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Health center employees and certain contractors
are eligible for FTCA coverage only while
providing services within the approved
section 330-grant supported scope of project.
This PIN describes the two mechanisms
by which, during an emergency, FTCA-deemed
health centers may include the provision
of FQHC services at a temporary location
within the scope of project. The choice
of which mechanism to use depends on whether
the proposed activity is located (1) inside
the health center’s service area
and within areas adjacent to the health
center’s service area (i.e., neighboring
counties, parishes, or other political
subdivisions) or (2) outside the health
center’s service area and beyond
neighboring counties, parishes, or other
political subdivisions. If a health center
needs to continue operating the temporary
site beyond 90 days from the onset of
the emergency, the health center must
submit a change in scope request through
the HRSA Electronic Handbooks. The request
must be consistent with the requirements
described in PIN 2002-07 and PIN 2007-14.
A. FTCA Coverage within the Service
Area
The scope of project is a description
of the health center’s project,
categorized by five core elements (sites,
services, providers, target population,
and service area) for which grant funds
have been approved. The FTCA statute and
regulations do not permit FTCA coverage
to follow health center providers providing
care outside of the health center’s
approved scope of project, which includes
a defined target population and service
area, nor outside of the scope of their
employment.
HRSA recognizes that, during an emergency,
FTCA-deemed health centers are likely
to participate in an organized State or
local response and may be called upon
to provide primary health care services
at temporary locations. Temporary locations
include any place that provides shelter
to evacuees and victims of an emergency.
It also includes those locations where
mass immunizations or medical care is
provided as part of a coordinated effort
to provide temporary medical infrastructure
where is it most needed. These temporary
locations will be considered part of a
health center’s scope of project
if all of the following conditions are
met:
1. Services are provided on a temporary
basis.
2. Temporary locations are within the
health center’s service area or
neighboring counties, parishes, or other
political subdivisions adjacent to the
health center’s service area.
3. Services provided by health center
staff [1] are within
the approved scope of project.
4. All activities of health center staff
are conducted on behalf of the health
center. (Health center providers who volunteer
in their individual capacity to respond
will not be protected under the health
center’s FTCA coverage.)
To assure that the emergency response
at temporary locations is considered part
of the health center’s scope of
project and that it will be covered by
the FTCA, the health center must provide
the following information to its HRSA
Project Officer by phone, e-mail, or fax:
(1) health center name; (2) the name of
a health center representative and that
person’s contact information; and
(3) a brief description of the emergency
response activities. Health centers must
submit this information as soon as practicable
but no later than 15 days after initiating
emergency response activities. HRSA will
determine on a case-by-case basis whether
extraordinary circumstances justify an
exception to this 15-day requirement.
If the HRSA Project Officer is not available,
the health center should contact (1) the
Bureau of Primary Health Care’s
main phone line at: 301-594-4110 or (2)
the FTCA Hotline at: 1-866-FTCA-Help (382-2435).
For purposes of FTCA coverage, patients
served by FTCA-deemed providers at temporary
locations included in the scope of project
(following the process above) will be
considered health center patients. As
such, the health center and its providers
will be covered by the FTCA for these
services.
As stated above, if a health center needs
to continue operating the temporary site
beyond 90 days from the onset of the emergency,
the health center must submit a change
in scope request as described in PIN 2002-07
and PIN 2007-14. The request must be submitted
through the HRSA Electronic Handbooks.
B. FTCA Coverage Outside the Service
Area
In rare cases, an emergency may impact
an entire region or State, causing widespread
devastation and evacuation of the population
served by the health center to another
area of the State or region. In those
unique situations, a health center may
be called upon to fulfill its requirements
under the Health Center Program by continuing
to provide care to its target population,
which has been displaced by the emergency
to a distant part of the State or region.
In these instances, if the site of a deemed
health center in the impacted area is
destroyed or unable to operate, the health
center may submit a request for prior
approval to temporarily change its scope
of project to include operation of a temporary
site within the health center’s
general geographic region, in an area
outside the health center’s regular
service area and beyond areas adjacent
to the health center’s service area.
The purpose of this scope change should
be to provide medical care primarily to
the health center’s target population
and to other medically underserved populations
that may have been displaced by the disaster.
