Presentation on theme: "FTCA MEDICAL MALPRACTICE BASICS AND PROGRAM UPDATES Christopher W"— Presentation transcript:
1 FTCA MEDICAL MALPRACTICE BASICS AND PROGRAM UPDATES Christopher W FTCA MEDICAL MALPRACTICE BASICS AND PROGRAM UPDATES Christopher W. Gibbs, JD, MPHDepartment of Health and Human ServicesHealth Resources and Services AdministrationBureau of Primary Health CareOffice of Quality and Data
2 Introduction FTCA Basics: The Who, When, Where, What, and How FTCA Program UpdateSummary of Deeming Requirements: Changes and Lessons Learned from CY 2012 DeemingHelpful Resources and Technical AssistanceQuestion and Answer
3 How the Program Works A program that provides immunity from lawsuit. Appears similar to an occurrence malpractice policy.Very successful in terms of savings for health centers and coverage of health centers and staff.
4 How the Program Works (continued) Under FSHCAA Health Centers are eligible to be deemed “federal employees”.Provides immunity from lawsuit alleging medical malpractice.Plaintiff’s only remedy is claim under Federal Tort Claims Act (FTCA).
5 How the Program Works (continued) Who, what, when, where?Who is covered - Relationship to Health Center.What is covered – medical malpractice.Where is it covered – scope of project.When is it covered – scope of employment.
6 How the Program Works (continued) Who is Eligible to be Deemed:Community Health Centers [section 330 (e)].Migrant Health Centers [section 330 (g)].Health Care for the Homeless [section 330 (h)].Public Housing Primary Care [section 330 (i)].
7 How the Program Works (continued) Who is coveredEmployees.Officers.Directors.Governing board members.Contractors (some, not all).
8 How the Program Works (continued) Who is covered - EmployeesAll employees, full time or part time.Volunteers are not employees.Employees get a W-2 at end of year.
9 How the Program Works (continued) Who is covered - ContractorsAny full time contract provider (over 32 1/2 hours per week).Part time contract provider of services in the fields of family practice, ob-gyn, general internal medicine, or general pediatrics.Contract must be between the deemed health center and the individual provider.Contracts between the deemed health center and a corporation (including Professional Corporations) are not covered.
10 How the Program Works (continued) What is covered?Medical malpractice.More specifically, medical, surgical, dental and related activities (if within the scope of employment and scope of project).
11 How the Program Works (continued) Where is it covered – within the scope of projectOnly incidents that occur within the scope of the project are covered. (See Policy Information Notice ).Scope of Project are the activities described in the grant application that are approved by Public Health Service via Notice of Grant Award.An existing Scope of Project can be changed by applying for a Change in Scope (CIS).
12 How the Program Works (continued) When is it coveredCoverage is only for acts that are within the scope of employment of the covered individual.No Moonlighting.Must be acting on behalf of the deemed entity.
13 Non-Health Center Patients Federal Register Notice September 25, 1995 (Volume 60 Number 185) page –Community-Wide Intervention School-Based ClinicsSchool-linked ClinicsHealth FairsImmunization CampaignsMigrant Camp OutreachHomeless OutreachHospital Related ActivitiesCoverage-Related ActivitiesOther situations require a “Particularized Determination” PINApplication Information for PDs is located on page 9 and 10
14 Notice of Proposed Rule Making Proposal to amend regulations at 42 CFR Part 6 (“FTCA Coverage of Certain Grantees and Individuals”)Immunization campaigns for all, not just children (as currently stated)FTCA coverage for services provided to non-health center patients in individual emergency situationsA health center provider is acting to provide care to a health center patient (and such care is part of the approved scope of project of the center) and the provider is then asked, as the result of a non-health center patient’s emergency situation, to temporarily treat or assist in treating that non-health center patient at that location. The health center has documentation (such as employee manual provisions, health center bylaws, or employee contract) that the provision of individual emergency treatment (when the practitioner is already on-site acting to provide care to health center patients) is a condition of employment at the health center.The Rule is in the final clearance stage
16 FTCA Claims Procedures Plaintiff files administrative claim against the United States.DHHS reviews claim and may deny it, pay it or offer a settlement.If DHHS denies claim plaintiff may file suit.If DHHS does not act on claim within six months plaintiff may file suit.When suit is filed case transferred to DOJ.DOJ may attempt to settle suit otherwise it goes into litigation.
17 FTCA Claims Procedures (continued) Plaintiffs often file suit in state court (Premature Claims).What to do:U.S. Department of Health and Human ServicesOffice of the General CounselGeneral Law Division330 Independence Avenue, S.W.Mail Stop Capitol PlaceWashington, DC 20201(fax)Have health center attorney request extension of time to reply.
