1. Federal Tort Claims Act (FTCA) Free Clinics Program Technical Assistance Call Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data June 29, 2010

2. Todays Call Purpose Background Eligibility Application Process How to Submit Important Dates Questions/Answers 2

3. Purpose To provide information on the Program Assistance Letter (PAL) 2010-08 which supplements the Program Information Notice (PIN) 2004-24 Program Requirements To provide guidance on requirements for medical malpractice coverage of additional eligible individuals in the free clinics. These include: Board Members, Officers, Employees, and Contractors. 3

4. Background Authority: Affordable Care Act (Public Law 111-148) (ACA), which amended Act 42 U.S.C. 233(o). PIN 2004-24 explains the Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) deeming process for free health clinic volunteer clinicians. 4

5. Background FTCA Medical Malpractice Liability Coverage in Free Clinics In 2004, Congress made effective FTCA medical malpractice protection for volunteer free clinic health professionals. Free Clinic volunteers who meet all the requirements of the program may be sponsored by the Free Clinic and "deemed" a Public Health Service Federal employee for the purpose of FTCA medical malpractice coverage. In 2010, Congress extended FTCA medical malpractice protection to eligible Board Members, Officers, Employees, and Contractors. 5

6. Eligible Entities A Designated Free Clinic must be operated by a non-profit private entity that: Does not accept reimbursement from any third party payor Does not impose charges on patients May accept patients voluntary donations, and Is licensed or certified per applicable law to provide health services. 6

7. Eligible Individuals Volunteer Health Professionals & Others Covered Individuals: Must meet all statutory and Free Clinic FTCA program requirements. Provide services to patients at Free Clinic or through certain offsite events conducted by the Free Clinic. Must be sponsored by an eligible Free Clinic. Provide qualifying Health Services. Do not receive compensation for services. Are licensed or certified to provide services as appropriate. Provide patients w/written notification of limited legal liability (if not provided by the Free Clinic). 7

8. Eligible Individuals Do not receive compensation for services. Are licensed or certified to provide services as appropriate. Provide patients w/written notification of limited legal liability (if not provided by the Free Clinic). A contract for services must be with an individual clinician. A contract between a Free Clinic and a corporation does not provide sufficient basis for deemed status under the Free Clinic FTCA Program. 8

9. Coverage Covered Individuals are provided coverage from medical malpractice lawsuits when deemed by HRSA and therefore suits are required to be brought under FTCA. Coverage is similar to an occurrence policy. Free Clinic coverage does not extend to Free Clinic entities, which therefore are not eligible for deemed employee status under 42 U.S.C. 233(o). Coverage extends only to medical malpractice, i.e., performance of medical, surgical, dental or related functions within the scope of covered individuals duties on behalf of the Free Clinic. 9

10. Program Requirements FTCA coverage is Not Automatic. Eligible individuals are covered by FTCA once an application submitted by their sponsoring Free Clinic is approved by HRSA. Free Clinics must demonstrate in their application that they have addressed all of the Free Clinic FTCA Program Requirements. Credentialing and privileging systems Patient notification of limited liability Risk management systems and periodic review of medical malpractice claims history Reporting on the number of patient visits covered by FTCA 10

11. Free Clinic FTCA deeming/redeeming application is an annual process. Free Clinics must submit deeming application on behalf of their volunteer health care professionals to HRSA. Free Clinics must submit deeming applications for board members, officers, employees, and/or individual contractors, as the sponsor of those individuals. Application Process 11

12. The Application Process has three Submission Categories: A, B, and C. Category A - Free Clinics with currently deemed volunteer health professionals submitting a supplemental deeming application for Calendar Year (CY) 2010. Category B - Free Clinics submitting an initial deeming application; including coverage for board members, officers, employees, and /or individual contractors. Category C - Free Clinics seeking renewed coverage for volunteers and new or renewed coverage for board members, officers, employees and/or individual contractors for CY 2011. Application Process 12

13. Category A Free Clinics with currently deemed volunteer health professionals submitting a supplemental deeming application for Calendar Year (CY) 2010: If seeking the new malpractice coverage for board members, officers, employees, and /or individual contractors for remainder of CY 2010; the Free Clinic must complete and submit the supplemental application form included with the PAL 2010-08, Attachment 1. 13

14. Category B Free Clinics submitting an initial deeming application/including coverage for board members, officers, employees, and /or individual contractors must submit an application that includes: An original Application Form from PIN 2004-24 (http://bphc.hrsa.gov/ftca/freeclinics/)http://bphc.hrsa.gov/ftca/freeclinics/ and Supplemental Application Form included with PAL 2010-08. 14

15. Category C Free Clinics seeking renewed coverage for volunteers and new or renewed coverage for board members, officers, employees and/or individual contractors for CY 2011 must submit: A renewal application by completing and submitting the new application form when it becomes available this summer. 15

16. Completing the Application To streamline the FTCA deeming application submission and processing, Free Clinics should submit a signed copy of the application electronically to freeclinicsFTCA@hrsa.gov. freeclinicsFTCA@hrsa.gov The e-mail subject line should include the heading Additional FTCA Coverage Application and the Free Clinics FTCA number (FC #XXXX). (This refers to Category A applicants). 16

17. Waiver If electronic submission is not feasible: The Free Clinic will need to submit a request for a waiver of the electronic process by e-mailing freeclinicsFTCA@hrsa.govfreeclinicsFTCA@hrsa.gov and To exercise this waiver, the Free Clinic must have prior approval from HRSA for a paper submission. 17

18. Check Completeness Reminder: Incomplete applications (including all attachments) will not be processed until all missing items are provided and the application is complete. Any delays will impact date of coverage! 18

19. September 1 st, 2010 - redeeming application (projected) due date. November 1 st, 2010 - PAL 2010-08 attachment for amending sponsoring Free Clinic Deeming Letter due date (to add existing Board Members, Officers, Employees, and Contractors). (This applies to Category A applicants). New hires and appointments may be added after that date until the end of the calendar year cut-off. January 1 st, 2011- New Deeming Coverage Begins. 19 Important Dates

20. CONTACT INFORMATION For more information on the Free Clinic Deeming Application requirements and related questions, please contact: 1-866-FTCA-HELP (866-382-2435) The Helpline is available 9:00 AM to 8:00 PM (ET) business days FreeClinicsFTCA@hrsa.gov 20

21. Questions and Answers Thank you for your continued interest in our programs. 21