected days and hours of operation and the services to be provided at the new affiliate primary care clinic site or mobile health care unit.
(6) Evidence that the new affiliate mobile health care unit meets the requirements of the Mobile Health Care Services Act (Chapter 9 (commencing with Section 1765.101)).
(7) The type and the manufacturer of the new affiliate mobile health care unit and the proposed area or areas where the new affiliate mobile health care unit will be providing services.
(8) Except as specified in subdivision (g), to the extent otherwise required by law, evidence of compliance with the minimum construction standards for adequacy and safety of the new affiliate clinic’s physical plant, pursuant to the OSHPD 3 requirements of the most recent version of the California Building Code applicable to clinics and subdivision (b) of Section 1226. The compliance may be established in the form prescribed by Section 1226.3.
(9) Evidence of fire clearance for the new affiliate clinic site.
(10) A copy of the lease or purchase agreement for the new affiliate clinic site.
(11) A copy of the transfer agreement between the new affiliate clinic and a local hospital.
(12) A current list of clinic corporation board members.
(c) The affiliate clinic application shall be signed by an officer of the clinic corporation’s board of directors or the clinic corporation’s chief executive officer or executive director.
(d) The department shall issue a clinic license under this section within 30 days of receipt of a completed affiliate clinic application. If approved, a clinic license shall be issued within seven days of approval. If the department determines that an applicant does not meet the conditions stated in subdivision (a), it shall identify, in writing and with particularity, the grounds for that determination, and shall instead process the application in accordance with the time specified in Section 1218.
(e) Nothing in this section shall prohibit the department from conducting a licensing inspection of the affiliate clinic at any time after receipt of the completed affiliate clinic application.
(f) For purposes of this section, “immediate jeopardy to a patient” means a situation in which the clinic’s noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient.
(g) If a parent clinic adds an affiliate clinic under an affiliate license pursuant to this section that was, prior to being acquired, an outpatient setting or a previously licensed primary care clinic that was actively seeing patients within the previous 18 months, that affiliate clinic shall be exempt from the minimum construction standards of adequacy and safety as specified in paragraph (8) of subdivision (b) and shall be deemed compliant with the minimum construction standards of adequacy and safety.

SEC. 3.

 Section 1226 of the Health and Safety Code is amended to read:

1226.
 (a) The regulations shall prescribe the kinds of services that may be provided by clinics in each category of licensure and shall prescribe minimum standards of adequacy, safety, and sanitation of the physical plant and equipment, minimum standards for staffing with duly qualified personnel, and minimum standards for providing the services offered. These minimum standards shall be based on the type of facility, the needs of the patients served, and the types and levels of services provided.
(b) The Office of Statewide Health Planning and Development, in consultation with the Community Clinics Advisory Committee, shall prescribe minimum construction standards of adequacy and safety for the physical plant of clinics as found in the California Building Standards Code. The minimum construction standards shall be developed in consideration of the unique and distinct needs of clinics in contrast to health facilities, as defined in Section 1250.
(c) A city or county, as applicable, shall have plan review and building inspection responsibilities for the construction or alteration of buildings described in paragraph (1) and paragraph (2) of subdivision (b) of Section 1204 and shall apply the provisions of the latest edition of the California Building Standards Code in conducting these plan review responsibilities. For these buildings, construction and alteration shall include conversion of a building to a purpose specified in paragraphs (1) and (2) of subdivision (b) of Section 1204.
Upon the initial submission to a city or county by the governing authority or owner of these clinics for plan review and building inspection services, the city or county shall reply in writing to the clinic whether or not the plan review by the city or county will include a certification as to whether or not the clinic project submitted for plan review meets the standards as propounded by the office in the California Building Standards Code.
If the city or county indicates that its review will include this certification it shall do all of the following:
(1) Apply the applicable clinic provisions of the latest edition of the California Building Standards Code.
(2) Certify in writing, to the applicant within 30 days of completion of construction whether or not these standards have been met.
(d) If upon initial submission, the city or county indicates that its plan review will not include this certification, the governing authority or owner of the clinic shall submit the plans to the Office of Statewide Health Planning and Development who shall review the plans for certification whether or not the clinic project meets the standards, as propounded by the office in California Building Standards Code.
(e) When the office performs review for certification, the office shall charge a fee in an amount that does not exceed its actual costs.
(f) The office of the State Fire Marshal shall prescribe minimum safety standards for fire and life safety in surgical clinics.
(g) Notwithstanding subdivision (c), the governing authority or owner of a clinic may request the office to perform plan review services for buildings described in subdivision (c). If the office agrees to perform these services, after consultation with the local building official, the office shall charge an amount not to exceed its actual costs. The construction or alteration of these buildings shall conform to the applicable provisions of the latest edition of the California Building Standards Code for purposes of the plan review by the office pursuant to this subdivision.
(h) Regulations adopted pursuant to this chapter establishing standards for laboratory services shall not be applicable to any clinic that operates a clinical laboratory licensed pursuant to Section 1265 of the Business and Professions Code.

SEC. 4.

 Section 1226.2 of the Health and Safety Code is amended to read:

1226.2.
 The Community Clinics Advisory Committee provided for in subdivision (b) of Section 1226 shall meet on an ad hoc basis and shall be comprised of at least 15 individuals who are employed by, or under contract to provide service to, a community clinic on a full-time basis, either directly or as a representative of a clinic association. Members of the committee shall be appointed by the three statewide primary care clinic associations in California that represent the greatest number of community or free clinic sites. The committee shall be empaneled on or before July 1, 2020.