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The purpose of this Policy Information
Notice (PIN) is to clarify the scope of
Federal Tort Claims Act (FTCA) coverage
for FTCA-deemed Health Center Program
grantees during an emergency. This PIN
does not address a health center’s
scope of project for purposes of Medicaid/Medicare
reimbursement during an emergency or eligibility
for the 340B Drug Pricing Program during
an emergency. PIN 2002-07, “Scope
of Project Policy,” and PIN 2007-14,
“Technical Revisions to PIN 2002-07,”
provide general guidance on these subjects.
A. Legislative Background
FTCA coverage for eligible Health Resources
and Services Administration (HRSA) grantees
was initially legislated through the Federally
Supported Health Centers Assistance Act
of 1992 (FSHCAA) (Public Law 102-501)
by amending section 224 of the Public
Health Service (PHS) Act. The eligible
entities are Health Center Program grantees
(section 330(e), (g), (h) and (i) of the
PHS Act). The FSHCAA of 1995, signed into
law on December 26, 1995, clarified the
1992 Act and eliminated its sunset provision,
making the program permanent.
The intent of FSHCAA is to increase the
availability of funds for the provision
of primary health care services by reducing
the expenditure of Health Center Program
funds for medical malpractice insurance
premiums. The FSHCAA accomplishes this
by making deemed health centers (and their
officers, directors, employees, and certain
contractors) Federal employees for the
purpose of medical malpractice protection.
As Federal employees, these organizations
and individuals are immune from medical
malpractice suits for actions within the
scope of their project and health center
employment. In the event that a medical
malpractice lawsuit is filed against a
deemed entity or covered provider acting
within the scope of his/her employment
in grant-related activities, the United
States is substituted for the deemed entity
and the covered employee. The health center
and the covered employee will be dismissed
from the case, with the case continuing
against the United States as the sole
defendant.
B. Applicability
This PIN applies to all health centers
funded under the Health Center Program
authorized in section 330 of the PHS Act
(42 U.S.C. 254b), as amended, specifically:
- Community Health Center (CHC) Programs,
funded under section 330(e);
- Migrant Health Center (MHC) Programs,
funded under section 330(g);
- Health Care for the Homeless (HCH)
Programs, funded under section 330(h);
and
- Public Housing Primary Care (PHPC)
Programs, funded under section 330(i).
For the purposes of this document, the
term “health center” refers
to the diverse types of health centers
(i.e., CHC, MHC, HCH, and PHPC) that are
supported under section 330 of the PHS
Act and that have been deemed to be employees
of the Public Health Service pursuant
to section 224(g) of the PHS Act.
For the purposes of this PIN, an “emergency”
or “disaster” is defined as
an event affecting the overall health
center target population and/or the health
center’s community at large, which
precipitates the declaration of a state
of emergency at a local, State, regional,
or national level by an authorized public
official such as a governor, the Secretary
of the U.S. Department of Health and Human
Services, or the President of the United
States. Examples include, but are not
limited to: hurricanes, floods, earthquakes,
tornadoes, widespread fires, and other
natural/environmental disasters; civil
disturbances; terrorist attacks, collapses
of significant structures within the community
(e.g., buildings, bridges); and infectious
disease outbreaks and other public health
threats.
In situations where an emergency has
not been officially declared, HRSA will
evaluate on a case-by-case basis whether
extraordinary circumstances justify a
determination that the situation faced
by the health center constitutes an “emergency”
for purposes of extending FTCA coverage
to services provided at temporary locations.
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