The purpose of this Policy Information Notice (PIN) is to clarify the scope of Federal Tort Claims Act (FTCA) coverage for FTCA-deemed Health Center Program grantees during an emergency. This PIN does not address a health center’s scope of project for purposes of Medicaid/Medicare reimbursement during an emergency or eligibility for the 340B Drug Pricing Program during an emergency. PIN 2002-07, “Scope of Project Policy,” and PIN 2007-14, “Technical Revisions to PIN 2002-07,” provide general guidance on these subjects.
A. Legislative Background
FTCA coverage for eligible Health Resources and Services Administration (HRSA) grantees was initially legislated through the Federally Supported Health Centers Assistance Act of 1992 (FSHCAA) (Public Law 102-501) by amending section 224 of the Public Health Service (PHS) Act. The eligible entities are Health Center Program grantees (section 330(e), (g), (h) and (i) of the PHS Act). The FSHCAA of 1995, signed into law on December 26, 1995, clarified the 1992 Act and eliminated its sunset provision, making the program permanent.
The intent of FSHCAA is to increase the availability of funds for the provision of primary health care services by reducing the expenditure of Health Center Program funds for medical malpractice insurance premiums. The FSHCAA accomplishes this by making deemed health centers (and their officers, directors, employees, and certain contractors) Federal employees for the purpose of medical malpractice protection. As Federal employees, these organizations and individuals are immune from medical malpractice suits for actions within the scope of their project and health center employment. In the event that a medical malpractice lawsuit is filed against a deemed entity or covered provider acting within the scope of his/her employment in grant-related activities, the United States is substituted for the deemed entity and the covered employee. The health center and the covered employee will be dismissed from the case, with the case continuing against the United States as the sole defendant.
This PIN applies to all health centers funded under the Health Center Program authorized in section 330 of the PHS Act (42 U.S.C. 254b), as amended, specifically:
For the purposes of this document, the term “health center” refers to the diverse types of health centers (i.e., CHC, MHC, HCH, and PHPC) that are supported under section 330 of the PHS Act and that have been deemed to be employees of the Public Health Service pursuant to section 224(g) of the PHS Act.
WHAT IS AN "EMERGENCY"
For the purposes of this PIN, an “emergency” or “disaster” is defined as an event affecting the overall health center target population and/or the health center’s community at large, which precipitates the declaration of a state of emergency at a local, State, regional, or national level by an authorized public official such as a governor, the Secretary of the U.S. Department of Health and Human Services, or the President of the United States. Examples include, but are not limited to: hurricanes, floods, earthquakes, tornadoes, widespread fires, and other natural/environmental disasters; civil disturbances; terrorist attacks, collapses of significant structures within the community (e.g., buildings, bridges); and infectious disease outbreaks and other public health threats.
In situations where an emergency has not been officially declared, HRSA will evaluate on a case-by-case basis whether extraordinary circumstances justify a determination that the situation faced by the health center constitutes an “emergency” for purposes of extending FTCA coverage to services provided at temporary locations.