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Health Center Application Process

The 2013 application process and guidance for submitting deeming applications for Federal Tort Claims Act (FTCA) medical malpractice coverage is detailed within the Program Assistance Letter 2012-02. The information found on this site is meant as a guide to applicants.

FTCA Deeming Application Assistance Videos

Introduction

• Slides (PPT - 981 KB)

This brief video provides an introduction to the FTCA deeming application assistance video series. It lists the nine videos available in the series, providing an overview of the content of each video and recommendations for viewing.

FTCA Application Assistance: Navigating the EHB

This video provides an overview of FTCA program and application requirements, including a list of policies and documents that applicants should prepare before completing the application, due dates for initial and redeeming applications, and instructions for submitting sub-recipient applications. In addition, the video includes step-by-step instructions for accessing the online FTCA deeming application form in the electronic handbook and general information about the online application. Applicants may want to view this video first to make sure they are prepared to complete all sections of the FTCA deeming application.

Risk Management Systems: Application Technical Assistance

This video is a step-by-step demonstration of completing the Risk Management Systems section of the FTCA deeming application. It includes instructions for completing each question in the section as well as uploading health center policies on hospitalization tracking, patient referral tracking, and diagnostic test tracking to the online application form.

Risk Management Systems: Supplemental Information and ECRI Institute Resources

• Slides (PPT - 1 MB)

This video provides guidance on assessing malpractice risk, developing policies on supervision of clinical and non-clinical staff, developing medical records policies, and maintaining clinical protocols for selected medical conditions. In addition, important components of policies on diagnostic test tracking, hospitalization tracking, and patient referral tracking, which applicants must upload to the online FTCA deeming application form, are discussed. The video includes links to resources, sample policies, and tools available on the Clinical Risk Management Program website and other websites that can help applicants prepare their policies and procedures in order to successfully complete the FTCA deeming application. Answers to frequently asked questions on the Risk Management Systems section of the FTCA deeming application are also provided.

Quality Improvement/Quality Assurance Plan: Application Technical Assistance

This video is a step-by-step demonstration of completing the Quality Improvement/Quality Assurance Plan section of the FTCA deeming application. It includes instructions for completing each question in the section as well as uploading health center quality improvement plans, six quality improvement committee meeting minutes that occurred between June 1, 2011 and the submission date of the application, and six board meeting minutes evidencing oversight of quality improvement activities that occurred between June 1, 2011 and the submission date of the application to the online application form.

Quality Improvement/Quality Assurance Plan: Supplemental Information and ECRI Institute Resource

• Slides (PPT - 1 MB)

This video provides guidance on developing quality improvement/quality assurance plans, assessing quality and risk issues and selecting quality measures, collecting data and monitoring improvement, organizing quality improvement committees, and reporting quality data to the board of directors. Tips for preparing agendas for quality improvement committee meetings and meeting minutes are discussed. The video also provides instructions for including the board signature and date on the health center’s quality improvement plan or board minutes that are uploaded to the application form, including examples of acceptable and unacceptable signatures. The video includes links to quality improvement tools and resources available on the ECRI Institute Clinical Risk Management Program website and other websites. Answers to frequently asked questions on the Quality Improvement/Quality Assurance Plan section of the FTCA deeming application are also provided.

Credentialing Systems: Application Technical Assistance

This video is a step-by-step demonstration of completing the Credentialing Systems section of the FTCA deeming application. It includes instructions for completing each question in the section as well as uploading the health center’s credentialing list and credentialing and privileging policy to the online application form. It also includes instructions for preparing the health center’s credentialing list and a screenshot of a sample list.

