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 paragraph
(1) of subdivision (a) of Section 1204, that are required to be
licensed under Section 1205, 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.
(5) "Centralized applications unit" means the centralized
applications unit in the Licensing and Certification Division of the
department, or a successor entity.
1200.1. (a) As used in this chapter, "clinic" also means an
organized outpatient health facility which, pursuant to Section
1204.1, provides direct psychological advice, services, or treatment
to patients who remain less than 24 hours, and which may also provide
diagnostic or therapeutic services authorized under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code to patients in the home as an incident to care
provided at the clinic facility.
(b) Psychological clinics, as defined in Section 1204.1, shall not
be considered primary care clinics for the purposes of any state
grants, state loans, or other state aid.
Nothing contained in this section shall prohibit psychological
clinics from receiving payment to which they are otherwise entitled
from the state or in which the state participates financially, for
services rendered pursuant to their license.
(c) Any reference in any statute to Section 1200 shall be deemed
and construed to also be a reference to this section.
1201. "License" means a basic permit to operate a clinic. A license
may only be granted to a clinic of a type enumerated in Section 1204
or 1204.1, and the license shall not be transferable. However, the
issuance of a license upon a change of ownership shall not of itself
constitute a project within the meaning of Section 127170.
1201.5. "Nonprofit speech and hearing center" means a nonprofit
agency which provides an integrated program of speech pathology and
audiology services in an outpatient setting designed to improve the
functioning of persons with communicative disorders. A nonprofit
speech and hearing center provides diagnostic and therapeutic
services for such individuals, together with related counseling,
pursuant to policies and procedures governing all aspects of the
program formulated with the aid of one or more physicians and
surgeons, who shall additionally serve on separate committees which
determine patient care policy and perform utilization review
functions. A multidisciplinary panel, which includes one or more
physicians and surgeons, shall serve as a consulting advisory body to
the center. All patients of the center shall be referred by a
physician and surgeon, or by a dentist or psychologist as
appropriate. A center shall prepare, maintain, and revise, as
necessary, a treatment plan for all active patients, and shall
provide periodic progress reports to the physician and surgeon or
other professional referring the patient. A center shall maintain a
complete record of all services rendered with respect to each
patient.
1202. "Special permit" means a permit issued in addition to a
license authorizing the clinic to offer one or more special services,
as defined in Section 1203 or regulations adopted pursuant thereto.
1203. "Special service" means a functional division, department, or
unit of a clinic, or a clinic that is organized, staffed, and
equipped to provide a specific type or types of care which have been
identified by this section or by regulations of the state department,
and for which the state department has established special standards
for ensuring the quality of such care. Special services shall
include, but need not be limited to, birth services.
1204. Clinics eligible for licensure pursuant to this chapter are
primary care clinics and specialty clinics.
(a) (1) Only the following defined classes of primary care clinics
shall be eligible for licensure:
(A) A "community clinic" means a clinic operated by a tax-exempt
nonprofit corporation that is supported and maintained in whole or in
part by donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on
the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal
income taxation under paragraph (3) of subsection (c) of Section 501
of the Internal Revenue Code of 1954 as amended, or a statutory
successor thereof, shall operate a community clinic; provided, that
the licensee of any community clinic so licensed on the effective
date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for,
or as a condition of, renewal of its license. No natural person or
persons shall operate a community clinic.
(B) A "free clinic" means a clinic operated by a tax-exempt,
nonprofit corporation supported in whole or in part by voluntary
donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a free clinic there shall be no charges directly to the patient
for services rendered or for drugs, medicines, appliances, or
apparatuses furnished. No corporation other than a nonprofit
corporation exempt from federal income taxation under paragraph (3)
of subsection (c) of Section 501 of the Internal Revenue Code of 1954
as amended, or a statutory successor thereof, shall operate a free
clinic; provided, that the licensee of any free clinic so licensed on
the effective date of this section shall not be required to obtain
tax-exempt status under either federal or state law in order to be
eligible for, or as a condition of, renewal of its license. No
natural person or persons shall operate a free clinic.
(2) Nothing in this subdivision shall prohibit a community clinic
or a free clinic from providing services to patients whose services
are reimbursed by third-party payers, or from entering into managed
care contracts for services provided to private or public health plan
subscribers, as long as the clinic meets the requirements identified
in subparagraphs (A) and (B). For purposes of this subdivision, any
payments made to a community clinic by a third-party payer,
including, but not limited to, a health care service plan, shall not
constitute a charge to the patient. This paragraph is a clarification
of existing law.
(b) The following types of specialty clinics shall be eligible for
licensure as specialty clinics pursuant to this chapter:
(1) A "surgical clinic" means a clinic that is not part of a
hospital and that provides ambulatory surgical care for patients who
remain less than 24 hours. A surgical clinic does not include any
place or establishment owned or leased and operated as a clinic or
office by one or more physicians or dentists in individual or group
practice, regardless of the name used publicly to identify the place
or establishment, provided, however, that physicians or dentists may,
at their option, apply for licensure.
(2) A "chronic dialysis clinic" means a clinic that provides less
than 24-hour care for the treatment of patients with end-stage renal
disease, including renal dialysis services.
(3) A "rehabilitation clinic" means a clinic that, in addition to
providing medical services directly, also provides physical
rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following
rehabilitation services: physical therapy, occupational therapy,
social, speech pathology, and audiology services. A rehabilitation
clinic does not include the offices of a private physician in
individual or group practice.
(4) An "alternative birth center" means a clinic that is not part
of a hospital and that provides comprehensive perinatal services and
delivery care to pregnant women who remain less than 24 hours at the
facility.
1204.1. In addition to the primary care clinics and specialty
clinics specified in Section 1204, clinics eligible for licensure
pursuant to this chapter include psychology clinics. A "psychology
clinic" is a clinic which provides psychological advice, services, or
treatment to patients, under the direction of a clinical
psychologist as defined in Section 1316.5, and is operated by a
tax-exempt nonprofit corporation which is supported and maintained in
whole or in part by donations, bequests, gifts, grants, government
funds, or contributions which may be in the form of money, goods, or
services. In a psychology clinic, any charges to the patient shall be
based on the patient's ability to pay, utilizing a sliding fee
scale. No corporation other than a nonprofit corporation, exempt from
federal taxation under paragraph (3), subsection (c) of Section 501
of the Internal Revenue Code of 1954, as amended, or a statutory
successor thereof, shall operate a psychology clinic.
Each psychology clinic licensed pursuant to this section shall
comply with the provisions of Part 2 (commencing with Section 13100)
of Division 12.
Only a psychology clinic may be licensed under this chapter to
exclusively provide psychological advice, services, or treatment.
However, nothing in this subdivision precludes clinics specified in
Section 1204 from providing psychological advice, services, or
treatment as included within, or adjunctive to, medical advice,
services, or treatment provided by such clinics. Failure to comply
with the requirements of this section may be grounds for denial,
revocation, or suspension of the license.
1204.3. (a) An alternative birth center that is licensed as an
alternative birth center specialty clinic pursuant to paragraph (4)
of subdivision (b) of Section 1204 shall, as a condition of
licensure, and a primary care clinic licensed pursuant to subdivision
(a) of Section 1204 that provides services as an alternative birth
center shall, meet all of the following requirements:
(1) Be a provider of comprehensive perinatal services as defined
in Section 14134.5 of the Welfare and Institutions Code.
(2) Maintain a quality assurance program.
