Well it is always interesting to touch base with the Licensing Division of the California Department of Public Health. As you know, Title 22 requires Primary Care Clinics to provide notifications to CDPH for changes such as hours of operation, a change in nurse manager, and notification of operating an intermittent clinic. Major changes like Executive Director, Medical Director, changes in services and others require the completion of HS 200 and likely several other forms. It should be noted that HS 200 was designed for Skilled Nursing Facilities and Hospitals, so there is much that does not really apply to PCP’s.
I am currently working on a change notification and made some inquires to the centralized applications branch office. I learned a couple things I thought I would pass on:
- My analyst Alyssa Armstrong let me know we should submit our letters of change to the Centralized Applications Branch instead of the local branch office. I guess in 2016 the CAB was created and has been transitioning into being truly centralized. The CDPH Licensing and Certification website also says this now. Alyssa said, “I recommend sending the clinical changes to Centralized Applications Branch (CAB). The local office will forward notices to CAB, but it is delayed and may be unreliable.” – that unreliability turned out to be an issue for me.
- They have a preferred format for these letters. It is not enough to just provide the information that will change, rather they want a reporting on all the reportable information each time. It is worth looking over their website for sample cover letters. I included the sample given to me below.
- Cover Letters for changes using HS 200 should be formatted similarly.
- Detail in this letter is important. They will not accept a letter if the details in the letter are not accurate according to their records. In my case, they wanted the name of the parent facility to be the one on the license, NOT the DBA! I even included the information about the DBA in the paragraph above, and it was kicked back to me.
- Use the tool on the bottom of the CDPH website to determine what forms you will need https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/ApplyForLicensure-Paper.aspx It will provide a list of forms, a checklist, and a sample packet. However, it should be noted it does not take into account all the details. For example, my change of services form requires the HS 200. However I do not need the Fire Marshall inspection form STD 850 (no beds). And I do not need to provide; Property Control (lease agreement), certificate of Occupancy, or CDPH 270 since no construction was made. I am also not applying for Medi-Cal, so page 5 of HS 200 is not necessary.
- Intermittent Clinics automatically fall under the parent where changes are concerned. We do not need to fill out HS 200 for both the parent and the Satellite. They do want us to indicate on the cover letter if the change affects the Intermittent Clinic or not.
Sample Notification Letter
ABC Community Care
999 Beach Side Ct. Sacramento, CA 95814
P: (999)555-2626
F: (999)555-2600
Email: janeDoe@abccommunitycare.org
March 15, 2019
VIA PRIORITY MAIL:
California Department of Public Health
Licensing and Certification
P.O. Box 997377
Sacramento, CA 95899
Attn: Centralized Applications Branch
RE: Initial/New Notification for Intermittent Clinic
To Whom It May Concern,
This letter serves as a notification that ABC Community Care intends to operate an intermittent clinic known as Family First, located at 1800 Beach Dr. Sacramento, CA 95814.
Here is the required information:
Parent Clinic
Facility Name: California Care
Facility address: 1899 Beach Dr. Sacramento, CA 95814
License number: 3333333333
Facility ID number: Unknown
Contact information: Jane Doe
Phone number: 999-555-2626
Email: JaneDoe@abccommunitycare.org
Hours of Operation:
Mon: 8am – 5pm Closed 12pm to 1pm for lunch
Tues: 8am – 5pm Closed 12pm to 1pm for lunch
Wed: 8am – 5pm Closed 12pm to 1pm for lunch
Thurs: 8am – 5pm Closed 12pm to 1pm for lunch
Fri: 8am – 5pm Closed 12pm to 1pm for lunch
Sat: Closed
Sun: Closed
Total 40hrs/ week
Previously approved intermittent clinics under the Parent Clinic:
Facility name: Health First
Facility address: 1500 Seal Beach Dr. Sacramento, CA 95814
Facility ID number: unknown
Contact Information: Shain Jones
Phone number: 999-555-0595
Email: ShainJones@xyccommunitycare.org
Hours of Operation:
Mon: 8am – 5pm Closed 12pm to 1pm for lunch
Tues: 8am – 5pm Closed 12pm to 1pm for lunch
Wed: 8am – 5pm Closed 12pm to 1pm for lunch
Thurs: 8am – 5pm Closed 12pm to 1pm for lunch
Fri: 8am – 5pm Closed 12pm to 1pm for lunch
Sat: Closed
Sun: Closed
Total 40hrs/ week
New Intermittent Clinic:
Facility name: Family First
Facility address: 1800 Beach Dr., Sacramento, CA 95814
Contact information: Wain Jones
Phone number: 999-555-0695
E-mail: Wain.Jones@abccommunitycare.org
Hours of Operation:
Mon: 8am – 5pm Closed 12pm to 1pm for lunch
Tues: Closed
Wed: 8am – 5pm Closed 12pm to 1pm for lunch
Thurs: 8am – 5pm Closed 12pm to 1pm for lunch
Fri: Closed
Sat: Closed
Sun: Closed
Total 24hrs / Week
Should you have any questions, I will be the direct contact regarding this notification.
Emergency Contact Information (available 365/24/7)
Name: Jane Doe
Email: JaneDoe@abccommunitycare.org
Alternate Email: JaneDoe@cmail.com
Phone: 999-555-2626
Cell: 999-123-4567
Text: 999-555-5555
Fax 999-555-2600
Sincerely,
Jane Doe, CEO/President
ABC Community Care