Credentialing Systems: Supplemental Information and ECRI Institute Resources

• Slides (PPT - 1 MB)

This video specifies which information should be included in a health center’s credentialing list, which applicants must upload to the online application form, and includes a screen shot of a sample credentialing list. The video also provides guidance on developing credentialing and privileging policies that meet HRSA requirements outlined in policy information notices 2002-22 and 2001-16. It includes instructions for including the board signature and date on the health center’s credentialing and privileging policy or board minutes that are uploaded to the application form, including examples of acceptable and unacceptable signatures. Guidance on primary and secondary source verification of credentials, including when to use primary or secondary source verification; peer review processes; and maintaining complete and organized credentialing files, is also provided. In addition, links to credentialing tools and resources available on the ECRI Institute Clinical Risk Management Program website and answers to frequently asked questions on the Credentialing section of the FTCA deeming application are included.

Professional Liability History/Additional Information: Application Technical Assistance

This video is a step-by-step demonstration of completing both the Professional Liability History Services and Activities and Additional Information sections of the FTCA deeming application. It includes instructions for completing each question in the two sections as well as uploading the health center’s professional liability history document, if applicable, to the online application form. It also includes a discussion of what information should be included in the professional liability history document and provides a sample professional liability history document.

Professional Liability History/Additional Information: Supplemental Information and ECRI Institute Resources

• Slides (PPT - 1 MB)

For the professional liability history section of the FTCA deeming application, applicants must upload a document that includes specific information on past claims against the health center and/or its providers only if they have had a claim filed against the health center and/or its providers within the past five years, and this video specifies which information should be included in that document if applicable. The video also provides information on how to achieve accreditation, certification, or recognition from national professional organizations, such as the Joint Commission or the National Committee for Quality Assurance, and resources for developing staff training programs in order to successfully complete the Additional Information section of the FTCA deeming application. An answer to a frequently asked question on the Professional Liability History section of the FTCA deeming application is also included.

Submitting FTCA Applications

All health centers (grantees) considering FTCA coverage should begin by reviewing the FTCA policies and regulations and consult with their Project Officer. All details with regard to completing the application are contained in the Program Assistance Letter that is issued each year. Below are the FTCA application requirements.  Please review the latest Program Assistance Letter for detailed information regarding the current FTCA deeming and redeeming requirements.

To be considered complete, an initial or renewal application must contain all of the following documentation within EHB:

1. Quality Improvement/Quality Assurance (QI/QA) Plan, with clear documentation that the Board reviewed and approved the plan within three (3) years of the date of submission to HRSA (e.g., on or after April 05, 2012 for a renewal application). Specifically, the QI/QA plan must be approved, dated, and contain the appropriate signature(s) of the Board of Directors (such as the Secretary and/or other appropriate Board members.)  If the QI/QA plan has not been signed by the Board, then the health center may submit an unsigned plan and Board meeting minutes that are dated, with appropriate signature(s), and provide clear evidence that the plan was approved by the Board.  If the Plan has not been approved by the Board within the last three years, the application will be returned to the grantee without further review until the plan is resubmitted with a Board signature/date indicating review/approval, or signed and dated board minutes that clearly evidence that the plan was approved by the Board.
   
   
2. Minutes from any six QI/QA committee meetings that took place between June 1, 2011 and the submission date of the application.  The application must provide an explanation if less than six sets of minutes are provided. 
   
   
3. Minutes from any six Board meetings evidencing oversight of QI/QA activities that took place between June 1, 2011 and the submission date of the application. The application must provide an explanation if less than six sets of minutes are provided.
   
   
4. Credentialing and privileging policies and procedures. The health center’s credentialing and privileging policies and procedures must include those elements outlined in Policy Information Notice (PIN) 2002-22. Similar to the QI/QA plan, there must be clear documentation that the Board has reviewed and approved these policies and procedures.  Specifically, the credentialing and privileging policies and procedures must be approved, signed and dated by the Board.  If the plan does not have a physical signature, then submission of an unsigned set of credentialing and privileging policies and procedures as well as Board minutes that are dated and have a signature from the Board, are acceptable evidence of approval.
   