(3) Meet the standards for certification established by the
National Association of Childbearing Centers, or at least equivalent
standards as determined by the state department.
(4) In addition to standards of the National Association of
Childbearing Centers regarding proximity to hospitals and presence of
attendants at births, meet both of the following conditions:
(A) Be located in proximity, in time and distance, to a facility
with the capacity for management of obstetrical and neonatal
emergencies, including the ability to provide cesarean section
delivery, within 30 minutes from time of diagnosis of the emergency.
(B) Require the presence of at least two attendants at all times
during birth, one of whom shall be either a physician and surgeon or
a certified nurse-midwife.
(5) Have 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 of the Vehicle Code
or Section 27362 of that code.
(C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.
(b) The state department shall issue a permit to a primary care
clinic licensed pursuant to subdivision (a) of Section 1204
certifying that the primary care clinic has met the requirements of
this section and may provide services as an alternative birth center.
Nothing in this section shall be construed to require that a
licensed primary care clinic obtain an additional license in order to
provide services as an alternative birth center.
(c) (1) Notwithstanding subdivision (a) of Section 1206, no place
or establishment owned or leased and operated as a clinic or office
by one or more licensed health care practitioners and used as an
office for the practice of their profession, within the scope of
their license, shall be represented or otherwise held out to be an
alternative birth center licensed by the state unless it meets the
requirements of this section.
(2) Nothing in this subdivision shall be construed to prohibit
licensed health care practitioners from providing birth related
services, within the scope of their license, in a place or
establishment described in paragraph (1).
1204.4. The State Department of Health Services shall provide
information to the California Health Facilities Financing Authority
with respect to primary care clinic grant applicants for capital
outlay projects as specified in Section 15438.6 of the Government
Code.
1204.5. Primary care clinics may submit verification of Joint
Commission on Accreditation of Healthcare Organization (JCAHO)
certification to the Licensing and Certification Division within the
State Department of Public Health for entry into the electronic
Licensing Management System for purposes of data collection and
extraction for licensing and certification fee calculations.
1205. Except as provided in Section 1206, no person, firm,
partnership, association, corporation, or public agency shall
operate, establish, manage, conduct or maintain a clinic in this
state without first obtaining a license therefor as provided in this
chapter; nor shall any such person, firm, partnership, association,
corporation, or public agency provide any special service without
obtaining a special permit therefor. However, any licensed clinic
offering any service which is later designated by regulation of the
state department as a special service shall be allowed to continue
offering such service until the state department evaluates the
quality of such service and issues a special permit therefor or
notifies the licensee that it is not eligible for a special permit
and must cease and desist from offering such service.
1205.5. A clinic that has been verified by the Licensing and
Certification Division of the State Department of Health Services and
the Office of Statewide Health Planning and Development as having
(1) provided chronic dialysis and (2) been licensed as an outpatient
clinic, before September 26, 1978, shall not be required to have a
certificate of need pursuant to Chapter 1 (commencing with Section
127125) of Part 2 of Division 107 in order to obtain licensure as a
chronic dialysis clinic. A clinic that has been verified by the
Licensing and Certification Division of the State Department of
Health Services and the Office of Statewide Health Planning and
Development as having (1) provided surgical services, (2) been
licensed as an outpatient clinic and (3) been eligible to receive
Medi-Cal reimbursement as an outpatient clinic in connection with the
surgical services, before September 26, 1978, shall not be required
to have a certificate of need pursuant to Chapter 1 (commencing with
Section 127125) of Part 2 of Division 107 in order to obtain
licensure as a surgical clinic.
Nothing in this section shall, however, be construed to exempt a
clinic subject to this section from the requirement for a certificate
of need with respect to projects specified in subdivision (c), (d),
or (e) of Section 127170, or with respect to changes of licensure
category occurring subsequent to initial licensure as a specialty
clinic pursuant to this section.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
surgical services, (2) been licensed as an outpatient clinic and (3)
been eligible to receive Medi-Cal reimbursement as an outpatient
clinic in connection with the surgical services, before September 26,
1978, and that meets the requirements for licensure as a surgical
clinic, need not operate on an open-staff basis in order to be
licensed as a surgical clinic.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
rehabilitation service and (2) been licensed as an outpatient clinic,
a community clinic, or free clinic, before September 26, 1978, shall
not be required to have a certificate of need pursuant to Chapter 1
(commencing with Section 127125) of Part 2 of Division 107 in order
to obtain licensure as a rehabilitation clinic.
1206. This chapter does not apply to the following:
(a) Except with respect to the option provided with regard to
surgical clinics in paragraph (1) of subdivision (b) of Section 1204
and, further, with respect to specialty clinics specified in
paragraph (2) of subdivision (b) of Section 1204, any place or
establishment owned or leased and operated as a clinic or office by
one or more licensed health care practitioners and used as an office
for the practice of their profession, within the scope of their
license, regardless of the name used publicly to identify the place
or establishment.
(b) Any clinic directly conducted, maintained, or operated by the
United States or by any of its departments, officers, or agencies,
and any primary care clinic specified in subdivision (a) of Section
1204 that is directly conducted, maintained, or operated by this
state or by any of its political subdivisions or districts, or by any
city. Nothing in this subdivision precludes the state department
from adopting regulations that utilize clinic licensing standards as
eligibility criteria for participation in programs funded wholly or
partially under Title XVIII or XIX of the federal Social Security
Act.
(c) Any clinic conducted, maintained, or operated by a federally
recognized Indian tribe or tribal organization, as defined in Section
450 or 1601 of Title 25 of the United States Code, that is located
on land recognized as tribal land by the federal government.
(d) Clinics conducted, operated, or maintained as outpatient
departments of hospitals.
(e) Any facility licensed as a health facility under Chapter 2
(commencing with Section 1250).
(f) Any freestanding clinical or pathological laboratory licensed
under Chapter 3 (commencing with Section 1200) of Division 2 of the
Business and Professions Code.
(g) A clinic operated by, or affiliated with, any institution of
learning that teaches a recognized healing art and is approved by the
state board or commission vested with responsibility for regulation
of the practice of that healing art.
(h) 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 20 hours
a week. An intermittent clinic as described in this subdivision
shall, however, meet all other requirements of law, including
administrative regulations and requirements, pertaining to fire and
life safety.
(i) The offices of physicians in group practice who provide a
preponderance of their services to members of a comprehensive group
practice prepayment health care service plan subject to Chapter 2.2
(commencing with Section 1340).
(j) Student health centers operated by public institutions of
higher education.
(k) Nonprofit speech and hearing centers, as defined in Section
1201.5. Any nonprofit speech and hearing clinic desiring an exemption
under this subdivision shall make application therefor to the
director, who shall grant the exemption to any facility meeting the
criteria of Section 1201.5. Notwithstanding the licensure exemption
contained in this subdivision, a nonprofit speech and hearing center
shall be deemed to be an organized outpatient clinic for purposes of
qualifying for reimbursement as a rehabilitation center under the
Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code).
(l) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, that conducts medical research and
health education and provides health care to its patients through a
group of 40 or more physicians and surgeons, who are independent
contractors representing not less than 10 board-certified
specialties, and not less than two-thirds of whom practice on a
full-time basis at the clinic.
(m) Any clinic, limited to in vivo diagnostic services by magnetic
resonance imaging functions or radiological services under the
direct and immediate supervision of a physician and surgeon who is
licensed to practice in California. This shall not be construed to
permit cardiac catheterization or any treatment modality in these
clinics.
