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Retail Health Clinics State Legislation and Laws

 

Retail Health Clinics: State Legislation and Laws   

Table of Contents

Updated: November 2011; material added September 2012

Retail health clinics have grown in number from a few that first opened in early 2000, to more than 1,100 clinics as of February 2009.  These clinics are generally open seven days a week, with extended weekday hours; no appointments are necessary and visits generally take 15 to 20 minutes due to the limited scope of services offered. The large majority are co-located within a larger retail store, ranging from supermarkets and "big-box" discount super-stores to drug stores.

According to the Convenient Care Association, a trade association for retail clinics, the top medical conditions treated at these clinics include: sore throat, common colds, flu symptoms, cough, and sinus infection.  Visits to these clinics generally cost consumers between $45 and $75.  In some retail clinics, such as MinuteClinics in Minnesota, prices for various medical services are posted on an electronic sign.  Many health insurance companies will cover and reimburse clinic visits and some have waived co-pay fees at these clinics.  A recent study discovered that 67 percent of retail clinic visits were paid for by insurance (Medicare, Medicaid, private insurance, or workers' compensation). In contrast, about 90 percent of visits to primary care physicians are paid by insurance. Most clinics can refer patients to local doctors or emergency rooms and the availability of these clinics can help people avoid emergency rooms.   

As of April 2011, state legislation that specifically addresses these retail clinics has been relatively limited.  However, 16 states have considered legislation and two bills were signed into law.  One additional state (Massachusetts) created regulation governing retail clinics through executive action.  State legislators have heard recommendations from interests representing multiple sides of the issue.  Some suggest that such clinics are a positive innovation and should be encouraged by state and local governments.  These and other advocates promote the clinics as a convenient and affordable alternative for people with relatively minor health care needs.  Others suggest caution and may seek to regulate the structure or qualifications of the personnel providing the medical services.  For example, some physician groups have raised concerns about the clinics and whether they will disrupt continuity of care.  Yet others call for a more in-depth study of the issue rather than immediately creating new statutes.

Looking at the business side of retail clinics and worried about conflict of interest, in 2007, New York state regulators investigated business relationships between drugstore companies and retail clinics to examine if patients treated in a retail clinic were being improperly steered to the affliated, onsite pharmacy locations to fill their prescriptions.  In a related issue, New York, Illinois, Rhode Island, and Tennessee recently also considered legislation to limit locations with retail clinics from selling tobacco products.  There has been no federal regulation of retail clinics as of early 2010.


Retail Clinic Legislation

The following chart lists proposed and enacted legislation targeting retail clinics in the states.

State/ Legislation or Regulation Details
Colorado
 

2010 SB 10-170- Sets forth policies and procedures; referrals; restricts scope; vaccine reporting obligations; medical record obligations.

Florida
 

2007 Title XXXII, Chap. 456.041- Prohibits primary care physicians from supervising more than one office facility.  Also limits the number of health care professionals (nurse practitioners and physician assistants) a primary care physician is able to supervise to four. (HB 699- Passed and signed into law by governor on 6/20/06.)

Georgia
 

2005-2006 SB 603- Bans NPs from practicing in retail locations that also house pharmacies.

Illinois
 

2007 HB 1885 by Rep. McAuliffe- Would require a permit for the operation of such a retail health clinic, issued by the Department of Public Health, and sets forth requirements for obtaining a permit.  Requires clinics to pay $2,500 per location for permits from state health dept., clinics must notify patients' physicians about visit details, have 1 physician supervisor per 2 nurse practitioners NPs, allow patients to fill prescriptions at pharmacy of choice. (Held in committee; did not pass House as of 10/30/08.)

2008 HB 5372- Sets forth regulations for patient safety and follow-up care; tobacco and alcohol sale ban on premises. 

Indiana
 

2009 SB 216- Accreditation; facilities; policies and protocols; referrals; patient notifications; compliance with state and federal laws; medical record obligations; state department enforcement and inspection.

2009 SB 216.1-  An amendment was proposed to change the bill to require the state department of health to conduct a study to determine: (1) the number of health clinics in the state; (2) the number of health clinics that are regulated by the state; (3) the adequacy of the state regulations for health clinics; and (4) whether any additional standards are necessary. (Proposed amendment #1 SB 216-1— Filed 02/11/2009.)

Kentucky
 

KRS 216B.024- Legislation authorizing licensure and regulation of health clinics and services.

902 KAR 20:400 (Regulations)- License; restricted scope; patient notification; administration and operation; facilities; non-promotion of host.

Massachusetts
 

Executive Branch Regulation - The Massachusetts Public Health Council, which sets policy for the Department of Public Health, created regulations for the operation of retail health clinics in Massachusetts.  These regulations stipulate what medical conditions can be treated, what age groups can be treated, medical record keeping procedures, medical referral procedures, treatment of repeat patients, and regulate the sale of tobacco products if the retail clinic is located in a retail location that sells such products. [See description below]
(Passed in 1/08.)

Missouri

2006 SB 1124- Limited the number of physician assistants that a physician could supervise to three.

New Hampshire
 

2008 HB 1484 by Rep. Emerton (Chapter 227)- Establishes a commission to study and develop legislation to regulate the operation of retail health clinics and limited service clinics, also known as "mini clinics". (Signed into law by governor on 6/16/08.)

