Muriet BowserMayor

MAY -4The Honorable Phil MendelsonChairman, Council of the District of Columbia1350 Pennsylvania Avenue, N.W.Suite 504Washington, D.C. 20004

Dear Chairman Mendelson:

Attached for your review and approval is a proposed bill entitled, “Clinics LicensingAmendment Act of 2019". It amends the Health-Care and Community Residence Facility,Hospice and Home Care Licensure Act of 1983, D.C. Law 5-48, D.C. Official Code § 44-501, e7seq. (hereinafter “the Act”) to provide that freestanding clinics be licensed. More specifically, itdefines “clinic”, adding to the health-care facilities that operate under the standards of the Actand concomitant rulemaking. In addition, it clarifies the Department of Health’s authority todevelop rulemaking on specific aspectsofclinic operations.

The Department of Health believes that this legislation will provide needed protection to clinicpatients and will allow the Department to require the commitmentofproviders to implement bestpractices on behalfofpatients.

If you need further information, please contact Phillip L. Husband, General Counsel, Departmentof Health, at 442-5970.

Sincerely,

Murfel BolserMaypr

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hairman Phil Mendelsonat the request of the Mayor

A BILL

IN THE COUNCIL OF THE DISTRICT OF COLUMBIA

Chairman Phil Mendelson, at the request of the Mayor, introduced the following bill which wasreferred to the Committee on

To amend the Health-Care and Community Residence Facility, Hospice and Home CareLicensureActof 1983 to incorporate clinics into the Act’s licensure requirements, and torequire regulationsofclinics that will include required qualifications for staff, applicablestaffing ratios, responsibilities of the governing body, authority and process for complaintinvestigations, access to patient records by government officials, and requirements thatclinics report certain data to the Department as specified by the Department, includingdata on patient volume, service delivery and workforce needs; and other requirementsthat will promote high quality care.

BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this

act may be cited as the “Clinics Licensing Amendment Act of 2019”.

Sec. 2. The Health Care and Community Residence Facility, Hospice and Home Care

Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48, D.C. Official Code § 44-

501 et seq.) is amended as follows:

(a) Section 2(a) (D.C. Official Code § 44-501(a)) is amended by inserting a new

paragraph (11) to read as follows:

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“(11)(A) "Clinic" means, except as provided in subparagraph (C)ofthis

paragraph, any facility, whether conducted for profit or not for profit and whether or not

managed in association with a government contract or grant, that advertises or announces itself

as providing, or is established or maintained for the purposeofproviding, ambulatory medical or

physical health services.

“(B) The term “clinic” includes:

“() An urgent care center;

“() A minute clinic operated in association with a pharmacy;

“(IIl)A Federally Qualified Health Center;

“(IV)A privately operated ambulatory care center; and

“(V) Any entity that is advertised, announced, established, or

maintained under a name which includes the word “clinic”, "dispensary", or "institute", and

which suggests that ambulatory medical or physical rehabilitation services are rendered, except

that this paragraph shall not apply to a dispensary or any other entity operated pursuant to the

District’s medical marijuana program.

“(C) Notwithstanding subparagraph (B) of this paragraph, the term

“clinic” does not include:

“()A hospital licensed in accordance with this act that provides

outpatient services;

“(II) A medical office building;

“(III) One or more practitioners engaged in a solo or group

practice, if:

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“(a) The solo or group practice is wholly owned and

controlled by one or more of the practitioners; or

“(b) The solo or group practice is a not-for-profit

organization whose only members are one or more of the practitioners, and the organization

exists solely to provide services to employees or students ofthe organization or ofan entity

dependent on or subordinate to the organization;

“(IV) An ad hoc health promotion or screening program; or

“(V) A government-owned and operated organization.”.

(b) Section 5(a) (D.C. Official Code § 44-504(a)) is amended as follows:

(1) Paragraph (2)(C) is amended to read as follows:

“(C) Ensuring that 6 months after the adoption of rules on clinics, under

this subsection, licensureofall affected facilities and agencies shall be under the new rules.”.

(2) Paragraph (3) is amended by striking the word “and” at the end.

(3) Paragraph (4) is amended by striking the period at the end and inserting the

phrase “; and” in its place.

(4) A new paragraph (5) is added to read as follows:

“(5) Rules governing clinics, which shall include required qualifications for staff,

applicable staffing ratios; responsibilities of the governing body; authority and process for

complaint investigations; access to patient records by District of Columbia officials; requiring

clinics to report certain data to the Department as specified by the Department in the rules,

including data on patient volume, service delivery and workforce needs; and other requirements

that will promote high quality care; provided, that no clinic shall be subject to the licensing

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requirements in section3of this act until the Department issues rules pursuant to this

paragraph.”,

Sec. 3. Fiscal impact statement.

The Council adopts the fiscal impact statement in the committee report as the fiscal

impact statement required by section 4a of the General Legislative Procedures Act of 1975,

approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a).

Sec. 4. Effective date.

