FTCA Coverage for Individuals at Free

ClinicsTechnical Assistance Call

PIN 2010-02Department 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. PurposeII. Overview of FTCA CoverageIII. Requirements for Free Clinic FTCA

CoverageIV. Overview of New Law and New PINV. Understanding the New ApplicationVI.Dates and Notes to RememberVII.Resources and Contact Info

3

I. Purpose

• To give an overview of the new Free Clinic PIN 2010-02

• 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 (

http://bphc.hrsa.gov/ftca/freeclinics/)

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

• Email entire application to freeclinicsFTCA@hrsa.gov

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 FreeClinic• Confirm eligibility • Click button for

yes or no• Explain any and

all “no” answers

23

V. Application

Third worksheet:Credentialing andPrivileging • Answer questions

regarding credentialing and privileging processes

• Click yes or no• Explain any and

all “no” answers

24

V. Application

Fourth worksheet:Risk ManagementSystems• 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 2010-08 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 2010-02, please contact the Bureau of Primary Health Care (BPHC)• 877-974-BPHC (877-974-2742)• The BPHC Helpline is available 8:30

AM to 5:00 PM (ET) business days• FreeclinicsFTCA@hrsa.gov• http://bphc.hrsa.gov/ftca/freeclinics/

30

Questions?

Questions and Answers

Thank you for your continued interest in our programs