2009 HB 422- Limits the scope of services to preventative and wellness promotion, and routine treatment of simple well-defined medical credentials; the employment of credentialed professional and medical staff; mandatory postings of services, hours and after-hour care sources. 

He-P 806- Licensing requirements for all non-emergency walk-in care centers (NEWCC) pursuant to RSA 151:2

New York

2011 NY S 3673- Relates to the establishment of convenient care clinics; authorizes the public health council to adopt/amend rules and regulations relating thereto.

2011 NY A 81- Relates to the establishment of convenient care clinics within a retail business operation or space used by an employer to provide health care services to its employees.

North Carolina
 

2007 SB 1256 by Sen. Rand- Would provide for a study by the Legislative Research Commission on Store-Based Retail Health Clinics. (Carried over to 2008 Session; did not pass by the end of session, 7/25/2008.)

Oklahoma
 

2008 SB 1523 by Sen. Leftwich- Would specify certain scope of practice requirements; would require certain supervision of retail health clinics; would direct the State Board of Health to promulgate rules. (Did not pass by the end of session.)

2008 SB 1638 by Sen. Paddack- Would provide for supervision of non-physician practitioner in certain circumstances.(Did not pass by the end of session.)

Pennsylvania 

2008 HB 2788- Applicant for retail license cannot offer clinical health care services.

Rhode Island
 

2008 HB 7676- Prohibits health clinic on same premises as a pharmacy licensed to compound and dispense prescriptions.

Tennessee
 

2008 HB 3502- Bans sale of cigarettes at any place of business where medical services are offered.

Texas

 

2007 HB 1096 by Sen. Patrick- Would relate to the delegation of certain medical acts by a physician to an advanced practice nurse or physician assistant. (Did not pass by the end of session.)

2009 SB 532- Expands the practice authority for nurse practitioners and physician assistants, reduces the burden on collaborating physicians, and significantly increases access to health care.

Washington
 
2009 HB 2257- Prohibits retail establishments from selling tobacco products where the establishment has a health care clinic on the premises.

 


Massachusetts: An Example of Retail Clinic Regulation

In early 2008 Massachusetts created regulations for the operation of retail health clinics, terming them "Limited Services Clinics."  These included a specific list of services that these clinics are limited to providing.  The list below includes services as provided by Ms. Denise Egan, Limited Services Clinic Coordinator in the Health Care Safety and Quality Bureau of the Massachusetts Department of Public Health.

  • Allergies (ages 6+)
  • Bronchitis (ages 10 -65)
  • Ear Infections
  • Pink Eye and Styes
  • Sinus Infection
  • Strep Throat
  • Swimmer's Ear
  • Upper Respiratory Infections
  • Ear Wax Removal
  • Flu Diagnosis (Ages 10-65)
  • Mononucleosis
  • Suture Removal
  • TB Testing
  • Vaccines and Immunizations
  • NO childhood immunizations other than Flu vaccine.
  • NO limited services clinic may provide treatment to children younger than 24 months.
  • Athlete's Foot
  • Cold Sores
  • Deer Tick Bites (ages 12+)
  • Impetigo
  • Minor Burns
  • Minor Skin Infections and Rashes
  • Minor Sunburn
  • Poison Ivy (ages 3+)
  • Ringworm
  • Shingles Treatment
  • Wart Removal

Scope of Practice Laws for Non-Physician Medical Practitioners

Retail clinics are staffed primarily by non-physician medical practitioners such as nurse practitioners (NPs), advanced nurse practitioners (ANPs), and physician assistants (PAs). State practices and laws vary regarding the flexibility of these non-physician medical practitioners to prescribe drugs and practice medicine. NCSL tracks Scope of Practice information through a legislative tracking database. To view legislation, please visit Scope of Practice Legislation Tracking Database.

Quote of the Month: (September 2012)

“It makes sense for self-insured employers to offer their own health care for employees, and for large health systems to offer their own insurance, so it follows that commercial payers might consider getting into the [retail] clinic space.”
— Tine Hansen-Turton, executive director of Convenient Care Assn., cited in AIS’s Health Plan Week.


Retail Clinics State-by-State, February 2009

Retail clinics have grown not only in their numbers, but also in their overall distribution across the states.  From their beginnings in Minnesota in 2000, retail clinics have spread out to a total of 37 states as of February 2009.  The following map represents the distribution of these clinics across the different states.

 

 

 

 

 

 

 

Source: Merchant Medicine, LLC.


Additional Resources

Health Groups' Statements on Retail Health Clinics:

  • American Academy of Pediatrics Statement in Opposition to Retail Health Clinics.                                                       
  • American Academy of Family Physicians Statement of Non-Endorsement of Retail Health Clinics.                                      
  • Convenient Care Association, which is a trade association of retail clinics, released this report titled, "Convenient Care Clinics: The Future of Accessible Health Care"

NCSL Resources:

Non - NCSL Research on Retail Clinics:

FTC Opinions:

Related Media Articles:

Disclaimer: NCSL is not responsible for information or opinions contained in internet links to web sites outside this organization.  The opinions and/or policies expressed in non-NCSL materials are those of the authors, sponsors or sponsoring organization, and not NCSL.

Authors: Richard Cauchi, Health Program Director compiled an original memorandum on retail clinic state actions. Andrew Thangasamy of Denver expanded and updated the material in 2009. Katherine Mason provided additional updates in 2011.

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