FTCA Credentialing TA Webcast Preparing for 2015 Deeming Application Mary Coffey , MBA, RN
FTCA Coverage for Individuals at Free Clinics Technical Assistance Call PIN 2010-02
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Transcript of FTCA Coverage for Individuals at Free Clinics Technical Assistance Call PIN 2010-02
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FTCA Coverage for Individuals at Free
ClinicsTechnical Assistance Call
PIN 2010-02Department of Health and Human Services
(HHS)Health Resources and Services Administration
(HRSA)Bureau of Primary Health Care (BPHC)
Office of Quality & Data (OQD)July 29, 2010
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Today’s Call
I. PurposeII. Overview of FTCA CoverageIII. Requirements for Free Clinic FTCA
CoverageIV. Overview of New Law and New PINV. Understanding the New ApplicationVI.Dates and Notes to RememberVII.Resources and Contact Info
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I. Purpose
• To give an overview of the new Free Clinic PIN 2010-02
• To provide information on the initial and redeeming application process for Free Clinics wishing to sponsor individuals for medical malpractice coverage provided by the Federal Tort Claims Act (FTCA)
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II. Overview of FTCA Coverage
• Established by Section 194 of HIPAA adding section 224(o) of the Public Health Service Act, covering volunteer health professionals
• Expanded by the Affordable Care Act in 2010 to include board members, officers, employees, and individual contractors
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II. Overview of FTCA Coverage
• Provides Medical Malpractice Coverage for deemed individuals providing medical, surgical, or dental services
• Eligible individuals must be sponsored by a free clinic
• NOT general liability coverage• Free clinic entity is NOT covered by
FTCA
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II. Overview of FTCA Coverage
• FTCA coverage is similar to an occurrence policy – coverage is for any incidents that occur during time the individual is covered under FTCA
• No specific coverage limit• Punitive damages not allowed • Cases defended by the United States
in Federal court
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III. Requirements
Sponsoring Clinics• Must be a nonprofit organization• Cannot accept third party
reimbursement• Does not impose charges on patients• May accept donations • Are licensed or certified in
accordance with applicable state law
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III. Requirements
Major Requirements for Deeming• Credentialing and Privileging System• Risk Management System• Patient Notification of Limited
Liability• Medical Malpractice Claims Review• Data Reporting
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III. Requirements
Credentialing• Process of
assessing and confirming the qualifications
• Verify licensure, certification, registration, and other forms of qualification
Privileging• Process of
authorizing the specific scope and content of patient care services
• Done along with evaluation of health care practitioner’s clinical qualifications
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III. Requirements
Credentialing & Privileging• Primary Source Verification (PSV)
- Verification of a practitioner's qualification by the original source or an approved agent. E.g., Credentials verification organizations
(CVOs)• Secondary Source Verification (SSV)
- Other methods not considered primary source. E.g., View original credential
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III. Requirements
Credentialing Examples• Verify
- Licensure (psv) - Education, training
(psv)- Ability to perform
job (psv)- Identification (ssv)- DEA registration
(ssv)- Hospital privileges
(ssv)- Immunization (ssv)
• Query National Practitioner Data Bank
Privileging Examples• Verify and assess
competence in:- Course of training
required to perform defined procedures
- Particular procedures and protocols needed for position
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III. Requirements
Risk Management• Quality Assurance Plan (QA Plan)
- Identifies free clinic’s plan to mitigate risk and improve quality care for patients
- Should map out plan for identification and evaluation of concerns, education plan for staff members, and responsibilities of management
- Also include free clinic’s credentialing and privileging process
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III. Requirements
Patient Notice of Limited Liability• Written Notification
- Provided by sponsoring free clinic or deemed individual
• Signature Preferred- Can be done once prior to first
encounter• Sample on website (
http://bphc.hrsa.gov/ftca/freeclinics/)
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III. Requirements
Review of Medical Malpractice Claims
• Used to ensure appropriate policies and procedures are in place to reduce risk of medical malpractice
• Report any medical malpractice claim or disciplinary action taken by licensing board- Report for past ten years for new
applicants- Report new claims from past year for
renewal applicants
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III. Requirements
Annual Data Reporting• Occurs the first quarter of each year• Examples of information requested:
- Number of visits per clinic by covered individuals
- Number of visits per covered individual- Number of patients per clinic by covered
individuals- Number of patients per covered
individual
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IV. New Law & PIN
Eligible Individuals• Volunteer Health Professionals• Board Members• Officers• Employees• Individual Contractors
- Must have individual contract between person and clinic
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IV. New Law & PIN
Covered Services• Qualified Health Service
- Specified in Title XIX of the Social Security Act
• Arise from medical, surgical, dental, or related services at free clinic site or offsite programs carried out by free clinic
• Offsite programs – health fairs with routine screening/health education- For others, contact HRSA for clarification- Generally allow 30 days for final answer
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IV. New Law & PIN
Claims Process• Medical Malpractice claims brought
against U.S. Government• Must first go through Administrative
Procedures• Filed in Federal District Court• Case argued in front of Judge, not
jury• Defended by the Department of
Justice and the HHS Office of General Counsel
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V. Application
• New application now in Excel
• Can save application in progress unlike previous fillable PDF
• Email entire application to [email protected]
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V. Application
• Each section of application has its own “worksheet”
• Five worksheets in total• Click tabs on bottom of page to move
between worksheets
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V. Application
First worksheet:Contact
Information• Free Clinic
organization information
• FTCA Contact Person/People
• Free Clinic Sites
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V. Application
Second worksheet:Sponsoring FreeClinic• Confirm eligibility • Click button for
yes or no• Explain any and
all “no” answers
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V. Application
Third worksheet:Credentialing andPrivileging • Answer questions
regarding credentialing and privileging processes
• Click yes or no• Explain any and
all “no” answers
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V. Application
Fourth worksheet:Risk ManagementSystems• Answer questions
about risk management and QA plan
• Click yes or no button
• Explain any and all “no” answers
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V. Application
Fifth worksheet:Individuals’
Information• List name of EACH
individual seeking deeming status- Including board
members, officers, employees, and contractors
• HRSA will only consider those listed on the application
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V. Application
Fifth worksheet: Individuals’ Information (continued)• Credentialing should be done every
two (2) years• Answer yes or no if there has been a
medical malpractice or disciplinary action against individual
• Attach explanation of any claims
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V. Application
Adding more fields• If need more lines
for people, sites, etc.
• Highlight rows (click on numbers on left)
• Right click• Choose “Insert”• Repeat as
necessary
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VI. Dates and Notes to Remember
• Deeming Applications due September 1, 2010 for 2011 coverage
• PAL 2010-08 Attachment Application due November 1st for 2010 coverage for additional persons
• Only individuals are eligible for medical malpractice coverage, not free clinic entity
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VII. Resources and Contact Info
For more information on the Free Clinic deeming application, FTCA coverage, or PIN 2010-02, please contact the Bureau of Primary Health Care (BPHC)• 877-974-BPHC (877-974-2742)• The BPHC Helpline is available 8:30
AM to 5:00 PM (ET) business days• [email protected]• http://bphc.hrsa.gov/ftca/freeclinics/
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Questions?
Questions and Answers
Thank you for your continued interest in our programs