Bill Text: CA SB779 | 2023-2024 | Regular Session | Amended

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

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Bill Title: Primary Care Clinic Data Modernization Act.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Passed) 2023-10-08 - Chaptered by Secretary of State. Chapter 505, Statutes of 2023. [SB779 Detail]

Download: California-2023-SB779-Amended.html

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Amended  IN  Senate  April 17, 2023

Amended  IN  Senate  March 30, 2023

Amended  IN  Senate  March 27, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 779

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Introduced by Senator Stern
(Coauthor: Senator Smallwood-Cuevas)

February 17, 2023

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An act to amend Section 1216 of, and to add Chapter 2 (commencing with Section 128900) to Part 5 of Division 107 of, the Health and Safety Code, relating to clinics.

LEGISLATIVE COUNSEL'S DIGEST

SB 779, as amended, Stern. Primary Care Clinic Data Modernization Act.

Existing law provides for the licensure and regulation of clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law excludes certain facilities from those provisions, including a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 40 hours a week, also referred to as an intermittent clinic.

Existing law imposes various reporting requirements on clinics, including requiring a clinic to provide a verified report to the Department of Health Care Access and Information including information relating to the previous calendar year, such as the number of patients served and specified descriptive information, medical and other health services provided, total clinic operating expenses, and gross patient charges by payer category. Existing law specifies that the reporting requirements apply to all primary care clinics.

This bill would revise those reporting requirements, including specifying the type of descriptive information required to be reported. The bill would extend application of the reporting requirements to intermittent clinics, as specified.

Existing law requires the Department of Health Care Access and Information to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies, as prescribed.

The bill would require an organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and its officers, to file specified reports with the Department of Health Care Access and Information for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, including, but not limited to, the percentage of all revenue spent on workforce expenditures, as specified, a report of all mergers and acquisitions, a detailed labor report, and a report of quality and equity measures. The bill would impose specified civil penalties on a primary care clinic or intermittent clinic that fails to file a required report pursuant to the bill’s requirements. The bill would authorize a clinic affected by a determination made pursuant to the bill’s requirements to petition the department for a review of the decision, and would further provide for judicial review of any final action by the department, as specified. The bill would authorize the department to adopt regulations necessary to implement these reporting requirements.

Because a violation of certain provisions of the bill by a primary care clinic or intermittent clinic would be a crime, the bill would 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.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

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

SECTION 1.

 This act shall be known, and may be cited, as the Primary Care Clinic Data Modernization Act.

SEC. 2.

 The Legislature finds and declares as follows:

(a) The Department of Health Care Access and Information (HCAI), and its predecessor, the Office of Statewide Health Planning and Development, annually collects from licensed primary care clinics financial, utilization, and patient demographic information.

(b) HCAI makes each clinic’s report available to the public. HCAI also creates a publicly available primary care clinic data set, which is used to produce additional publicly available data sets. The data sets and products are critical for accountability, transparency, and understanding trends in primary care.

(c) It is the intent of the Legislature to increase accountability, quality, and transparency in health care by updating annual data reporting and publication requirements for licensed primary care clinics, in recognition of the increasing complexity in the organization and operation of those clinics.

(d) It is in the interest of the state and consumers to collect greater information about primary care clinics, including, but not limited to, workforce, workforce development, financial and patient care quality and equity data, and to make that information publicly available to study health care policy questions, to assess trends in workforce, care, finance, and corporate responsibility, including anticipating workforce shortages, and to inform public funding and public policy decisions related to health care equity, quality, and access.

SEC. 3.

 Section 1216 of the Health and Safety Code is amended to read:

1216.

 (a)  Every clinic holding a license and, notwithstanding subdivision (h) of Section 1206, every intermittent clinic exempt from licensure shall, on or before the 15th day of February each year, file with the Department of Health Care Access and Information, upon forms to be furnished by the department, a verified report showing the following information relating to the previous calendar year:

(1)  Number of patients served and descriptive information, including, but not limited to, age, sex, race, ethnicity, preferred language spoken, disability status, sexual orientation, gender identity, and payor category.

