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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health



Primary Care Clinic

Definitions

 

Affiliate clinic

​is a clinic corporation on behalf of a primary care clinic that has held a valid, unrevoked, and unsuspended license for at least the immediately preceding five years, with no demonstrated history of repeated or uncorrected violations or any regulation that pose immediate jeopardy to a patient, and that has no pending action to suspend or revoke its license may file an affiliate clinic application to establish a primary care clinic at an additional site or a mobile health care unit. The clinic corporation (parent clinic) that operates the existing licensed PCC:

  1. has submitted a completed affiliate clinic application and application fee;
  2. corporate officers are the same;
  3. are owned and operated by the same nonprofit organization with the same board of directors; and,
  4. have the same medical director or directors and medical policies, procedures, protocols, and standards.”
    [Health and Safety Code (HSC) section 1218.1]
Community clinic​is “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 scale.”
[HSC section 1204(a)(1)(A)]
Consolidated license​means “allowing eligible PCCs or affiliate clinics to add additional physical plants, maintained and operated on separate premises, to an existing PCC or affiliate clinic site. The PCC or affiliate clinic license shall be amended to include the additional physical plant as part of a single consolidated license. A PCC or affiliate clinic may add additional locations that are no more than one-half mile from the licensed clinic adding the additional physical plant under the consolidated license.”
[HSC section 1212(d)]
Federally Qualified Health Centers (FQHC) ​are “a community-based health care providers that receive funds from the Health Resources and Services Administration (HRSA) Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.
[Social Security Act section 1905(l)(2)(B)]
Note: A licensed PCC may be certified as a FQHC, if the clinic meets Centers for Medicare and Medicaid Services (CMS) requirements.
Free clinic​is “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 free clinic there shall be no charges directly to the patient for services rendered or for drugs, medicines, appliances, or apparatuses furnished.”
[HSC section 1204(a)(1)(B)]
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 30 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.”
[HSC section 1206(h)]
Mobile service unit or mobile unit​means “a special purpose commercial coach or a commercial coach that provides medical, diagnostic, and treatment services and does not mean a modular, relocatable, or transportable unit that is designed to be placed on a foundation when it reaches its destination, nor does it mean any entity that is exempt from licensure.”
[HSC section 1765.105]
​​Rural health clinic (RHC)is “a clinic that is located in a rural area designed as a shortage area, is not a rehabilitation agency or a facility primarily for the care and treatment of mental diseases.” [Code of Federal Regulations (CFR) 42 section 491.2]
Note: RHC may or may not be licensed PCC.

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When an application package or written notification is required

 

An application package or applicable forms is required for:

  • Establishment of a new (initial) PCC (Community or Free),
  • Operation of a PCC in a new location (affiliate clinic, consolidated license)
  • Change of Ownership (PCC, mobile clinic)
  • Addition of special service, dental service, medical service or podiatric service [Title 22 California Code of Regulations (22 CCR) section 75021(2)]
    Note: Contact the Centralized Applications Branch at CAB@cdph.ca.gov or (916) 552-8632 for instructions and specific forms required to add additional services

 

A written notification is required for:

  • A consolidated license (see All Facilities Letter (AFL) 16-17 Assembly Bill 2053 – Primary Care Clinic Consolidated Licensure)
  • An intermittent clinic
    Note: Statute requires a licensed primary care community or free clinic to report to CDPH, 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. However, for providers seeking Medi-Cal or Medicare enrollment, to avoid delays, do not wait until renewal to notify CDPH of an intermittent clinic.

    An intermittent clinic must meet all requirements of law, including administrative regulations and requirements, pertaining to life and safety. The written notice shall include the following information regarding the addition of an intermittent clinic(s):
    • The name of the "Parent" primary care clinic. Include the facility number, license number, address, and contact information.
    • All the facilities operating as an intermittent clinic(s) under the "Parent" primary care clinic. Include the intermittent clinic(s) name, address, hours of operation, and contact information for each intermittent clinic(s).
    • Submit a completed Fire Safety Inspection Request (STD 850) for each intermittent clinic.

 

Note: An application package is not required for clinics exempt from licensure. [HSC section 1206]
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Report of changes

 

A Report of Change (ROC) applicant checklist for reporting changes to existing clinic information and/or operations is currently under development and will be posted on CDPH’s website upon completion.

Any changes to existing clinic information and/or operations (i.e., clinic name, mailing address, location, administrator, principle officers, directors, board members, etc.), must be reported to the department.

Contact the Centralized Applications Branch at CAB@cdph.ca.gov or (916) 552-8632 for assistance on reporting changes.

 

Note:

  1. Any change in the principle officer(s) shall be reported in writing immediately, but in no case later than 10 days following such change. Notice shall include the name and principal business address of each new principal officer. 
  2. A change of administrator shall be report in writing immediately, but in no case later than 5 days following such change. Notice shall include the name of the new administrator, mailing address, the date of assuming office and a brief description of his/her background and qualifications.

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Application fee

 

A licensing application fee must accompany the required application package before the application package will be processed. Include a check or money order, made payable to the “California Department of Public Health” with the application package.

Application fees are can be accessed at:

https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/LC-Health-Care-Facility-Licensing-Fees.aspx

 

Note: If an application is withdrawn or denied, pursuant to Title 22 California Code of Regulations (CCR) section 75023, the application fee shall not be refunded to the applicant.
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Where to submit applications

 

Submit applications to:

California Department of Public Health
Licensing and Certification Program
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377

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Special instructions

 

  1. Please read each required application form carefully and provide the requested supplemental documents
  2. Do not change or alter the forms.
  3. The applicant/licensee name must be exactly the same on all documents used in the application package. Failure to be consistent will result in an incomplete application.
  4. Do not leave any items blank. If a question does not apply, respond with “Not Applicable” or “N.A.”.
  5. Do not use white out or correction fluid to make corrections. To correct an error, line out the entry enter the correct information. The individual responsible for making the correction must initial and date the correction.
  6. Use “BLUE” ink to sign all forms.
  7. Retain a photocopy of the completed application package.

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Review process

 

Once the application package is received and assigned to an analyst the:

  • CAB analyst will review the package to ensure all required forms and supplemental documents are received and complete.
  • If information is missing or incorrect, the analyst will contact the provider by email, letter or phone to obtain the information.
  • Once the application is deemed complete, the analyst will notify the applicant and appropriate district office by letter, e-mail or phone and will either:
    1. forward the application to the appropriate district office if an on-site survey is required, or 
    2. if a survey is not required, CAB will issue a license.

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Questions

 

For assistance, contact the CAB at (916) 552-8632 or by e-mail at CAB@cdph.ca.gov

Have or submit the following information with your request:

  • Name of facility or agency
  • License or facility/agency number (if you already have one)
  • Address
  • Facility or provider type
  • Date documentation sent
  • Contact number

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