FTCA Coverage for Individuals at Free Clinics Technical Assistance Call PIN Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) Office of Quality & Data (OQD) July 29, 2010

2 Today’s Call I.Purpose II.Overview of FTCA Coverage III.Requirements for Free Clinic FTCA Coverage IV.Overview of New Law and New PIN V.Understanding the New Application VI.Dates and Notes to Remember VII.Resources and Contact Info

3 I. Purpose To give an overview of the new Free Clinic PIN To provide information on the initial and redeeming application process for Free Clinics wishing to sponsor individuals for medical malpractice coverage provided by the Federal Tort Claims Act (FTCA)

4 II. Overview of FTCA Coverage Established by Section 194 of HIPAA adding section 224(o) of the Public Health Service Act, covering volunteer health professionals Expanded by the Affordable Care Act in 2010 to include board members, officers, employees, and individual contractors

5 II. Overview of FTCA Coverage Provides Medical Malpractice Coverage for deemed individuals providing medical, surgical, or dental services Eligible individuals must be sponsored by a free clinic NOT general liability coverage Free clinic entity is NOT covered by FTCA

6 II. Overview of FTCA Coverage FTCA coverage is similar to an occurrence policy – coverage is for any incidents that occur during time the individual is covered under FTCA No specific coverage limit Punitive damages not allowed Cases defended by the United States in Federal court

7 III. Requirements Sponsoring Clinics Must be a nonprofit organization Cannot accept third party reimbursement Does not impose charges on patients May accept donations Are licensed or certified in accordance with applicable state law

8 III. Requirements Major Requirements for Deeming Credentialing and Privileging System Risk Management System Patient Notification of Limited Liability Medical Malpractice Claims Review Data Reporting

9 III. Requirements Credentialing Process of assessing and confirming the qualifications Verify licensure, certification, registration, and other forms of qualification Privileging Process of authorizing the specific scope and content of patient care services Done along with evaluation of health care practitioner’s clinical qualifications

10 III. Requirements Credentialing & Privileging Primary Source Verification (PSV)  Verification of a practitioner's qualification by the original source or an approved agent.  E.g., Credentials verification organizations (CVOs) Secondary Source Verification (SSV)  Other methods not considered primary source.  E.g., View original credential

11 III. Requirements Credentialing Examples Verify  Licensure (psv)  Education, training (psv)  Ability to perform job (psv)  Identification (ssv)  DEA registration (ssv)  Hospital privileges (ssv)  Immunization (ssv) Query National Practitioner Data Bank Privileging Examples Verify and assess competence in:  Course of training required to perform defined procedures  Particular procedures and protocols needed for position

12 III. Requirements Risk Management Quality Assurance Plan (QA Plan)  Identifies free clinic’s plan to mitigate risk and improve quality care for patients  Should map out plan for identification and evaluation of concerns, education plan for staff members, and responsibilities of management  Also include free clinic’s credentialing and privileging process

13 III. Requirements Patient Notice of Limited Liability Written Notification  Provided by sponsoring free clinic or deemed individual Signature Preferred  Can be done once prior to first encounter Sample on website (

14 III. Requirements Review of Medical Malpractice Claims Used to ensure appropriate policies and procedures are in place to reduce risk of medical malpractice Report any medical malpractice claim or disciplinary action taken by licensing board  Report for past ten years for new applicants  Report new claims from past year for renewal applicants

15 III. Requirements Annual Data Reporting Occurs the first quarter of each year Examples of information requested:  Number of visits per clinic by covered individuals  Number of visits per covered individual  Number of patients per clinic by covered individuals  Number of patients per covered individual

16 IV. New Law & PIN Eligible Individuals Volunteer Health Professionals Board Members Officers Employees Individual Contractors  Must have individual contract between person and clinic

17 IV. New Law & PIN Covered Services Qualified Health Service  Specified in Title XIX of the Social Security Act Arise from medical, surgical, dental, or related services at free clinic site or offsite programs carried out by free clinic Offsite programs – health fairs with routine screening/health education  For others, contact HRSA for clarification  Generally allow 30 days for final answer

18 IV. New Law & PIN Claims Process Medical Malpractice claims brought against U.S. Government Must first go through Administrative Procedures Filed in Federal District Court Case argued in front of Judge, not jury Defended by the Department of Justice and the HHS Office of General Counsel

19 V. Application New application now in Excel Can save application in progress unlike previous fillable PDF entire application to

20 V. Application Each section of application has its own “worksheet” Five worksheets in total Click tabs on bottom of page to move between worksheets

21 V. Application First worksheet: Contact Information Free Clinic organization information FTCA Contact Person/People Free Clinic Sites

22 V. Application Second worksheet: Sponsoring Free Clinic Confirm eligibility Click button for yes or no Explain any and all “no” answers

23 V. Application Third worksheet: Credentialing and Privileging Answer questions regarding credentialing and privileging processes Click yes or no Explain any and all “no” answers

24 V. Application Fourth worksheet: Risk Management Systems Answer questions about risk management and QA plan Click yes or no button Explain any and all “no” answers

25 V. Application Fifth worksheet: Individuals’ Information List name of EACH individual seeking deeming status  Including board members, officers, employees, and contractors HRSA will only consider those listed on the application

26 V. Application Fifth worksheet: Individuals’ Information (continued) Credentialing should be done every two (2) years Answer yes or no if there has been a medical malpractice or disciplinary action against individual Attach explanation of any claims

27 V. Application Adding more fields If need more lines for people, sites, etc. Highlight rows (click on numbers on left) Right click Choose “Insert” Repeat as necessary

28 VI. Dates and Notes to Remember Deeming Applications due September 1, 2010 for 2011 coverage PAL Attachment Application due November 1st for 2010 coverage for additional persons Only individuals are eligible for medical malpractice coverage, not free clinic entity

29 VII. Resources and Contact Info For more information on the Free Clinic deeming application, FTCA coverage, or PIN , please contact the Bureau of Primary Health Care (BPHC) BPHC ( ) The BPHC Helpline is available 8:30 AM to 5:00 PM (ET) business days

30 Questions? Questions and Answers Thank you for your continued interest in our programs