(2)  Number of patient visits by type of service, including all of the following:

(A)  Child health and disability prevention screens, treatment, and followup services.

(B)  Medical services.

(C)  Dental services.

(D)  Other health services.

(3) For primary care clinics participating in the Medi-Cal program or county indigent programs, include the following:

(A) Number of assigned members per Medi-Cal managed care plan and county indigent program.

(B) Number of assigned members per Medi-Cal managed care plan and county indigent program that had one or more clinic visits.

(4) Total clinic operating expenses.

(5) Gross patient charges by payer category, including Medicare, Medi-Cal, the Child Health Disability Prevention Program, county indigent programs, other county programs, private insurance, self-paying patients, nonpaying patients, and other payers.

(6) Deductions from revenue by payer category, bad debts, and charity care charges.

(7) Additional information as may be required by the Department of Health Care Access and Information or the State Department of Public Health.

(b) (1) If a clinic fails to file a timely report pursuant to this section or pursuant to Section 127285 or 128905, either for itself or for any intermittent clinic it operates, the State Department of Public Health may suspend the license of the clinic until the report is all required reports are completed and filed with the Department of Health Care Access and Information.

(2) In order to facilitate timely enforcement of this section, the Department of Health Care Access and Information shall, on or before March 1 of each year, send a written notice of violation to every clinic that fails to file a timely report pursuant to this section or Section 127285 or 128905, either for itself or for any intermittent clinic it operates. The department shall also provide the State Department of Public Health with a list of every clinic that receives a written notice of violation and notify the State Department of Public Health when a clinic on the list completes and files all delinquent reports. The department shall make these notices and lists, including notifications of when a clinic on the list completes and files all delinquent reports, available on its internet website.

(c) In order to promote efficient reporting of accurate data, the Department of Health Care Access and Information shall consider the unique operational characteristics of different classifications of licensed clinics, including, but not limited to, the limited scope of services provided by some specialty clinics, in its design of forms for the collection of data required by this section.

(d) For the purpose of administering funds appropriated from the Cigarette and Tobacco Products Surtax Fund for support of licensed clinics, clinics receiving those funds may be required to report any additional data the Department of Health Care Access and Information or the State Department of Public Health may determine necessary to ensure the equitable distribution and appropriate expenditure of those funds. This shall include, but not be limited to, information about the poverty level of patients served and communicable diseases reported to local health departments.

(e) This section shall apply to all licensed primary care clinics, and to all intermittent clinics operated by those licensed primary care clinics, notwithstanding subdivision (h) of Section 1206 of the Health and Safety Code.

(f) This section shall apply to all specialty clinics, as defined in subdivision (b) of Section 1204 that receive tobacco tax funds pursuant to Article 2 (commencing with Section 30121) of Chapter 2 of Part 13 of Division 2 of the Revenue and Taxation Code.

(g) Specialty clinics that are not required to report pursuant to subdivision (f) shall report data as directed in Section 1216 as it existed prior to the enactment of Chapter 1331 of the Statutes of 1989 and Chapter 51 of the Statutes of 1990.

SEC. 4.

 Chapter 2 (commencing with Section 128900) is added to Part 5 of Division 107 of the Health and Safety Code, to read:

CHAPTER  2. Primary Care Clinic Data

128900.

 The following definitions apply for purposes of this chapter:

(a) “Clinic” means an organized outpatient health facility required to be licensed pursuant to Chapter 1 (commencing with Section 1200) of Division 2.

(b) “Primary care clinic” means a clinic specified in subdivision (a) of Section 1204, including community clinics and free clinics.

(c) “Intermittent clinic” means a clinic operated by a primary care community or free clinic that is operated on separate premises from the licensed clinic and is only open for limited services, as described in subdivision (h) of Section 1206.

(d) “Department” means the Department of Health Care Access and Information.

(e) “FQHC” means a federally qualified health center.