(n) A clinic operated by an employer or jointly by two or more
employers for their employees only, or by a group of employees, or
jointly by employees and employers, without profit to the operators
thereof or to any other person, for the prevention and treatment of
accidental injuries to, and the care of the health of, the employees
comprising the group.
(o) A community mental health center, as defined in Section 5601.5
of the Welfare and Institutions Code.
(p) (1) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, as an entity organized and operated
exclusively for scientific and charitable purposes and that satisfied
all of the following requirements on or before January 1, 2005:
(A) Commenced conducting medical research on or before January 1,
1982, and continues to conduct medical research.
(B) Conducted research in, among other areas, prostatic cancer,
cardiovascular disease, electronic neural prosthetic devices,
biological effects and medical uses of lasers, and human magnetic
resonance imaging and spectroscopy.
(C) Sponsored publication of at least 200 medical research
articles in peer-reviewed publications.
(D) Received grants and contracts from the National Institutes of
Health.
(E) Held and licensed patents on medical technology.
(F) Received charitable contributions and bequests totaling at
least five million dollars ($5,000,000).
(G) Provides health care services to patients only:
(i) In conjunction with research being conducted on procedures or
applications not approved or only partially approved for payment (I)
under the Medicare program pursuant to Section 1359y(a)(1)(A) of
Title 42 of the United States Code, or (II) by a health care service
plan registered under Chapter 2.2 (commencing with Section 1340), or
a disability insurer regulated under Chapter 1 (commencing with
Section 10110) of Part 2 of Division 2 of the Insurance Code;
provided that services may be provided by the clinic for an
additional period of up to three years following the approvals, but
only to the extent necessary to maintain clinical expertise in the
procedure or application for purposes of actively providing training
in the procedure or application for physicians and surgeons unrelated
to the clinic.
(ii) Through physicians and surgeons who, in the aggregate, devote
no more than 30 percent of their professional time for the entity
operating the clinic, on an annual basis, to direct patient care
activities for which charges for professional services are paid.
(H) Makes available to the public the general results of its
research activities on at least an annual basis, subject to good
faith protection of proprietary rights in its intellectual property.
(I) Is a freestanding clinic, whose operations under this
subdivision are not conducted in conjunction with any affiliated or
associated health clinic or facility defined under this division,
except a clinic exempt from licensure under subdivision (m). For
purposes of this subparagraph, a freestanding clinic is defined as
"affiliated" only if it directly, or indirectly through one or more
intermediaries, controls, or is controlled by, or is under common
control with, a clinic or health facility defined under this
division, except a clinic exempt from licensure under subdivision
(m). For purposes of this subparagraph, a freestanding clinic is
defined as "associated" only if more than 20 percent of the directors
or trustees of the clinic are also the directors or trustees of any
individual clinic or health facility defined under this division,
except a clinic exempt from licensure under subdivision (m). Any
activity by a clinic under this subdivision in connection with an
affiliated or associated entity shall fully comply with the
requirements of this subdivision. This subparagraph shall not apply
to agreements between a clinic and any entity for purposes of
coordinating medical research.
(2) By January 1, 2007, and every five years thereafter, the
Legislature shall receive a report from each clinic meeting the
criteria of this subdivision and any other interested party
concerning the operation of the clinic's activities. The report shall
include, but not be limited to, an evaluation of how the clinic
impacted competition in the relevant health care market, and a
detailed description of the clinic's research results and the level
of acceptance by the payer community of the procedures performed at
the clinic. The report shall also include a description of procedures
performed both in clinics governed by this subdivision and those
performed in other settings. The cost of preparing the reports shall
be borne by the clinics that are required to submit them to the
Legislature pursuant to this paragraph.
1206.1. The provisions of this chapter do not require licensure of
any place or establishment owned or leased and operated as a clinic
or office by one or more licensed psychologists and used as an office
for the practice of psychology, regardless of the name used publicly
to identify such place or establishment.
1207. The state department shall inspect and license clinics, and
shall inspect and approve clinics to offer special services.
1208. The state department may provide consulting services upon
request to any clinic to assist in the identification or correction
of deficiencies or the upgrading of the quality of care provided by
the clinic.
1209. This chapter does not authorize any person other than a
licensed practitioner of a healing art, or any corporation except
charitable or professional corporations as expressly provided in this
chapter, to furnish to any person any advice, services, or treatment
within the scope of such professional licensure.
This chapter does not authorize any person, other than a
licentiate of a healing art acting within the scope of his or her
license, to engage directly or indirectly in the practice of medicine
and surgery, dentistry, optometry, podiatry, psychology, or
pharmacy.
This chapter does not regulate, govern, or affect in any manner
the practice of medicine and surgery, pharmacy, dentistry, optometry,
chiropractic, podiatry, psychology, or drugless healing by any
person duly licensed to engage in such practice.
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 paragraph
(1) of subdivision (a) of Section 1204, that are required to be
licensed under Section 1205, 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.
(5) "Centralized applications unit" means the centralized
applications unit in the Licensing and Certification Division of the
department, or a successor entity.
1200.1. (a) As used in this chapter, "clinic" also means an
organized outpatient health facility which, pursuant to Section
1204.1, provides direct psychological advice, services, or treatment
to patients who remain less than 24 hours, and which may also provide
diagnostic or therapeutic services authorized under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code to patients in the home as an incident to care
provided at the clinic facility.
(b) Psychological clinics, as defined in Section 1204.1, shall not
be considered primary care clinics for the purposes of any state
grants, state loans, or other state aid.
Nothing contained in this section shall prohibit psychological
clinics from receiving payment to which they are otherwise entitled
from the state or in which the state participates financially, for
services rendered pursuant to their license.
(c) Any reference in any statute to Section 1200 shall be deemed
and construed to also be a reference to this section.
1201. "License" means a basic permit to operate a clinic. A license
may only be granted to a clinic of a type enumerated in Section 1204
or 1204.1, and the license shall not be transferable. However, the
issuance of a license upon a change of ownership shall not of itself
constitute a project within the meaning of Section 127170.
1201.5. "Nonprofit speech and hearing center" means a nonprofit
agency which provides an integrated program of speech pathology and
audiology services in an outpatient setting designed to improve the
functioning of persons with communicative disorders. A nonprofit
speech and hearing center provides diagnostic and therapeutic
services for such individuals, together with related counseling,
pursuant to policies and procedures governing all aspects of the
program formulated with the aid of one or more physicians and
surgeons, who shall additionally serve on separate committees which
determine patient care policy and perform utilization review
functions. A multidisciplinary panel, which includes one or more
physicians and surgeons, shall serve as a consulting advisory body to
the center. All patients of the center shall be referred by a
physician and surgeon, or by a dentist or psychologist as
appropriate. A center shall prepare, maintain, and revise, as
necessary, a treatment plan for all active patients, and shall
provide periodic progress reports to the physician and surgeon or
other professional referring the patient. A center shall maintain a
complete record of all services rendered with respect to each
patient.
1202. "Special permit" means a permit issued in addition to a
license authorizing the clinic to offer one or more special services,
as defined in Section 1203 or regulations adopted pursuant thereto.
1203. "Special service" means a functional division, department, or
unit of a clinic, or a clinic that is organized, staffed, and
equipped to provide a specific type or types of care which have been
identified by this section or by regulations of the state department,
and for which the state department has established special standards
for ensuring the quality of such care. Special services shall
include, but need not be limited to, birth services.
1204. Clinics eligible for licensure pursuant to this chapter are
primary care clinics and specialty clinics.