The following conditions must be met in
order for the temporary site outside of
the service area and in an area that is
not in a neighboring county, parish, or
political subdivision to be eligible for
inclusion within the scope of project:
1. The health center must demonstrate
that the purpose of the temporary site
is to provide services primarily to its
original health center target population
(as defined in the most recent application
for section 330 grant support), which
has been displaced by the emergency, and
to other medically underserved populations
that may have been displaced by the disaster.
2. Services provided are on a temporary
basis.
3. Services are provided by health center
staff [2] and are within
the approved scope of project.
4. All activities of health center staff
are conducted on behalf of the health
center. (Health center providers who volunteer
in their individual capacity to respond
will not be protected under the health
center’s FTCA coverage.)
Please note that State licensure requirements
apply in all instances.
To ensure that the temporary site is
considered part of the center’s
scope of project and that FTCA coverage
will apply, grantees must contact their
HRSA Project Officer by telephone, e-mail
or fax and submit a request for prior
approval to add the new site. The request
must include a summary of the requested
change in scope of project, including
verification that the four conditions
above will be met. HRSA will expedite
the review of these requests with the
goal of notifying the grantee of HRSA’s
decision (i.e., approval or disapproval)
by telephone or via e-mail within 48 hours
of receipt of the request. Again, if a
health center needs to continue operating
an approved temporary site beyond 90 days
from the onset of the emergency, the health
center must submit, through the HRSA Electronic
Handbooks, a change in scope request as
described in PIN 2002-07 and PIN 2007-14.
C. FTCA Coverage for Non-Impacted
Health Centers
In emergency situations, health centers
that are not impacted by the emergency
may (1) assist at temporary sites within
the same service area and within neighboring
counties, parishes, or political subdivisions
or (2) operate temporary sites within
the service area and within neighboring
counties, parishes, or political subdivisions
by including the temporary locations within
the scope of project using the process
described in Section IV.A., above. The
processes described in this PIN are not
applicable to situations where employees
of non-impacted health centers seek FTCA
coverage to provide care during emergencies
outside their service area and beyond
neighboring counties, parishes, or political
subdivisions.
The law that authorizes the Health Center
FTCA Program does not extend FTCA coverage
to volunteers at health centers. The current
statute specifically limits FTCA coverage
to health center employees, governing
board members, officers, and certain contractors.
[3] While it can be anticipated
that health centers will receive numerous
offers of and requests for volunteer assistance
during emergencies, those volunteers will
not be covered by the FTCA under the Health
Center FTCA Program.
However, it is possible that the volunteer
would qualify for immunity or limited
liability under State or Federal charitable
immunity/limited liability statutes (such
as the Federal Volunteer Protection Act
of 1997)[4] or under
Federal provisions related to the National
Disaster Medical System (section 2811
of the PHS Act). [5]
1. Is the FTCA Katrina PIN (2005-19)
policy applicable to future emergencies?
A: No. PIN 2005-19, “Federal Tort
Claims Act Coverage for Deemed Consolidated
Health Center Program Grantees Responding
to Hurricane Katrina,” applied only
to the emergency response after Hurricanes
Katrina and Rita. This PIN (PIN 2007–16)
describes a broader, prospective policy
that applies to future emergencies.
2. Does FTCA coverage apply if
a health center provider crosses State
lines?
A: The key question is not whether the
provider has crossed State lines, but
whether the provider is providing services
within the approved scope of project.
If the health center’s clinicians
are providing care outside of the approved
scope of project, the center and clinicians
will NOT be covered by the FTCA.
In certain border area cases, the health
center’s service area or neighboring
counties may cross State lines. In this
instance, if the health center’s
clinicians are providing care within the
health center’s approved scope of
project, the health center and clinicians
will be covered by the FTCA. In situations
of regional emergencies, it may be possible
for a health center to request prior approval
to temporarily change its scope of project
to include operation of a temporary site
outside the State, as described in Section
IV.B. of this PIN. Please note that State
licensure requirements apply in all instances.
3. When should a health center
submit a formal change in scope of project
request?
A: Health centers expecting to operate
at a temporary location beyond 90 days
from the onset of the emergency must submit
a formal change in scope of project request.
Health centers are encouraged to submit
the formal request well in advance of
the 90-day limitation for a temporary
site to allow for processing time and
to ensure FTCA coverage beyond the 90
days.
