Free Clinics Medical Malpractice

Authorizing Legislation: Section 224 of the Public Health Service Act

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

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.