(a) (1) Only the following defined classes of primary care clinics
shall be eligible for licensure:
(A) A "community clinic" means a clinic operated by a tax-exempt
nonprofit corporation that is supported and maintained in whole or in
part by donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on
the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal
income taxation under paragraph (3) of subsection (c) of Section 501
of the Internal Revenue Code of 1954 as amended, or a statutory
successor thereof, shall operate a community clinic; provided, that
the licensee of any community clinic so licensed on the effective
date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for,
or as a condition of, renewal of its license. No natural person or
persons shall operate a community clinic.
(B) A "free clinic" means a clinic operated by a tax-exempt,
nonprofit corporation supported in whole or in part by voluntary
donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a free clinic there shall be no charges directly to the patient
for services rendered or for drugs, medicines, appliances, or
apparatuses furnished. No corporation other than a nonprofit
corporation exempt from federal income taxation under paragraph (3)
of subsection (c) of Section 501 of the Internal Revenue Code of 1954
as amended, or a statutory successor thereof, shall operate a free
clinic; provided, that the licensee of any free clinic so licensed on
the effective date of this section shall not be required to obtain
tax-exempt status under either federal or state law in order to be
eligible for, or as a condition of, renewal of its license. No
natural person or persons shall operate a free clinic.
(2) Nothing in this subdivision shall prohibit a community clinic
or a free clinic from providing services to patients whose services
are reimbursed by third-party payers, or from entering into managed
care contracts for services provided to private or public health plan
subscribers, as long as the clinic meets the requirements identified
in subparagraphs (A) and (B). For purposes of this subdivision, any
payments made to a community clinic by a third-party payer,
including, but not limited to, a health care service plan, shall not
constitute a charge to the patient. This paragraph is a clarification
of existing law.
(b) The following types of specialty clinics shall be eligible for
licensure as specialty clinics pursuant to this chapter:
(1) A "surgical clinic" means a clinic that is not part of a
hospital and that provides ambulatory surgical care for patients who
remain less than 24 hours. A surgical clinic does not include any
place or establishment owned or leased and operated as a clinic or
office by one or more physicians or dentists in individual or group
practice, regardless of the name used publicly to identify the place
or establishment, provided, however, that physicians or dentists may,
at their option, apply for licensure.
(2) A "chronic dialysis clinic" means a clinic that provides less
than 24-hour care for the treatment of patients with end-stage renal
disease, including renal dialysis services.
(3) A "rehabilitation clinic" means a clinic that, in addition to
providing medical services directly, also provides physical
rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following
rehabilitation services: physical therapy, occupational therapy,
social, speech pathology, and audiology services. A rehabilitation
clinic does not include the offices of a private physician in
individual or group practice.
(4) An "alternative birth center" means a clinic that is not part
of a hospital and that provides comprehensive perinatal services and
delivery care to pregnant women who remain less than 24 hours at the
facility.
1204.1. In addition to the primary care clinics and specialty
clinics specified in Section 1204, clinics eligible for licensure
pursuant to this chapter include psychology clinics. A "psychology
clinic" is a clinic which provides psychological advice, services, or
treatment to patients, under the direction of a clinical
psychologist as defined in Section 1316.5, and is operated by a
tax-exempt nonprofit corporation which is supported and maintained in
whole or in part by donations, bequests, gifts, grants, government
funds, or contributions which may be in the form of money, goods, or
services. In a psychology clinic, any charges to the patient shall be
based on the patient's ability to pay, utilizing a sliding fee
scale. No corporation other than a nonprofit corporation, exempt from
federal taxation under paragraph (3), subsection (c) of Section 501
of the Internal Revenue Code of 1954, as amended, or a statutory
successor thereof, shall operate a psychology clinic.
Each psychology clinic licensed pursuant to this section shall
comply with the provisions of Part 2 (commencing with Section 13100)
of Division 12.
Only a psychology clinic may be licensed under this chapter to
exclusively provide psychological advice, services, or treatment.
However, nothing in this subdivision precludes clinics specified in
Section 1204 from providing psychological advice, services, or
treatment as included within, or adjunctive to, medical advice,
services, or treatment provided by such clinics. Failure to comply
with the requirements of this section may be grounds for denial,
revocation, or suspension of the license.
1204.3. (a) An alternative birth center that is licensed as an
alternative birth center specialty clinic pursuant to paragraph (4)
of subdivision (b) of Section 1204 shall, as a condition of
licensure, and a primary care clinic licensed pursuant to subdivision
(a) of Section 1204 that provides services as an alternative birth
center shall, meet all of the following requirements:
(1) Be a provider of comprehensive perinatal services as defined
in Section 14134.5 of the Welfare and Institutions Code.
(2) Maintain a quality assurance program.
(3) Meet the standards for certification established by the
National Association of Childbearing Centers, or at least equivalent
standards as determined by the state department.
(4) In addition to standards of the National Association of
Childbearing Centers regarding proximity to hospitals and presence of
attendants at births, meet both of the following conditions:
(A) Be located in proximity, in time and distance, to a facility
with the capacity for management of obstetrical and neonatal
emergencies, including the ability to provide cesarean section
delivery, within 30 minutes from time of diagnosis of the emergency.
(B) Require the presence of at least two attendants at all times
during birth, one of whom shall be either a physician and surgeon or
a certified nurse-midwife.
(5) Have 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 of the Vehicle Code
or Section 27362 of that code.
(C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.
(b) The state department shall issue a permit to a primary care
clinic licensed pursuant to subdivision (a) of Section 1204
certifying that the primary care clinic has met the requirements of
this section and may provide services as an alternative birth center.
Nothing in this section shall be construed to require that a
licensed primary care clinic obtain an additional license in order to
provide services as an alternative birth center.
(c) (1) Notwithstanding subdivision (a) of Section 1206, no place
or establishment owned or leased and operated as a clinic or office
by one or more licensed health care practitioners and used as an
office for the practice of their profession, within the scope of
their license, shall be represented or otherwise held out to be an
alternative birth center licensed by the state unless it meets the
requirements of this section.
(2) Nothing in this subdivision shall be construed to prohibit
licensed health care practitioners from providing birth related
services, within the scope of their license, in a place or
establishment described in paragraph (1).
1204.4. The State Department of Health Services shall provide
information to the California Health Facilities Financing Authority
with respect to primary care clinic grant applicants for capital
outlay projects as specified in Section 15438.6 of the Government
Code.
1204.5. Primary care clinics may submit verification of Joint
Commission on Accreditation of Healthcare Organization (JCAHO)
certification to the Licensing and Certification Division within the
State Department of Public Health for entry into the electronic
Licensing Management System for purposes of data collection and
extraction for licensing and certification fee calculations.
1205. Except as provided in Section 1206, no person, firm,
partnership, association, corporation, or public agency shall
operate, establish, manage, conduct or maintain a clinic in this
state without first obtaining a license therefor as provided in this
chapter; nor shall any such person, firm, partnership, association,
corporation, or public agency provide any special service without
obtaining a special permit therefor. However, any licensed clinic
offering any service which is later designated by regulation of the
state department as a special service shall be allowed to continue
offering such service until the state department evaluates the
quality of such service and issues a special permit therefor or
notifies the licensee that it is not eligible for a special permit
and must cease and desist from offering such service.