This act shall take effect following approval by the Mayor (or in the event of veto

by the Mayor, action by the Council to override the veto), a 30-day period of congressional

review as provided in section 602(c)(1)ofthe District ofColumbia Home Rule Act, approved

December 24, 1973 (87 Stat. 813; D. C. Official Code § 1-206.02(c)(1)), and publication in the

District ofColumbia Register.

Government of the District of ColumbiaOffice of the Chief Financial Officer

x kkPSLaeay

Jeffrey S. DewittChief Financial Officer

MEMORANDUM

TO: The Honorable Phil MendelsonChairman, Council ofthe District of Columbia

FROM: Jeffrey S. DewittChief Financial Office!

DATE: April 1, 2019

SUBJECT: Fiscal Impact Statement - Clinics Licensing Amendment Act of 2019

REFERENCE: Draft introduction as shared with the Office of Revenue Analysis onMarch 4, 2019

Conclusion

Funds are not sufficient in the fiscal year 2019 budget and proposed fiscal year 2020 through fiscalyear 2023budget and financial plan to implementthe bill. The bill is estimated to cost $119,000 infiscal year 2019 and $1.44 million through fiscal year 2023.

Background

‘The Department of Health (DOH) is responsible for licensing healthcare facilities to ensure thatDistrict of Columbia healthcare providers offer high quality care to patients. The bill requires’ambulatory medical clinics, physical health service clinics, urgent care centers, clinics operatedwithin a pharmacy, Federally Qualified Health Centers, clinics managed in association with agovernment contract or grant, and privately-operated for-profit or not-for-profit ambulatory carecenters to receive licenses from DOH in order to provide services in the District. The bill allowsDOH to promulgate rules for these facilities regarding, among other things staff qualifications,staffing ratios, responsibilities of the governing body, complaint investigations, access to patientrecords by government officials, and data reporting? DOH estimates that 70 facilities currently

operating in the District will be required to geta license.

By amending the Health Care and Community Residence Facility, Hospice and Home Care Licensure Act of1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code § 44-501 et seq).? Including data on patient volume, service delivery, and workforce need.

1350 Pennsylvania Avenue, NW, Suite 203, Washington, DC 20004 (202)727-2476www.cfo.degov

‘The Honorable Phil MendelsonFIS: “Clinics Licensing Amendment Actof 2019,” Draft introduction as shared with the Office of Revenue‘Analysis on March 4, 2019

Financial Plan Impact

Funds are not sufficient in the fiscal year 2019 budget and proposed fiscal year 2020 through fiscalyear 2023 budget and financial plan to implement the bill. The bill is estimated to cost $119,000 infiscal year 2019 and $1.44 million over the proposed four-year financial plan.

DOH must hire a Nurse Specialist, a Sanitarian, and a part-time Pharmaenforce regulations and licensing requirements. Additionally, newlycomputer equipment and office supplies to conduct their assigned duties.

to conduct site visits to

d employees will need

DOH collects licensing fee revenue from the facilities that are currently required to be licensed inthe District: Each time a facility appliesfor or renews a healthcare facility license, it pays a fee thatis determined by the size of the facility and the services it offers. DOH will impose licensing fees onthe facilities covered by this bill, but rules to specify the fee amount have not yet been drafted. Oncefinalized, these fees will offset a portionofthe enforcement costs associated with this bill.

meee mendmentAct of 201Proposed Financial

Fy2019| Fy2020|Fy2021|Fy2022| FY2023 PlanTotalTotal SalaryandFringe) | $114,026| $348,920| $355,899| $363,017| _ $370,277 $1,438,113,Total Non-PersonalServices |_$5,000| $100| _s1soo| __sisoo| $1500 $6,000

TotalFiscal Impact 119,026| $350,420 | $357,399|s364517| _$371.777 $1,444,113,

Table Notes:(2) Includes one grade-11 Nurse Specialist, one grade-12 Sanitarian, and one grade-14 part-time Pharmacist.Assumes a start dateofJune 1, 2019 and a fringe benefit rate of21.9 percent.(2) Assumes a2 percent salary and fringe growth rate.(3) Includes office supplies and computer equipment.

3 Chapter B31of Title 22-B of the District of Columbia Municipal Regulations.

Page 2 of 2

GOVERNMENT OF THE DISTRICT OF COLUMBIAOffice of the Attorney General

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ATTORNEY GENERAL totKARL A. RACINE EES

Legal Counsel Division

MEMORANDUM

TO: Alana IntrieriExecutive DirectorOffice of Policy and Legislative Affairs

FROM: Arthur J, ParkerActing Deputy Attorney GeneralLegal Counsel Division

DATE: March 21, 2019

SUBJECT: Legal Sufficiency Review — Draft “Clinic Licensing Amendment Act of 2019”(AE-19-214)

This is to Certify that this oftice has reviewed the above-referenced draft legislation and found it to be legally sufficient. If you have any questionsin this regard, please do not hesitate to call me at 724-5565.

OpehcboforArthur J. Parker