Particularized Determination

The Federally Supported Health Centers Assistance Acts (FSHCAA) of 1992 and 1995 and 42 CFR section 6.6(d) authorize FTCA coverage for services to non-health center patients in certain situations. The September 1995 Notice provided notice that activities that fit squarely within the listed examples are approved for FTCA coverage under 42 CFR section 6.6(d) and section 224(g)(1)(B)(ii), as long as there is compliance with all other coverage requirements under FSHCAA. As indicated by the September 1995 Notice, if any element of an activity or arrangement does not fit squarely into the examples listed within the Notice (repeated below) for non-health center patients, the covered entity should request a particularized determination of coverage.

The activities described by these examples are as follows:

Examples of Covered Services to Non-Health Center Patients in Federal Register Notice (FRN) of September 1995:

Community-Wide Intervention School-Based Clinics - Health center primary and preventive health care services at a facility located in a school or on school grounds. The covered entity has a written affiliation agreement with the school.

School-Linked Clinics - Health center primary and preventive health care services, at a site not located on school grounds, to students of one or more schools. The covered entity has a written affiliation agreement with each school.

Health Fairs - Health center event to attract community members for purposes of performing health assessments. Such events may be held in the covered entity, outside on its grounds, or elsewhere in the community.

Immunization Campaigns - Health center event to immunize children against infectious childhood illnesses. The event may be held at the covered entity, schools, or elsewhere in the community.

Migrant Camp Outreach - Health center staff travel to a migrant farm worker residence camp to conduct intake screening to determine those in need of clinic services. Health care services may be provided at the time of the intake activity or during subsequent clinic staff visits to the camp.

Homeless Outreach - Health center staff travel to a shelter for homeless persons, or a street location where homeless persons congregate, to conduct intake screening to determine those in need of clinic services. Health care services may be provided at the time of the intake activity or during subsequent clinic staff visits to that location.

Hospital-Related Activities - Periodic hospital call or hospital emergency room coverage, as required by the hospital as a condition for obtaining hospital admitting privileges. There must be documentation for the particular covered individual that this coverage is a condition of employment at the covered entity.

Coverage-Related Activities - As part of a health center's arrangement with local community providers for after-hours coverage of its patients, the covered entity’s providers are required, by their employment contract, to provide periodic or occasional cross-coverage for patients of these providers.

Acts and omissions related to services provided to individuals who are not patients of a covered entity will be covered if HRSA/BPHC has approved an application in the form and manner prescribed by HRSA/BPHC below for a particularized determination of FTCA coverage. HRSA/BPHC does not utilize particularized determinations to provide advisory opinions or to address coverage arrangements concerning services provided to existing health center patients.

The application for a particularized determination must provide sufficient information for HRSA/BPHC to determine if:

The provision of the services to non-health center patients will benefit patients of the covered entity and general populations that could be served by the covered entity through community-wide intervention efforts within the communities served by such entity;
The provision of the services to non-health center patients facilitates the provision of services to patients of the covered entity; or
Such services are otherwise required to be provided to non-health center patients under an employment contract or similar arrangement between the covered entity and the covered individual.

Accordingly, a request for a particularized determination of FTCA coverage must include sufficient detail to determine:

What services are provided;
Who provides the services;
Where the services are provided;
Why covered entity personnel are needed to provide such services; and
How these services benefit the patients of the covered entity.

The request for particularized determination must also provide a narrative explanation, signed by the Chief Executive Officer of the covered entity, setting forth how the request satisfies the criteria listed above. Job descriptions/positions and other relevant agreements or arrangements must be attached with the request to show how the covered entity will implement the activity for which FTCA coverage is sought. Please send all particularized determination applications or questions to ftcapd@hrsa.gov.