Federal Tort Claims Act (FTCA) Free Clinics Program Overview
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1 Federal Tort Claims Act (FTCA) Free Clinics Program Overview April Fields Mike Chellis Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care
2 Agenda Purpose Program Overview Program Requirements Coverage Application Process Questions 2
3 Purpose To provide an overview of program and statutory requirements for FTCA medical malpractice coverage for eligible individuals. These eligible individuals include: Free Clinic Board Members, Health Professionals, Officers, Employees, and Individual Contractors 3
4 Program Overview 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 4
5 Program Requirements Four Major Program Requirements: Credentialing and Privileging system Quality Improvement/Quality Assurance (QI/QA) program, including a risk management (RM) system Disclosure of medical malpractice claims and professional disciplinary actions Annual data reporting 5
6 Program Requirements Continued. An eligible free clinic must be operated by a nonprofit private entity that: Does not accept reimbursement from any third party payor Does not impose charges on patients May accept patients voluntary donations Must be licensed or certified per applicable law to provide health services 6
7 Program Requirements Continued. Free clinic volunteer health care professional, board member, officer, employee and/or contractor: Must be sponsored by an eligible free clinic Must meet all statutory and program requirements Provide services to patients at the free clinic or through certain offsite events conducted by the free clinic Provide a qualifying health service (i.e., any medical assistance required or authorized to be provided under Title XIX of the Social Security Act (42 U.S.C. 1396,et seq.) 7
8 Program Requirements Continued. Appropriately licensed or certified to provide services Provide patients with written notification of limited legal liability (if not provided by the free clinic) Must have an individual contract for services with an individual clinician 8
9 Covered Services Qualified Health Service Claims that 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 o For others, contact HRSA for clarification 9
10 Credentialing and Privileging Credentialing Privileging Process of assessing and confirming the qualifications Verify licensure, certification, registration, and other forms of qualification Process of authorizing the specific scope and content of patient care services Completed in conjunction with evaluation of health care practitioner s clinical qualifications 10
11 Credentialing and Privileging Primary Source Verification (PSV) o Verification of a practitioner's qualification by the original source or an approved agent. E.g. Credentials verification organizations (CVOs) Secondary Source Verification (SSV) o Original credential o Notarized copy of credential o Copy of credential (when copy is made from an original by approved free clinic staff) 11
12 Credentialing Examples Verify o Licensure (psv) o Education, training (psv) o Ability to perform job (psv) o Identification (ssv) o DEA registration (ssv) o Hospital privileges (ssv) o Immunization (ssv) Query National Practitioner Data Bank 12
13 Privileging Examples Verify and Assess Competence in: o Course of training required to perform defined procedures o Particular procedures and protocols needed for position Note on Privileging o Very important to do on regular basis o Clinic based procedures 13
14 Quality Improvement/Quality Assurance Plan Quality Assurance Plan (QA Plan) or Risk Management Plan o Identifies free clinic s plan to mitigate risk and improve quality care for patients o Should map out plan for identification and evaluation of concerns, education plan for staff members, and responsibilities of management o Also include free clinic s credentialing and privileging process 14
15 Review of Liability History 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 o Report for past ten (10) years for Initial/Supplemental applicants o Report for past five (5) years for redeeming applicants 15
16 Annual Data Reporting FTCA Free Clinics are required to submit annual data for the previous Calendar Year (CY) within the Electronic Handbook (EHB) web based application system Free Clinics are required to report on the following data: o Total number of FTCA deemed providers o Total number of FTCA covered patient visits o Total number of FTCA deemed individuals 16
17 Claims Process Medical Malpractice claims brought against U.S. Government Must first go through Administrative Review at HHS/Office of General Counsel May later be 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 17
18 Coverage Covered individuals are provided liability protection from medical malpractice lawsuits when deemed by HRSA and therefore lawsuits are required to be brought under FTCA Free clinic coverage does not extend to free clinic entities 18
19 Coverage Approval Medical malpractice coverage under the free clinics FTCA Program does not occur automatically FTCA coverage requires HRSA s approval of applications for deeming of certain individuals from the sponsoring free clinic FTCA coverage is not retroactive and is not effective until the date shown on your deeming letter 19
20 Application Process Health Resources and Services Administration (HRSA) has developed a FTCA free clinic deeming module within the HRSA Electronic Handbook (EHB) system To streamline FTCA deeming application submission and processing, all free clinics must submit all deeming applications within the EHB online system 20
21 Application Process Continued.. Submission Categories: A, B, and C Category A - Free Clinics with currently deemed individuals submitting a supplemental deeming application for coverage for the current Calendar Year (CY) Category B - Free Clinics submitting an initial deeming application; including coverage for health professionals, board members, officers, volunteer clinicians, employees, and /or individual contractors Category C - Free Clinics seeking renewed or new coverage for health professionals, board members, officers, volunteer clinicians, employees and/or individual contractors for CY
22 Category A Supplemental In addition to a completed electronic application the clinic must also submit the following: Uploaded copy of the new QI/QA plan only if it has changed since the most recent original or redeeming application Description of any and all disciplinary actions and malpractice claims alleged against any new sponsored eligible individuals within ten (10) years prior to the submission of this FTCA application (including pending claims) 22
23 Category B Initial In addition to a completed electronic application the clinic must also submit the following: Documentation of non-profit status Board approved Quality Improvement/Quality Assurance plan (QI/QA) Description of any and all disciplinary actions and malpractice claims alleged against the free clinic and/or its sponsored individuals within ten (10) years prior 23
24 Category C Redeeming In addition to a completed electronic application the clinic must also submit the following: Board approved Quality Improvement/Quality Assurance plan (QI/QA) Description of any and all disciplinary actions and medical malpractice claims alleged against any sponsored eligible individuals within five (5) years prior to the submission of this FTCA application (including pending claims) 24
25 FTCA Free Clinic Resources Website: Archived Webinars Application Resources ( Quick Reference Guides, FAQ s) Policy Documents ( Program Assistance Letter (PAL ), Program Information Notice (PIN ) Clinical Risk Management Resources (ECRI) 25
26 Contact Us FTCA Help Line Phone: BPHC ( ) 9:00 AM to 5:30 PM (ET) April Fields/Mike Chellis Federal Tort Claims Act Free Clinic Program
27 Questions 27
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