(f) “RHC” means a rural health center.

128905.

 An organization that operates, conducts, owns, or maintains a primary care clinic or intermittent clinic, and the officers thereof, shall, for every primary care clinic and every intermittent clinic that it operates, conducts, owns, or maintains, on or before the 15th day of February each year, file with the department all of the following reports on forms furnished by the department, in conjunction with the forms required under Sections 1216 and 127285, that are in accord, if applicable, with the systems of accounting and uniform reporting required by this part:

(a) The Medi-Cal FQHC/RHC prospective payment system (PPS) rate, if applicable.

(b)The percentage of all revenue spent on workforce expenditures, including, but not limited to, salaries, wages, benefits, and associated payroll taxes.

(c)

(b) A report of all mergers and acquisitions, including, but not limited to, the following information:

(1) Whether the clinic has been purchased, acquired or merged with any other clinic parent corporation since the prior reporting period.

(2) Information identifying all purchased, acquired, or merged clinics, including all applicable clinic sites.

(3)A summary of costs related to the mergers and acquisitions.

(d)

(c) A detailed labor report including, but not limited to, the following information:

(1) The actual number, not full-time equivalents, of employees by job classification, including nonlicensed and noncredentialed positions. positions, at the beginning and end of the reporting period.

(2) The actual number, not full-time equivalents, of contracted, registry, and temporary contracted or registry staff by job classification, including nonlicensed and noncredentialed positions. positions at the beginning and end of the reporting period.

(3)Staff retention and turnover information for total employees and for key job classifications including the following:

(A)The number of employees at the beginning and end of the reporting period.

(B)The average number of employees throughout the reporting period.

(C)The total number of people employed during the reporting period.

(D)Employee turnover and retention percentages during the reporting period.

(E)The number of employees with continuous service for the entire reporting period.

(4)

(3) The number of staff vacancies by job classification.

(5)

(4) The average base hourly wages and hourly base wage ranges (minimum and maximum base hourly wage), for all employees and by job classification. wage) by job classification for each job classification with three or more employees.

(6)The average weekly hours worked and average weekly overtime hours worked for all employees and by job classification.

(7)

(5) Workforce demographic information by job classification, information, including, but not limited to, age, sex, race, ethnicity, languages spoken, disability status, sexual orientation, and gender identity. Workers shall not be required to provide the information in this subparagraph and shall not be subject to discipline or any other adverse action for not providing the information listed. Data shall be reported separately for licensed and credentialed persons, and for nonlicensed positions. Data shall be reported only in an aggregate form that cannot be used to identify an individual.

(e)

(d) A detailed workforce development report, including, but not limited to, the following:

(1)The number of residents participating in a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME), per program, over the reporting period.

(2)The number of advanced practice clinicians participating in an advanced practice clinician postgraduate training or fellowship program, per program, over the reporting period.

(3)

(1) Participation in any local, regional, or statewide labor-management cooperation committee (LMCC), and for each LMCC, the identity of all partners.

(4)Participation

(2) Data about the nature and extent of participation in allied health care professional degrees and certificate programs, including: including, but not limited to, the number of clinical placements for each program.

(A)The name of each program and affiliated school.

(B)The number of clinical placements for each program over the reporting period.

(C)The number of students participating in each program over the reporting period.

(5)Participation

(3) Data about the nature and extent of participation in behavioral health professional degree and certificate programs, including: including, but not limited to, the number of clinical placements for each program.

(A)The name of each program and affiliated school.

(B)The number of clinical placements for each program over the reporting period.

(C)The number of students participating in each program over the reporting period.

(f)

(e) A report of quality and equity measures. The department shall coordinate with the State Department of Health Care Services, in consultation with stakeholders, on quality measure data and other information necessary to include in this report. The department shall align reporting with the department’s Health Equity Measures Advisory Committee, the Department of Managed Health Care Health Equity and Quality Committee Recommendations, and the Centers for Medicare and Medicaid Services Framework for Health Equity.

