This Policy Information Notice (PIN) supplements existing guidance of the Bureau of Primary
Health Care (BPHC) regarding malpractice liability protection by the Federal Tort Claims Act
(FTCA) for section 330 grantees (Health Centers) deemed under the Federally Supported Health
Centers Assistance Acts (FSHCAA) of 1992 and the FSHCAA of 1995. It clarifies coverage
provisions when health center providers bill for services provided to health center patients.
The FTCA coverage for eligible BPHC grantees was initially established through the FSHCAA of
1992 (Public Law 102-501) by amending section 224 of the Public Health Service Act. The
eligible entities ("Health Centers") are Migrant Health Centers, Community Health Centers,
Health Care for the Homeless grantees, and Health Services for Public Housing Residents
grantees. The FSHCAA of 1995, signed into law by the President on December 26, 1995,
clarified the 1992 Act and eliminated its sunset provision, making the program permanent.
The intent of the legislation was to increase the availability of funds for the provision of primary
health care services by reducing the expenditure of Health Center funds for malpractice insurance
premiums. The FSHCAAs accomplish this by making deemed Health Centers (and their officers,
directors, employees and certain contractors) Federal mployees for claims and suits arising out of
medical or related functions. As Federal employees these organizations and individuals are
immune from medical malpractice claims and suits for actions within the Health Center’s
approved scope of project. Claimants must follow the requirements of the FTCA for relief. The
FTCA applies to acts or omissions of covered entities in the performance of covered activities.
This PIN clarifies certain policy and procedure for coverage under the FTCA and supersedes
Program Assistance Letter 99-15, Question 4.
The FSHCAA of 1995 made clear that section 224 covers any officer, governing board member,
or employee of a deemed Health Center. Employees are covered by the FTCA whether they are
full-time or part-time. Furthermore, the FSHCAA of 1995 provides FTCA coverage for licensed
or certified health care practitioner contractors working full-time (i.e., on average at least 32 ½
hours per week). The FSHCAA of 1995 also provides FTCA coverage for part-time licensed or
certified health care practitioner contractors providing services in the fields of family practice,
general internal medicine, general pediatrics, or obstetrics and gynecology.
In certain circumstances, a deemed Health Center may be prohibited by State Medicaid regulation
from billing for off-site and/or inpatient services or the deemed health center may find it financially
impractical or disadvantageous to bill for off-site services. As a result, Health Centers have used
alternative means to bill for services provided by their covered employees or contractors to Health
Center patients. The most common method used is to have the provider bill for the service and
remit the funds received for that service to the health center. It is the policy of BPHC that such
an arrangement will not, by itself, remove the provider of that service from coverage under the
FTCA. If an employed provider or a contract provider, meeting all other requirements for
coverage under the FTCA (see PIN 99-08, “Health Centers and the Federal Tort Claims Act”),bills for a service delivered at or away from the health center site, FTCA coverage will apply to
the provider and the center so long as all the following occur:
- The provider reports to the Health Center all such billings.
- The funds received by the provider for the specific billing are transferred directly to the
Health Center within a reasonable period of time.
- The provider’s employment contract authorizes the billing arrangements described above.
If you have any questions, please contact CAPT Martin Bree, Director, Center for Risk Management at
215-861-4373 or comments@hrsa.gov. |