1205.5. A clinic that has been verified by the Licensing and
Certification Division of the State Department of Health Services and
the Office of Statewide Health Planning and Development as having
(1) provided chronic dialysis and (2) been licensed as an outpatient
clinic, before September 26, 1978, shall not be required to have a
certificate of need pursuant to Chapter 1 (commencing with Section
127125) of Part 2 of Division 107 in order to obtain licensure as a
chronic dialysis clinic. A clinic that has been verified by the
Licensing and Certification Division of the State Department of
Health Services and the Office of Statewide Health Planning and
Development as having (1) provided surgical services, (2) been
licensed as an outpatient clinic and (3) been eligible to receive
Medi-Cal reimbursement as an outpatient clinic in connection with the
surgical services, before September 26, 1978, shall not be required
to have a certificate of need pursuant to Chapter 1 (commencing with
Section 127125) of Part 2 of Division 107 in order to obtain
licensure as a surgical clinic.
Nothing in this section shall, however, be construed to exempt a
clinic subject to this section from the requirement for a certificate
of need with respect to projects specified in subdivision (c), (d),
or (e) of Section 127170, or with respect to changes of licensure
category occurring subsequent to initial licensure as a specialty
clinic pursuant to this section.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
surgical services, (2) been licensed as an outpatient clinic and (3)
been eligible to receive Medi-Cal reimbursement as an outpatient
clinic in connection with the surgical services, before September 26,
1978, and that meets the requirements for licensure as a surgical
clinic, need not operate on an open-staff basis in order to be
licensed as a surgical clinic.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
rehabilitation service and (2) been licensed as an outpatient clinic,
a community clinic, or free clinic, before September 26, 1978, shall
not be required to have a certificate of need pursuant to Chapter 1
(commencing with Section 127125) of Part 2 of Division 107 in order
to obtain licensure as a rehabilitation clinic.
1206. This chapter does not apply to the following:
(a) Except with respect to the option provided with regard to
surgical clinics in paragraph (1) of subdivision (b) of Section 1204
and, further, with respect to specialty clinics specified in
paragraph (2) of subdivision (b) of Section 1204, any place or
establishment owned or leased and operated as a clinic or office by
one or more licensed health care practitioners and used as an office
for the practice of their profession, within the scope of their
license, regardless of the name used publicly to identify the place
or establishment.
(b) Any clinic directly conducted, maintained, or operated by the
United States or by any of its departments, officers, or agencies,
and any primary care clinic specified in subdivision (a) of Section
1204 that is directly conducted, maintained, or operated by this
state or by any of its political subdivisions or districts, or by any
city. Nothing in this subdivision precludes the state department
from adopting regulations that utilize clinic licensing standards as
eligibility criteria for participation in programs funded wholly or
partially under Title XVIII or XIX of the federal Social Security
Act.
(c) Any clinic conducted, maintained, or operated by a federally
recognized Indian tribe or tribal organization, as defined in Section
450 or 1601 of Title 25 of the United States Code, that is located
on land recognized as tribal land by the federal government.
(d) Clinics conducted, operated, or maintained as outpatient
departments of hospitals.
(e) Any facility licensed as a health facility under Chapter 2
(commencing with Section 1250).
(f) Any freestanding clinical or pathological laboratory licensed
under Chapter 3 (commencing with Section 1200) of Division 2 of the
Business and Professions Code.
(g) A clinic operated by, or affiliated with, any institution of
learning that teaches a recognized healing art and is approved by the
state board or commission vested with responsibility for regulation
of the practice of that healing art.
(h) 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 20 hours
a week. An intermittent clinic as described in this subdivision
shall, however, meet all other requirements of law, including
administrative regulations and requirements, pertaining to fire and
life safety.
(i) The offices of physicians in group practice who provide a
preponderance of their services to members of a comprehensive group
practice prepayment health care service plan subject to Chapter 2.2
(commencing with Section 1340).
(j) Student health centers operated by public institutions of
higher education.
(k) Nonprofit speech and hearing centers, as defined in Section
1201.5. Any nonprofit speech and hearing clinic desiring an exemption
under this subdivision shall make application therefor to the
director, who shall grant the exemption to any facility meeting the
criteria of Section 1201.5. Notwithstanding the licensure exemption
contained in this subdivision, a nonprofit speech and hearing center
shall be deemed to be an organized outpatient clinic for purposes of
qualifying for reimbursement as a rehabilitation center under the
Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code).
(l) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, that conducts medical research and
health education and provides health care to its patients through a
group of 40 or more physicians and surgeons, who are independent
contractors representing not less than 10 board-certified
specialties, and not less than two-thirds of whom practice on a
full-time basis at the clinic.
(m) Any clinic, limited to in vivo diagnostic services by magnetic
resonance imaging functions or radiological services under the
direct and immediate supervision of a physician and surgeon who is
licensed to practice in California. This shall not be construed to
permit cardiac catheterization or any treatment modality in these
clinics.
(n) A clinic operated by an employer or jointly by two or more
employers for their employees only, or by a group of employees, or
jointly by employees and employers, without profit to the operators
thereof or to any other person, for the prevention and treatment of
accidental injuries to, and the care of the health of, the employees
comprising the group.
(o) A community mental health center, as defined in Section 5601.5
of the Welfare and Institutions Code.
(p) (1) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, as an entity organized and operated
exclusively for scientific and charitable purposes and that satisfied
all of the following requirements on or before January 1, 2005:
(A) Commenced conducting medical research on or before January 1,
1982, and continues to conduct medical research.
(B) Conducted research in, among other areas, prostatic cancer,
cardiovascular disease, electronic neural prosthetic devices,
biological effects and medical uses of lasers, and human magnetic
resonance imaging and spectroscopy.
(C) Sponsored publication of at least 200 medical research
articles in peer-reviewed publications.
(D) Received grants and contracts from the National Institutes of
Health.
(E) Held and licensed patents on medical technology.
(F) Received charitable contributions and bequests totaling at
least five million dollars ($5,000,000).
(G) Provides health care services to patients only:
(i) In conjunction with research being conducted on procedures or
applications not approved or only partially approved for payment (I)
under the Medicare program pursuant to Section 1359y(a)(1)(A) of
Title 42 of the United States Code, or (II) by a health care service
plan registered under Chapter 2.2 (commencing with Section 1340), or
a disability insurer regulated under Chapter 1 (commencing with
Section 10110) of Part 2 of Division 2 of the Insurance Code;
provided that services may be provided by the clinic for an
additional period of up to three years following the approvals, but
only to the extent necessary to maintain clinical expertise in the
procedure or application for purposes of actively providing training
in the procedure or application for physicians and surgeons unrelated
to the clinic.
(ii) Through physicians and surgeons who, in the aggregate, devote
no more than 30 percent of their professional time for the entity
operating the clinic, on an annual basis, to direct patient care
activities for which charges for professional services are paid.
(H) Makes available to the public the general results of its
research activities on at least an annual basis, subject to good
faith protection of proprietary rights in its intellectual property.
(I) Is a freestanding clinic, whose operations under this
subdivision are not conducted in conjunction with any affiliated or
associated health clinic or facility defined under this division,
except a clinic exempt from licensure under subdivision (m). For
purposes of this subparagraph, a freestanding clinic is defined as
"affiliated" only if it directly, or indirectly through one or more
intermediaries, controls, or is controlled by, or is under common
control with, a clinic or health facility defined under this
division, except a clinic exempt from licensure under subdivision
(m). For purposes of this subparagraph, a freestanding clinic is
defined as "associated" only if more than 20 percent of the directors
or trustees of the clinic are also the directors or trustees of any
individual clinic or health facility defined under this division,
except a clinic exempt from licensure under subdivision (m). Any
activity by a clinic under this subdivision in connection with an
affiliated or associated entity shall fully comply with the
requirements of this subdivision. This subparagraph shall not apply
to agreements between a clinic and any entity for purposes of
coordinating medical research.