   
5. A list of all licensed and certified staff members at all health center sites including employed or contracted practitioners, volunteers and locum tenems, with evidence of credentialing and privileging within the last two years (e.g., all credentialing must have been documented to have taken place on or after April 05, 2010 for a renewal application).  For the purposes of this application, documentation of a credentialing date within the last two years is required in accordance with Policy Information Notice 2002-22.  If any listed individual’s most recent credentialing did not occur within the last two years, the application will be returned to the grantee as described in Section VI: Initial FTCA Applications and Section VII: FTCA Renewal Applications.

Due to EHB technical requirements, the credentialing list must be in an Excel Spreadsheet compatible with EHB and include the following for all licensed and certified staff members (please see attachment 1 for an example):

• • Name and Professional Designation (e.g., MD/DO, RN, CNM, DDS, LPN, PA, MA, NP, etc.);
  • Title/Position;
  • Specialty;
  • Employment Status (full-time employee, part-time employee, contractor or volunteer);
  • Hire Date;
  • Current Credentialing Date (must be within past two years); and
  • Next Expected Credentialing Date (if known).

The purpose of this credentialing and privileging documentation is to show that the grantee has reviewed and verified required credentialing information. Inclusion of practitioners on this listing does not infer the deeming (or absence of deeming) for any individual or practitioner, as this is based on satisfaction of statutory deeming criteria under 42 U.S.C. 233(h).

6. Health Center policies and procedures for the following:
   
   
   • Referral tracking
   • Hospitalization tracking
   • Diagnostic tracking (Note that the application no longer requires separate clinical policies and procedures for x-ray and labs. However, if the application does not have separate clinical policies for these activities, then these activities should be covered by the diagnostic tracking policies and procedures.)
     
     
7. A Statement verifying that any professional liability claims were internally analyzed, and that appropriate actions were implemented in response to any liability claims as needed. The statement should include the following for each claim filed within the last five years:
   
   
   • Name of provider(s) involved
   • Area of practice/Specialty
   • Date of occurrence
   • Summary of allegations
   • Status and outcome of claim
     
     
8. Electronic Signature of the Executive Director certifying the contents of the application. If the FTCA application is not signed by the Executive Director, the application will be returned to the grantee as described in Section VI: Initial FTCA Applications and Section VII: FTCA Renewal Applications.
   
   
9. Deeming Applications for any subrecipient(s) that appear on the health center’s most recent Form 5B, who are requesting FTCA coverage. The subrecipient(s) deeming application is considered part of the deeming application of the grantee of record. If a subrecipient's application is incomplete, HRSA will notify the grantee through the EHB, and the grantee will have 10 business days to respond. If the grantee does not respond within 10 days, the entire application package will be considered incomplete, and marked VOID in the EHB system. Please see Section VI: Initial FTCA Applications and Section VII: FTCA Renewal Applications for more information.

10. Please note that deeming applications by eligible entities must be submitted in the form and manner prescribed by HRSA and must demonstrate that the entity seeking FTCA coverage has successfully implemented all deeming requirements set forth in law and further described herein.  Applications that do not meet the applicable requirements will not be approved, and affirmative deeming determinations will not be issued in those cases. 

    Annual Renewal Applications

    All currently deemed grantees must submit a FTCA renewal application for themselves and any subrecipients (as applicable) no later than April 5, 2012 in order to be deemed for the entirety of  the calender year (CY), without a gap in coverage.

    If additional information or clarification is needed to support the application, HRSA will notify the grantee through the EHB, and the grantee will be given ten (10) business days to provide the additional information. It is critical that grantees provide a timely response to all requests for information in order to assure a timely review and notification of CY 2013 deeming.

    Current Program Assistance Letter 

    The current Program Assistance Letter (PAL) 2012-02: Calendar Year (CY) 2013 Requirements for Federal Tort Claims ACT (FTCA) Medical Malpractice Coverage for Health Centers  (PDF 240KB) is now available. This PAL addresses the process that health centers must take in order to submit their FTCA deeming and redeeming applications for calendar year 2013.

Persons using assistive technology may not be able to fully access information in these files. For assistance, contact comments@hrsa.gov or 888-275-4772 (TTY: 877-489-4772).