4. Do health centers have to
submit a formal change in scope of project
request to provide services at temporary
sites during an emergency?
A: No. HRSA will consider these temporary
sites part of the center’s scope
of project if the criteria described in
Section IV.A. or IV.B. are met and the
health center follows the process described
in the applicable section. Note that prior
approval is necessary for changes in scope
described in Section IV.B. Health centers
expecting to operate at a temporary location
beyond 90 days from the onset of the emergency
must submit a formal change in scope of
project request.
5. As the result of an emergency,
a deemed health center provides services
at a site within its scope of project
to evacuees who have traveled from another
service area where medical facilities
have been destroyed. Are the health center
and its providers covered by the FTCA
for services to evacuees?
A: For purposes of FTCA coverage, anyone
seeking care at a deemed facility, including
at temporary sites within the scope of
project, is a “health center patient.”
It does not matter whether the person
is a permanent resident of the community
or is there temporarily. Therefore, in
the example above, FTCA coverage applies
to the health center and its providers
who provide services to the evacuees at
its regular facility and at temporary
sites.
6. A deemed health center is
destroyed as a result of a disaster. In
order to continue providing services,
the destroyed health center sets up and
operates a temporary site within the service
area or within neighboring counties, parishes,
or political subdivisions. Are medical
services provided by the health center’s
staff at this temporary site covered under
the FTCA?
A: Yes, HRSA will consider a temporary
site part of the center’s scope
of project if the criteria described in
Section IV.A. are met and the health center
follows the process prescribed in that
section. If a health center needs to continue
operating a temporary site beyond 90 days
from the onset of the emergency, the health
center must submit a change in scope request
as described in PIN 2002-07 and PIN 2007-14.
7. A deemed health center is
destroyed as a result of a disaster. In
order to continue providing services,
the destroyed health center sets up and
operates a temporary site OUTSIDE the
service area, in an area that is NOT in
a neighboring county, parish, or political
subdivision. Are medical services provided
by the health center’s staff at
this temporary site covered under the
FTCA?
A: In this situation, the process described
in section IV.A. is not applicable because
the health center is providing services
outside its service area and beyond neighboring
counties, parishes, or political subdivisions.
Instead, the health center should follow
the process described in section IV.B.
of the PIN, which applies to requests
to temporarily change the scope of project
to include operation of a temporary site
outside the service area and beyond neighboring
counties, parishes, or political subdivisions.
8. In order to assist with the
medical response after an emergency, staff
from a deemed health center go to work
at a temporary location such as a shelter
for evacuees within its service area or
within neighboring counties, parishes
or other political subdivisions adjacent
to its service area. Are medical services
provided by the health center’s
staff at this temporary location covered
under the FTCA?
A: If temporary locations are included
within the approved scope of project following
the prescribed process in Section IV.A.,
the evacuees treated by those clinicians
are considered health center patients.
Therefore, the health center staff would
be covered under the FTCA for medical
services provided to the evacuees.
9. A health center employee is
providing care at a local hospital as
part of a community-wide emergency response.
Are these services covered under FTCA?
A: Yes, as long as the employee is providing
services within the health center’s
approved scope of project, at the direction
of the health center (not volunteering
on his/her own), and the health center
has followed the process described in
Section IV.A.
10. If grantees use volunteers
to provide services during an emergency,
are these volunteers eligible for coverage
under the Health Center FTCA program?
A: No. The relevant statute does not
allow for FTCA coverage of health center
volunteers. It is possible that the volunteer,
if he/she has been deployed by the Federal
Government as an intermittent Federal
employee under a Federal Emergency Mission
Act (FEMA) Mission Assignment, would be
covered under another FTCA authority.
It is also possible that the volunteer
would qualify for immunity or limited
liability under State or Federal charitable
immunity/limited liability statutes (such
as the Federal Volunteer Protection Act
of 1997) or under Federal provisions related
to the National Disaster Medical System
(section 2811 of the PHS Act).
Footnotes
[1] Including contractors eligible under
section 224(g)(5) of the PHS Act.
[2] Including contractors eligible under
section 224(g)(5) of the PHS Act.
[3] PHSA section 224(g)(1)(A).
[4] Public Law 105-19.
[5] For more information on the National
Disaster Medical System, see the HHS
Web site.
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