(2) By January 1, 2007, and every five years thereafter, the
Legislature shall receive a report from each clinic meeting the
criteria of this subdivision and any other interested party
concerning the operation of the clinic's activities. The report shall
include, but not be limited to, an evaluation of how the clinic
impacted competition in the relevant health care market, and a
detailed description of the clinic's research results and the level
of acceptance by the payer community of the procedures performed at
the clinic. The report shall also include a description of procedures
performed both in clinics governed by this subdivision and those
performed in other settings. The cost of preparing the reports shall
be borne by the clinics that are required to submit them to the
Legislature pursuant to this paragraph.
1206.1. The provisions of this chapter do not require licensure of
any place or establishment owned or leased and operated as a clinic
or office by one or more licensed psychologists and used as an office
for the practice of psychology, regardless of the name used publicly
to identify such place or establishment.
1207. The state department shall inspect and license clinics, and
shall inspect and approve clinics to offer special services.
1208. The state department may provide consulting services upon
request to any clinic to assist in the identification or correction
of deficiencies or the upgrading of the quality of care provided by
the clinic.
1209. This chapter does not authorize any person other than a
licensed practitioner of a healing art, or any corporation except
charitable or professional corporations as expressly provided in this
chapter, to furnish to any person any advice, services, or treatment
within the scope of such professional licensure.
This chapter does not authorize any person, other than a
licentiate of a healing art acting within the scope of his or her
license, to engage directly or indirectly in the practice of medicine
and surgery, dentistry, optometry, podiatry, psychology, or
pharmacy.
This chapter does not regulate, govern, or affect in any manner
the practice of medicine and surgery, pharmacy, dentistry, optometry,
chiropractic, podiatry, psychology, or drugless healing by any
person duly licensed to engage in such practice.
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 paragraph
(1) of subdivision (a) of Section 1204, that are required to be
licensed under Section 1205, 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.
(5) "Centralized applications unit" means the centralized
applications unit in the Licensing and Certification Division of the
department, or a successor entity.
1200.1. (a) As used in this chapter, "clinic" also means an
organized outpatient health facility which, pursuant to Section
1204.1, provides direct psychological advice, services, or treatment
to patients who remain less than 24 hours, and which may also provide
diagnostic or therapeutic services authorized under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code to patients in the home as an incident to care
provided at the clinic facility.
(b) Psychological clinics, as defined in Section 1204.1, shall not
be considered primary care clinics for the purposes of any state
grants, state loans, or other state aid.
Nothing contained in this section shall prohibit psychological
clinics from receiving payment to which they are otherwise entitled
from the state or in which the state participates financially, for
services rendered pursuant to their license.
(c) Any reference in any statute to Section 1200 shall be deemed
and construed to also be a reference to this section.
1201. "License" means a basic permit to operate a clinic. A license
may only be granted to a clinic of a type enumerated in Section 1204
or 1204.1, and the license shall not be transferable. However, the
issuance of a license upon a change of ownership shall not of itself
constitute a project within the meaning of Section 127170.
1201.5. "Nonprofit speech and hearing center" means a nonprofit
agency which provides an integrated program of speech pathology and
audiology services in an outpatient setting designed to improve the
functioning of persons with communicative disorders. A nonprofit
speech and hearing center provides diagnostic and therapeutic
services for such individuals, together with related counseling,
pursuant to policies and procedures governing all aspects of the
program formulated with the aid of one or more physicians and
surgeons, who shall additionally serve on separate committees which
determine patient care policy and perform utilization review
functions. A multidisciplinary panel, which includes one or more
physicians and surgeons, shall serve as a consulting advisory body to
the center. All patients of the center shall be referred by a
physician and surgeon, or by a dentist or psychologist as
appropriate. A center shall prepare, maintain, and revise, as
necessary, a treatment plan for all active patients, and shall
provide periodic progress reports to the physician and surgeon or
other professional referring the patient. A center shall maintain a
complete record of all services rendered with respect to each
patient.
1202. "Special permit" means a permit issued in addition to a
license authorizing the clinic to offer one or more special services,
as defined in Section 1203 or regulations adopted pursuant thereto.
1203. "Special service" means a functional division, department, or
unit of a clinic, or a clinic that is organized, staffed, and
equipped to provide a specific type or types of care which have been
identified by this section or by regulations of the state department,
and for which the state department has established special standards
for ensuring the quality of such care. Special services shall
include, but need not be limited to, birth services.
1204. Clinics eligible for licensure pursuant to this chapter are
primary care clinics and specialty clinics.
(a) (1) Only the following defined classes of primary care clinics
shall be eligible for licensure:
(A) A "community clinic" means a clinic operated by a tax-exempt
nonprofit corporation that is supported and maintained in whole or in
part by donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a community clinic, any charges to the patient shall be based on
the patient's ability to pay, utilizing a sliding fee scale. No
corporation other than a nonprofit corporation, exempt from federal
income taxation under paragraph (3) of subsection (c) of Section 501
of the Internal Revenue Code of 1954 as amended, or a statutory
successor thereof, shall operate a community clinic; provided, that
the licensee of any community clinic so licensed on the effective
date of this section shall not be required to obtain tax-exempt
status under either federal or state law in order to be eligible for,
or as a condition of, renewal of its license. No natural person or
persons shall operate a community clinic.
(B) A "free clinic" means a clinic operated by a tax-exempt,
nonprofit corporation supported in whole or in part by voluntary
donations, bequests, gifts, grants, government funds or
contributions, that may be in the form of money, goods, or services.
In a free clinic there shall be no charges directly to the patient
for services rendered or for drugs, medicines, appliances, or
apparatuses furnished. No corporation other than a nonprofit
corporation exempt from federal income taxation under paragraph (3)
of subsection (c) of Section 501 of the Internal Revenue Code of 1954
as amended, or a statutory successor thereof, shall operate a free
clinic; provided, that the licensee of any free clinic so licensed on
the effective date of this section shall not be required to obtain
tax-exempt status under either federal or state law in order to be
eligible for, or as a condition of, renewal of its license. No
natural person or persons shall operate a free clinic.
(2) Nothing in this subdivision shall prohibit a community clinic
or a free clinic from providing services to patients whose services
are reimbursed by third-party payers, or from entering into managed
care contracts for services provided to private or public health plan
subscribers, as long as the clinic meets the requirements identified
in subparagraphs (A) and (B). For purposes of this subdivision, any
payments made to a community clinic by a third-party payer,
including, but not limited to, a health care service plan, shall not
constitute a charge to the patient. This paragraph is a clarification
of existing law.
(b) The following types of specialty clinics shall be eligible for
licensure as specialty clinics pursuant to this chapter:
(1) A "surgical clinic" means a clinic that is not part of a
hospital and that provides ambulatory surgical care for patients who
remain less than 24 hours. A surgical clinic does not include any
place or establishment owned or leased and operated as a clinic or
office by one or more physicians or dentists in individual or group
practice, regardless of the name used publicly to identify the place
or establishment, provided, however, that physicians or dentists may,
at their option, apply for licensure.
(2) A "chronic dialysis clinic" means a clinic that provides less
than 24-hour care for the treatment of patients with end-stage renal
disease, including renal dialysis services.