19 Program Updates FTCA Branch FTCA Policy Manual (PIN 2011-01) Branch within OQD6 staff membersActing Branch Chief: Naomi TomoyasuFocus on FTCA policies, procedures, risk management, presentations, TA and program development for Health Centers and Free ClinicsFTCA Policy Manual (PIN )
20 Program Updates (Continued) Focus on implementation and qualityCreation of policies and proceduresImplementation of policies and proceduresReevaluation of policies and proceduresTechnical Assistance and Education
21 Future Plans FTCA Deeming PIN Clarification of Requirements Focus QI/QA,Application process expectationsRisk ManagementCredentialingMedical Records
22 Future Plans (continued) QI/QA PINClarify and articulate the standards for:QI/QA Program and Committee roles and responsibilitiesQI/QA PlanLeadership Roles in QI/QA oversightRisk Management ProgramMedical Records
23 FTCA Site Visits FTCA Site Visits Focuses specifically on FTCA requirementsConducted byFTCA StaffMSCG ContractorsRegional StaffCollaboration with project officers
24 FTCA Site Visits Types of Visits Verification of Implementation Technical Assistance and EducationClaims and Liability Issues
25 FTCA by the DollarsFTCA represents a significant savings for Health CentersSignificant money spent on claimsIncreased focus on quality and risk management
26 2011 – Top 5 incidents by Type 190 Claims filed in 2011 Diagnosis and treatment - related incidents lead to largest amount of claimsClosely followed by Obstetrics- related incidents
28 Types of ApplicationsThere are two types of applications for FTCA coverage:EHB System was opened to receive applications on February 23, 2012INITIAL DEEMING APPLICATIONMay be submitted at any time during the year when the EHB system is open to receive applications.Will be acted upon by HRSA within 30 days after receipt of a completed applicationANNUAL REDEEMING APPLICATIONAll currently deemed health centers must file a renewal deeming application to be deemed for CY This year’s deadline was April 5, 2012
29 CY 2013 Requirement Updates Minutes from any six QI/QA committee meetings. All minutes must be dated between June 1, 2011 and the submission date of the application.Remove patient names and other identifiersMinutes from any six Board meetings that reflect Board approval of QI/QA activities. All minutes must be dated between June 1, 2011 and the submission date of the application.Remove all information not related to QI/QA activity
30 CY 2013 Requirement Updates (continued) Board-approved Credentialing and Privileging (C&P) policiesMust be signed and dated by the Board(C&P) Plan + Page with Board of Directors Signature(C&P) Plan + Signed Board Minutes showing C&P plan was approvedClinical policies and procedures for the following activities:Referral TrackingHospitalization TrackingDiagnostic Tracking (Should include X-Ray Tracking Lab Result Tracking)
31 Requirements A complete initial or redeeming application must include: An Application Form completed in EHBAn approved Quality Improvement/Quality Assurance Plan, including governing board signature and approval dateTwo Methods to demonstrate Board approvalQI/QA Plan + Page with Board of Directors SignatureQI/QA Plan + Signed Board Minutes showing QI/QA plan was approved
32 RequirementsSummary of professional liability history for cases filed or closed within the last 5 years, if applicableName of provider(s) involvedArea of practice/SpecialtyDate of OccurrenceSummary of allegationsStatus and outcome of claim
33 Requirements (continued) Explanation of any “NO” responsesDeeming applications for any sub-recipients (as documented on the organization’s most recent approved scope from FORM 5B - see “sub-recipient submission instructions.”)
34 Requirements (continued) Credentialing list (in an excel spreadsheet) of all licensed and/or certified health care personnel employed and/or contracted by the health center, with the following information:Name & Professional Designation (e.g., MD/DO, RN, CNM, DDS)Title/PositionSpecialtyEmployment Status (full-time employee, part-time employee, contractor, volunteer)Date of HireCurrent Credentialing DateNext Expected Credentialing Date** Please note that for the 2012 application “Initial Credentialing Date (the first time the individual was credentialed by your organization)” has been removed and is no longer required.
37 CY 2013 FTCA Application Technical Assistance (TA) Videos Online Instructional VideosStep by step instructional videos that demonstrate how to fill each section of the FTCA application and general EHB guidance.Supplemental videos that reviews best practices and points out resources that are useful in developing policies and procedures that are connected to the FTCA Deeming process.Currently Available on the ECRI website at the following link: : https://members2.ecri.org/Components/HRSA/Pages/Videos_Deeming.aspx