Primary Care Clinic – Intermittent Clinic Change of Name Notification
A licensed Primary Care Clinic (PCC) is required to notify the California Department of Public Health (CDPH), whether it is currently operating an intermittent clinic. An Intermittent clinic is "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. 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," pursuant to Health and Safety Code (HSC) section 1206(h).
Pursuant to HSC section 1218.4, a licensed primary care community or free clinic shall report to the department, when renewing its license, whether it is currently operating an intermittent clinic, the location of any intermittent clinic, and the estimated hours of operation of any intermittent clinic.
To simplify the process and prevent delays in processing providers Medi-Cal certification for intermittent clinics; providers will only need to submit the intermittent notification to Department of Health Care Services (DHCS), Provider Enrollment Division (PED), who will forward a copy of the intermittent notification to the Centralized Applications Branch (CAB) for processing.
How to Notify DHCS
PCC providers should report an intermittent clinic change of name by submitting correspondence to the DHCS/PED. The correspondence should list the intermittent clinic's previous and new name, service address, hours of operation (including any hours closed for lunch; not to exceed the maximum allowed weekly hours), National Provider Identifier (NPI), and identify the parent clinic's name, license number and service address. PCC providers may check the status of the intermittent clinic correspondence by going to the Provider Enrollment Division webpage on the DHCS website (here) and completing an Inquiry Form (found under Provider Resources).
Please refer to the following links to get started:
Where to Submit the Intermittent Notification
Department of Health Care Services
Provider Enrollment Division
P.O. Box 997412
Sacramento, CA 95899-7412
NOTE: If you are a licensed primary care clinic requesting to convert to an intermittent clinic, these requests must come to CDPH first. Please see instructions for converting here: Primary Care Clinic Intermittent Clinic Converting an existing Primary Care Clinic to an Intermittent Clinic.