(3) A "rehabilitation clinic" means a clinic that, in addition to
providing medical services directly, also provides physical
rehabilitation services for patients who remain less than 24 hours.
Rehabilitation clinics shall provide at least two of the following
rehabilitation services: physical therapy, occupational therapy,
social, speech pathology, and audiology services. A rehabilitation
clinic does not include the offices of a private physician in
individual or group practice.
(4) An "alternative birth center" means a clinic that is not part
of a hospital and that provides comprehensive perinatal services and
delivery care to pregnant women who remain less than 24 hours at the
facility.
1204.1. In addition to the primary care clinics and specialty
clinics specified in Section 1204, clinics eligible for licensure
pursuant to this chapter include psychology clinics. A "psychology
clinic" is a clinic which provides psychological advice, services, or
treatment to patients, under the direction of a clinical
psychologist as defined in Section 1316.5, and is operated by a
tax-exempt nonprofit corporation which is supported and maintained in
whole or in part by donations, bequests, gifts, grants, government
funds, or contributions which may be in the form of money, goods, or
services. In a psychology clinic, any charges to the patient shall be
based on the patient's ability to pay, utilizing a sliding fee
scale. No corporation other than a nonprofit corporation, exempt from
federal taxation under paragraph (3), subsection (c) of Section 501
of the Internal Revenue Code of 1954, as amended, or a statutory
successor thereof, shall operate a psychology clinic.
Each psychology clinic licensed pursuant to this section shall
comply with the provisions of Part 2 (commencing with Section 13100)
of Division 12.
Only a psychology clinic may be licensed under this chapter to
exclusively provide psychological advice, services, or treatment.
However, nothing in this subdivision precludes clinics specified in
Section 1204 from providing psychological advice, services, or
treatment as included within, or adjunctive to, medical advice,
services, or treatment provided by such clinics. Failure to comply
with the requirements of this section may be grounds for denial,
revocation, or suspension of the license.
1204.3. (a) An alternative birth center that is licensed as an
alternative birth center specialty clinic pursuant to paragraph (4)
of subdivision (b) of Section 1204 shall, as a condition of
licensure, and a primary care clinic licensed pursuant to subdivision
(a) of Section 1204 that provides services as an alternative birth
center shall, meet all of the following requirements:
(1) Be a provider of comprehensive perinatal services as defined
in Section 14134.5 of the Welfare and Institutions Code.
(2) Maintain a quality assurance program.
(3) Meet the standards for certification established by the
National Association of Childbearing Centers, or at least equivalent
standards as determined by the state department.
(4) In addition to standards of the National Association of
Childbearing Centers regarding proximity to hospitals and presence of
attendants at births, meet both of the following conditions:
(A) Be located in proximity, in time and distance, to a facility
with the capacity for management of obstetrical and neonatal
emergencies, including the ability to provide cesarean section
delivery, within 30 minutes from time of diagnosis of the emergency.
(B) Require the presence of at least two attendants at all times
during birth, one of whom shall be either a physician and surgeon or
a certified nurse-midwife.
(5) Have 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 of the Vehicle Code
or Section 27362 of that code.
(C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.
(b) The state department shall issue a permit to a primary care
clinic licensed pursuant to subdivision (a) of Section 1204
certifying that the primary care clinic has met the requirements of
this section and may provide services as an alternative birth center.
Nothing in this section shall be construed to require that a
licensed primary care clinic obtain an additional license in order to
provide services as an alternative birth center.
(c) (1) Notwithstanding subdivision (a) of Section 1206, no place
or establishment owned or leased and operated as a clinic or office
by one or more licensed health care practitioners and used as an
office for the practice of their profession, within the scope of
their license, shall be represented or otherwise held out to be an
alternative birth center licensed by the state unless it meets the
requirements of this section.
(2) Nothing in this subdivision shall be construed to prohibit
licensed health care practitioners from providing birth related
services, within the scope of their license, in a place or
establishment described in paragraph (1).
1204.4. The State Department of Health Services shall provide
information to the California Health Facilities Financing Authority
with respect to primary care clinic grant applicants for capital
outlay projects as specified in Section 15438.6 of the Government
Code.
1204.5. Primary care clinics may submit verification of Joint
Commission on Accreditation of Healthcare Organization (JCAHO)
certification to the Licensing and Certification Division within the
State Department of Public Health for entry into the electronic
Licensing Management System for purposes of data collection and
extraction for licensing and certification fee calculations.
1205. Except as provided in Section 1206, no person, firm,
partnership, association, corporation, or public agency shall
operate, establish, manage, conduct or maintain a clinic in this
state without first obtaining a license therefor as provided in this
chapter; nor shall any such person, firm, partnership, association,
corporation, or public agency provide any special service without
obtaining a special permit therefor. However, any licensed clinic
offering any service which is later designated by regulation of the
state department as a special service shall be allowed to continue
offering such service until the state department evaluates the
quality of such service and issues a special permit therefor or
notifies the licensee that it is not eligible for a special permit
and must cease and desist from offering such service.
1205.5. A clinic that has been verified by the Licensing and
Certification Division of the State Department of Health Services and
the Office of Statewide Health Planning and Development as having
(1) provided chronic dialysis and (2) been licensed as an outpatient
clinic, before September 26, 1978, shall not be required to have a
certificate of need pursuant to Chapter 1 (commencing with Section
127125) of Part 2 of Division 107 in order to obtain licensure as a
chronic dialysis clinic. A clinic that has been verified by the
Licensing and Certification Division of the State Department of
Health Services and the Office of Statewide Health Planning and
Development as having (1) provided surgical services, (2) been
licensed as an outpatient clinic and (3) been eligible to receive
Medi-Cal reimbursement as an outpatient clinic in connection with the
surgical services, before September 26, 1978, shall not be required
to have a certificate of need pursuant to Chapter 1 (commencing with
Section 127125) of Part 2 of Division 107 in order to obtain
licensure as a surgical clinic.
Nothing in this section shall, however, be construed to exempt a
clinic subject to this section from the requirement for a certificate
of need with respect to projects specified in subdivision (c), (d),
or (e) of Section 127170, or with respect to changes of licensure
category occurring subsequent to initial licensure as a specialty
clinic pursuant to this section.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
surgical services, (2) been licensed as an outpatient clinic and (3)
been eligible to receive Medi-Cal reimbursement as an outpatient
clinic in connection with the surgical services, before September 26,
1978, and that meets the requirements for licensure as a surgical
clinic, need not operate on an open-staff basis in order to be
licensed as a surgical clinic.
A clinic that has been verified by the Licensing and Certification
Division of the State Department of Health Services and the Office
of Statewide Health Planning and Development as having (1) provided
rehabilitation service and (2) been licensed as an outpatient clinic,
a community clinic, or free clinic, before September 26, 1978, shall
not be required to have a certificate of need pursuant to Chapter 1
(commencing with Section 127125) of Part 2 of Division 107 in order
to obtain licensure as a rehabilitation clinic.
1206. This chapter does not apply to the following:
(a) Except with respect to the option provided with regard to
surgical clinics in paragraph (1) of subdivision (b) of Section 1204
and, further, with respect to specialty clinics specified in
paragraph (2) of subdivision (b) of Section 1204, any place or
establishment owned or leased and operated as a clinic or office by
one or more licensed health care practitioners and used as an office
for the practice of their profession, within the scope of their
license, regardless of the name used publicly to identify the place
or establishment.
