According to the California Health and Safety Code, Section 1201, “Licensing” is the process of acquiring a basic, nontransferable permit to operate a clinic in California. “Certification,” in practice, refers to the process of becoming eligible to bill and receive payments for services provided to Medi-Cal or Medicare patients. This is commonly referred to as “Provider Enrollment.” When Federally Qualified Health Centers (FQHCs) and FQHC Look-alikes plan to see Medicare patients, the term “certification” becomes a de facto process in applying for Medi-Cal eligibility or Medi-Cal provider enrollment only, and not Medicare.
Primary care clinics are required to be licensed through the authority of the California Department of Public Health (CDPH) Licensing & Certification Program (L&C). The L&C program utilizes standards defined in state and federal law and regulations to evaluate health facility compliance. The Office of Statewide Health Planning and Development (OSHPD) is responsible for writing regulations pertaining to licensed clinics. These regulations are identified in Title 24, the California Building Standards Code as “OSHPD 3”. OSHPD 3 requirements for clinics shall only be applied to clinics that are licensed pursuant to Health and Safety Code Section 1200, which includes primary care and specialty care clinics. (See link above).
The Licensing and Certification process is intended to both ensure public safety at community clinics and to prevent fraud and abuse of the Medi-Cal and Medicare billing systems. The Central Applications Unit (CAU) at the state level in Sacramento is responsible for initial review of all licensing applications. Applications deemed complete are then passed on to one of the 15 regional district offices (DO) that perform site surveys, investigate complaints, and issue licenses if all requirements have been met.
The Licensing and Certification process, as currently administered, is a source of great difficulty and confusion for community clinics. CPCA’s goal is to demonstrate our commitment and readiness in providing a stronger technical assistance capability to our members specifically in the area of licensing and certification.
Please contact Emily Shipman, Senior Program Coordinator of Health Center Operations, at email@example.com or call (916) 440-8170 for all L&C related inquiries.