(1)Reported quality and equity measures shall include, but not be limited to, the quality measures selected for the FQHC alternative payment methodology program, to assess performance for the Medi-Cal program or other programs administered by the State Department of Health Care Services. Reported quality measures shall include, at a minimum, quality measures in the following categories:

(A)Prevention-adults.

(B)Prevention-pediatrics.

(C)Access to care.

(D)Behavioral health integration.

(E)Chronic care.

(F)Maternity care.

(G)Patient experience of access and care.

(H)Hospital and emergency department utilization.

(I)Patient-reported outcome measures.

(2)Quality measure reporting should be clinic site specific and stratified by patient demographics, including, but not limited to, age, sex, race, ethnicity, preferred language spoken, disability status, sexual orientation, gender identity, and payor category.

(3)The department shall coordinate with the Department of Health Care Services, in consultation with stakeholders, on additional quality measure data and other information necessary to include in this report.

(4)The department shall align reporting with the department’s Health Equity Measures Advisory Committee, the Department of Managed Health Care Health Equity and Quality Committee Recommendations, and the Centers for Medicare and Medicaid Services Framework for Health Equity.

(5)Data reported should be for all assigned patients that visited the health center at least once during the reporting period.

128910.

(a)A primary care clinic or intermittent clinic that does not file a report with the department as required by this chapter, or by Sections 1216 and 127285 of the Health and Safety Code, with the department is liable for a civil penalty of one hundred dollars ($100) per day for each day the filing of any report is delayed. A penalty shall not be imposed if an extension is granted in accordance with the guidelines and procedures established by the department.

(b)Civil penalties shall be assessed and recovered in a civil action brought in the name of the people of the State of California by the department. Assessment of a civil penalty may, at the request of any clinic, be reviewed on appeal, and the penalty may be reduced or waived for good cause.

(c)Funds received by the department pursuant to this section, upon appropriation by the Legislature, shall be allocated to health care workforce education and training programs, in consultation with the California Health Workforce Education and Training Council and in accordance with the duties and priorities established by Article 2 (commencing with Section 128250) of Chapter 4 of Part 3.

128915.

(a)A primary care clinic or intermittent clinic affected by any determination made under this part by the department may petition the department for review of the decision. This petition shall be filed with the department within 15 business days, or within a greater time as the department may allow for good cause, and shall specifically describe the matters which are disputed by the petitioner.

(b)A hearing shall be commenced within 60 calendar days of the date on which the petition was filed. The hearing shall be held before an employee of the department, or an administrative law judge employed by the Office of Administrative Hearings. If held before an employee of the department, the hearing shall be held in accordance with any procedures as the office shall prescribe. If held before an administrative law judge employed by the Office of Administrative Hearings, the hearing shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. The employee or administrative law judge shall prepare a recommended decision including findings of fact and conclusions of law and present it to the department for its adoption. The decision of the department shall be in writing and shall be final. The decision of the department shall be made within 60 calendar days after the conclusion of the hearing and shall be effective upon filing and service upon the petitioner.

(c)Judicial review of a final action, determination, or decision may be had by any party to the proceedings as provided in Section 1094.5 of the Code of Civil Procedure. The decision of the department shall be upheld against a claim that its findings are not supported by the evidence unless the court determines that the findings are not supported by substantial evidence.

(d)The employee of the office, or the administrative law judge employed by the Office of Administrative Hearings or the Office of Administrative Hearings, may issue subpoenas and subpoenas duces tecum in a manner and subject to the conditions established by Article 11 (commencing with Section 11450.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the Government Code.

128920.128910.

 The department shall maintain a file of all reports filed under this chapter and under Sections 1216 and 127285 at its Sacramento office. Subject to any rules the department may prescribe, these reports shall be produced and made available for inspection upon the demand of any person, and shall also be posted on the department’s internet website.

128925.128915.

 The department shall administer this chapter and shall adopt all regulations necessary to implement the provisions of this chapter.

SEC. 5.

 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.