(b) Any clinic directly conducted, maintained, or operated by the
United States or by any of its departments, officers, or agencies,
and any primary care clinic specified in subdivision (a) of Section
1204 that is directly conducted, maintained, or operated by this
state or by any of its political subdivisions or districts, or by any
city. Nothing in this subdivision precludes the state department
from adopting regulations that utilize clinic licensing standards as
eligibility criteria for participation in programs funded wholly or
partially under Title XVIII or XIX of the federal Social Security
Act.
(c) Any clinic conducted, maintained, or operated by a federally
recognized Indian tribe or tribal organization, as defined in Section
450 or 1601 of Title 25 of the United States Code, that is located
on land recognized as tribal land by the federal government.
(d) Clinics conducted, operated, or maintained as outpatient
departments of hospitals.
(e) Any facility licensed as a health facility under Chapter 2
(commencing with Section 1250).
(f) Any freestanding clinical or pathological laboratory licensed
under Chapter 3 (commencing with Section 1200) of Division 2 of the
Business and Professions Code.
(g) A clinic operated by, or affiliated with, any institution of
learning that teaches a recognized healing art and is approved by the
state board or commission vested with responsibility for regulation
of the practice of that healing art.
(h) 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 20 hours
a week. An intermittent clinic as described in this subdivision
shall, however, meet all other requirements of law, including
administrative regulations and requirements, pertaining to fire and
life safety.
(i) The offices of physicians in group practice who provide a
preponderance of their services to members of a comprehensive group
practice prepayment health care service plan subject to Chapter 2.2
(commencing with Section 1340).
(j) Student health centers operated by public institutions of
higher education.
(k) Nonprofit speech and hearing centers, as defined in Section
1201.5. Any nonprofit speech and hearing clinic desiring an exemption
under this subdivision shall make application therefor to the
director, who shall grant the exemption to any facility meeting the
criteria of Section 1201.5. Notwithstanding the licensure exemption
contained in this subdivision, a nonprofit speech and hearing center
shall be deemed to be an organized outpatient clinic for purposes of
qualifying for reimbursement as a rehabilitation center under the
Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code).
(l) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, that conducts medical research and
health education and provides health care to its patients through a
group of 40 or more physicians and surgeons, who are independent
contractors representing not less than 10 board-certified
specialties, and not less than two-thirds of whom practice on a
full-time basis at the clinic.
(m) Any clinic, limited to in vivo diagnostic services by magnetic
resonance imaging functions or radiological services under the
direct and immediate supervision of a physician and surgeon who is
licensed to practice in California. This shall not be construed to
permit cardiac catheterization or any treatment modality in these
clinics.
(n) A clinic operated by an employer or jointly by two or more
employers for their employees only, or by a group of employees, or
jointly by employees and employers, without profit to the operators
thereof or to any other person, for the prevention and treatment of
accidental injuries to, and the care of the health of, the employees
comprising the group.
(o) A community mental health center, as defined in Section 5601.5
of the Welfare and Institutions Code.
(p) (1) A clinic operated by a nonprofit corporation exempt from
federal income taxation under paragraph (3) of subsection (c) of
Section 501 of the Internal Revenue Code of 1954, as amended, or a
statutory successor thereof, as an entity organized and operated
exclusively for scientific and charitable purposes and that satisfied
all of the following requirements on or before January 1, 2005:
(A) Commenced conducting medical research on or before January 1,
1982, and continues to conduct medical research.
(B) Conducted research in, among other areas, prostatic cancer,
cardiovascular disease, electronic neural prosthetic devices,
biological effects and medical uses of lasers, and human magnetic
resonance imaging and spectroscopy.
(C) Sponsored publication of at least 200 medical research
articles in peer-reviewed publications.
(D) Received grants and contracts from the National Institutes of
Health.
(E) Held and licensed patents on medical technology.
(F) Received charitable contributions and bequests totaling at
least five million dollars ($5,000,000).
(G) Provides health care services to patients only:
(i) In conjunction with research being conducted on procedures or
applications not approved or only partially approved for payment (I)
under the Medicare program pursuant to Section 1359y(a)(1)(A) of
Title 42 of the United States Code, or (II) by a health care service
plan registered under Chapter 2.2 (commencing with Section 1340), or
a disability insurer regulated under Chapter 1 (commencing with
Section 10110) of Part 2 of Division 2 of the Insurance Code;
provided that services may be provided by the clinic for an
additional period of up to three years following the approvals, but
only to the extent necessary to maintain clinical expertise in the
procedure or application for purposes of actively providing training
in the procedure or application for physicians and surgeons unrelated
to the clinic.
(ii) Through physicians and surgeons who, in the aggregate, devote
no more than 30 percent of their professional time for the entity
operating the clinic, on an annual basis, to direct patient care
activities for which charges for professional services are paid.
(H) Makes available to the public the general results of its
research activities on at least an annual basis, subject to good
faith protection of proprietary rights in its intellectual property.
(I) Is a freestanding clinic, whose operations under this
subdivision are not conducted in conjunction with any affiliated or
associated health clinic or facility defined under this division,
except a clinic exempt from licensure under subdivision (m). For
purposes of this subparagraph, a freestanding clinic is defined as
"affiliated" only if it directly, or indirectly through one or more
intermediaries, controls, or is controlled by, or is under common
control with, a clinic or health facility defined under this
division, except a clinic exempt from licensure under subdivision
(m). For purposes of this subparagraph, a freestanding clinic is
defined as "associated" only if more than 20 percent of the directors
or trustees of the clinic are also the directors or trustees of any
individual clinic or health facility defined under this division,
except a clinic exempt from licensure under subdivision (m). Any
activity by a clinic under this subdivision in connection with an
affiliated or associated entity shall fully comply with the
requirements of this subdivision. This subparagraph shall not apply
to agreements between a clinic and any entity for purposes of
coordinating medical research.
(2) By January 1, 2007, and every five years thereafter, the
Legislature shall receive a report from each clinic meeting the
criteria of this subdivision and any other interested party
concerning the operation of the clinic's activities. The report shall
include, but not be limited to, an evaluation of how the clinic
impacted competition in the relevant health care market, and a
detailed description of the clinic's research results and the level
of acceptance by the payer community of the procedures performed at
the clinic. The report shall also include a description of procedures
performed both in clinics governed by this subdivision and those
performed in other settings. The cost of preparing the reports shall
be borne by the clinics that are required to submit them to the
Legislature pursuant to this paragraph.
1206.1. The provisions of this chapter do not require licensure of
any place or establishment owned or leased and operated as a clinic
or office by one or more licensed psychologists and used as an office
for the practice of psychology, regardless of the name used publicly
to identify such place or establishment.
1207. The state department shall inspect and license clinics, and
shall inspect and approve clinics to offer special services.
1208. The state department may provide consulting services upon
request to any clinic to assist in the identification or correction
of deficiencies or the upgrading of the quality of care provided by
the clinic.
1209. This chapter does not authorize any person other than a
licensed practitioner of a healing art, or any corporation except
charitable or professional corporations as expressly provided in this
chapter, to furnish to any person any advice, services, or treatment
within the scope of such professional licensure.
This chapter does not authorize any person, other than a
licentiate of a healing art acting within the scope of his or her
license, to engage directly or indirectly in the practice of medicine
and surgery, dentistry, optometry, podiatry, psychology, or
pharmacy.
This chapter does not regulate, govern, or affect in any manner
the practice of medicine and surgery, pharmacy, dentistry, optometry,
chiropractic, podiatry, psychology, or drugless healing by any
person duly licensed to engage in such practice.
