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Free
Clinics Medical Malpractice
|
FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$41,000
|
$40,000
|
$40,000
|
--- |
FTE
|
2
|
2
|
2 |
--- |
Authorizing
Legislation: Section 224 of the Public Health Service
Act
FY
2009 Authorization |
$10,000,000
|
Allocation
Method |
Other
|
Program Description and Accomplishments
The Free Clinics Medical Malpractice Program encourages
health care providers to volunteer their time at free
clinics by providing medical malpractice protection
at sponsoring health clinics, thus expanding the capacity
of the health care safety net. In many communities,
free clinics assist in meeting the health care needs
of the uninsured and underserved. They provide a venue
for providers to volunteer their services. Most free
clinics are small organizations with annual budgets
of less than $250,000.
In FY 2004, Congress provided first-time funding for
payments of free clinic provider’s claims under
the Federal Tort Claims Act (FTCA). The appropriation
established the Free Clinics Medical Malpractice judgment
fund and extended FTCA coverage to medical professional
volunteers in free clinics in order to expand access
to health care services for low-income individuals
in medically underserved areas.
Allocation Method: Qualifying Free
Clinics submit applications to the Department of Health
and Human Service to have volunteer providers deemed
that they sponsor. Qualifying ‘free clinics’
or health care facilities operated by nonprofit private
entities must be licensed or certified in accordance
with applicable law regarding the provision of health
services. They cannot:
Accept reimbursements from any third-party payor (including
reimbursement under any insurance policy or health
plan, or under any Federal or State health benefits
program including Medicare or Medicaid).
Impose charges on the individuals to whom the services
are provided, or impose charges according to the ability
of the individual involved to pay the charge. Increasing
Access: In FY 2006, 1,657 volunteer health care providers
received Federal malpractice coverage through the
Program, exceeding Program targets. In 2005, the first
year that the program began deeming providers, 38
free clinics were operating with FTCA-deemed volunteer
clinicians and, in 2006, this number increased to
65 clinics, also exceeding the Program’s annual
target. The Program also examines the quality of services
annually by monitoring the percentage of free clinic
health professionals meeting licensing and certification
requirements. Performance continues to meet the target
with 100 percent of FTCA-deemed clinicians meeting
appropriate licensing and credentialing requirements.
Promoting Efficiency: The Free Clinics
Medical Malpractice Program is committed to improving
overall efficiency by controlling the Federal administrative
costs necessary to deem each provider. By restraining
these annual administrative costs, the Program is
able to provide an increasing number of clinicians
with malpractice coverage, thus building the free
clinic workforce capacity nationwide and increasing
access to care for the vulnerable populations served
by these clinics. In 2005, the first year the program
deemed providers, the cost per provider was $221.
The 2006 target included a projected one-time increase
due to new contractor costs, substantial initial redeeming
application activities, increased technical assistance,
development of claims administration systems and outreach
assistance. As a result, the actual cost per provider
deemed in FY 2006 of $331 was higher than projected.
Program Assessment Rating Tool: An
Office of Management and Budget (OMB) Program Assessment
Rating Tool (PART) assessment of the Free Clinics
Medical Malpractice Program was conducted in 2006,
and the Program received a rating of Adequate, a significant
accomplishment for a program that only began in FY
2004. The review found that the Program is achieving
its annual goal in the percentage of volunteer FTCA-deemed
clinicians who meet certification and privileging
requirements and is managing risk with procedures
in place to ensure that only providers with a relatively
low risk of receiving a malpractice suit receive malpractice
coverage. The PART noted, however, that the program's
national impact is not known. In response, the Program
is working with OMB to obtain approval to modify its
original, renewal, and supplemental applications to
ensure that data for measuring the program's impact
can be collected.
Funding History
FY
2004 |
$4,821,000
|
FY
2005 |
$99,000 |
FY
2006 |
$40,000
|
FY
2007 |
$41,000 |
FY
2008 |
$40,000 |
Budget Request
The FY 2009 Request of $40,000 is the same as the
FY 2008 Enacted level. The entire FY 2009 Budget request
will support the Program’s achievement of its
ambitious performance targets and continue its goal
of increasing access and capacity in the health care
safety net.
Ambitious future targets for FY 2009 focus on increasing
the number of volunteer free clinic health care providers
deemed eligible for FTCA malpractice coverage while
also increasing the number of free clinics operating
with FTCA-deemed volunteer clinicians. The focus on
quality will continue to hold the Program to a target
of 100 percent for FTCA-deemed clinicians meeting
appropriate licensing and certification requirements.
The Program will also continue to promote efficiency
by restraining and actually decreasing the annual
Federal administrative costs necessary to deem each
provider.
The budget request will also support the Program’s
continued coordination and collaboration with related
Federal programs in order to further leverage and
promote efforts to increase the capacity of the health
care safety net. Areas of collaboration include coordination
with the Health Center FTCA program, also administered
by HRSA, to share program expertise. In addition,
the two programs control costs by sharing a contract
to process future claims, and by providing technical
support and outreach. The program will coordinate
with non-profit free clinic-related umbrella groups
on issues related to program information dissemination
and outreach and will continue to collaborate with
the Department of Justice (DOJ) and the HHS Office
of General Counsel (HHS/OGC) to assist in drafting
items including deeming applications and related policies.
The Program continues to work with the HHS/OGC to
answer legal technical assistance issues raised by
free clinics in the program and clinics interested
in joining the program.
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006
|
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target (2014) |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand the capacity of the health care
safety net |
2.I.A.1.
|
Increase
the number of volunteer free clinic health care
providers deemed eligible for FTCA malpractice
coverage. [Baseline - 2005] |
|
657 |
1,350 |
1,657 |
1,950 |
Nov-
08 |
2,500 |
3,100 |
N/A |
2.1 |
Patient
visits provided by free clinics sponsoring volunteer
FTCA-deemed clinicians. Developmental |
|
|
|
|
|
|
TBD |
TBD |
TBD |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. (2014) |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Expand the capacity of the health care
safety net |
2.I.A.2.
|
Number
of free clinics operating with FTCA-deemed volunteer
clinicians. [Baseline - 2005] |
|
38 |
55 |
65 |
70 |
Mar-08
|
85 |
105 |
2011:
135 |
2.I.A.3.
|
Percent
of volunteer FTCA-deemed clinicians who meet certification
and privileging requirements. [Baseline - 2005] |
|
100% |
100% |
100% |
100% |
Mar-08 |
100% |
100% |
N/A |
Efficiency
Measure |
2.E |
Administrative
costs of the program per Federal Tort Claims Act
(FTCA) -covered volunteer [Baseline – 2004] |
|
$221
|
$281
|
$331
|
$204
|
Mar-08 |
$195(a) |
$190
|
N/A |
|
Appropriated
Amount ($ Million) |
4.821 |
0.099 |
0.04 |
0.041 |
0.04 |
0.04 |
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