COVID-19 Frequently Asked Questions (FAQs)

Health centers may not have a separate sliding fee discount schedule for telehealth. However, where the locally prevailing charges or the actual costs for services delivered via telehealth differ from those delivered in person, health centers may have different charges on a fee schedule. For example, if the cost of providing a primary health care visit through telehealth is less than an in-person visit, the health center may establish a separate, lower charge for the telehealth primary care visit on the fee schedule. The health center would then apply their sliding fee discount schedule to the charge for the telehealth visit, which would be the same sliding fee discount schedule applied to an in-person primary care visit. For more information, see Health Center Program Billing and Collections requirements.

(Added: 5/6/2020)

When in-scope services are provided through telehealth on behalf of a deemed health center to either established patients or individuals who are not patients of the health center, and all other FTCA Program requirements are met, such services may be eligible for liability protections under 42 U.S.C. 233(g)-(n), pursuant to 42 CFR 6.6.

Health centers and providers are encouraged to consult with private counsel and/or consider the purchase of private malpractice insurance when undertaking activities that may not be within the health center’s scope of project.

(Updated: 8/9/2023)

Yes.  Otherwise qualified free clinic health care practitioners, employees, and contractors who have been deemed as Public Health Service employees for purposes of liability protections through the Free Clinics FTCA Program are eligible for such protections for screenings and triage activities relating to the diagnosis and treatment of COVID-19, as well as for other qualifying health services, provided to patients and other individuals seeking such services from the free clinic. These services may be provided at the free clinic or offsite, including at offsite programs or events carried out by the free clinic, which includes providing services on behalf of the free clinic at “drive-up” screening locations in the free clinic parking lot or in other nearby locations.

Free clinic providers located at the free clinic or in such other locations may also utilize telehealth to facilitate the delivery of services to free clinic patients and other individuals. All such contact must be appropriately documented in free clinic patient medical records. In addition, all other Free Clinics FTCA Program requirements remain applicable. For additional information, see Policy Information Notice 2011-02: Free Clinics Federal Tort Claims Act (FTCA) Program Policy Guide (PDF - 380 KB), and other FTCA Policy for Free Clinics.

(Updated: 12/14/2022)

HRSA issued a particularized determination for health center providers (PDF - 34 KB) that clarifies eligibility for FTCA coverage during the COVID-19 pandemic for the provision of grant-supported health services by individuals who have been deemed as Public Health Service employees through the Health Center FTCA Program and the Health Center VHP FTCA Program. It applies to grant-supported health services to prevent, prepare, or respond to COVID-19 (including but not limited to screening, triage, testing, diagnosis, and treatment) to individuals who are established or non-established patients of the health center, whether in person at the health center, offsite (including at offsite programs or events carried out by the health center), or via telehealth.

Note: Following the end of the public health emergency originally declared on January 31, 2020, HRSA has determined that the particularized determination for health center providers shall sunset and expire on December 31, 2024. Health centers should consult the FTCA Health Center Policy Manual (PDF - 406 KB), sections C.4 and C.5, for more information on covered services to non-patients.

(Added: 8/9/2023)

HRSA has issued a particularized determination for free clinic providers (PDF - 33 KB) that clarifies eligibility for FTCA coverage during the COVID-19 pandemic for the provision of qualifying health services by individuals who have been deemed as Public Health Service employees through the Free Clinics FTCA Program. It applies to qualifying health services to prevent, prepare, or respond to COVID-19 (including but not limited to screening, triage, testing, diagnosis, and treatment) to individuals who are established or non-established patients of the free clinic, whether in person at the free clinic, through responsive offsite programs or events carried out by the free clinic, or via telehealth.

Note: Following the end of the public health emergency originally declared on January 31, 2020, HRSA has determined that the particularized determination for free clinic providers shall sunset and expire on December 31, 2024. Free clinics should consult the Free Clinics FTCA Health Center Program Policy Guide (PDF - 380 KB), section IV, for more information on covered services to non-patients.

(Updated: 8/15/2023)

From a Health Center Program scope of project policy perspective, using telehealth to provide services to a patient at a location that is not an in-scope service site is allowable if:

1. The service being provided via telehealth is within the health center's approved scope of project (recorded on Form 5A);
2. The clinician delivering the service is a health center provider working on behalf of the health center; and
3. The individual receiving the service is a health center patient.

HRSA strongly encourages health centers that provide, or are planning to provide, health services via telehealth to consult with professional organizations, regulatory bodies, and private counsel to help assess, develop, and maintain written telehealth policies that are compliant with Health Center Program requirements; federal, state, and local requirements; and applicable standards of practice. HRSA also encourages health centers to consider the range of issues that would support successful implementation of telehealth. Please review PAL 2020-01: Telehealth and Health Center Scope of Project (PDF - 176 KB) for more information.

For questions about FTCA coverage, please use the BPHC Contact Form or call for FTCA assistance at 877-464-4772, 8:00 a.m. to 5:30 p.m. ET, Monday-Friday (except federal holidays).

(Updated: 4/7/2020)

Health centers do not need to request a change in scope to deliver in-scope services via telehealth on behalf of the health center from the provider’s home or from another location that is not a Form 5B Service Site. In addition, health centers do not need to have "Home Visits" listed on their Form 5C: Other Activities/ Locations in order to provide in-scope services via telehealth.

For questions about FTCA coverage, please use the BPHC Contact Form or call for FTCA assistance at 877-464-4772, 8:00 a.m. to 5:30 p.m. ET, Monday-Friday (except federal holidays).

(Added: 4/7/2020)

The following resources provide information on the status of various COVID-19 public health emergency flexibilities and waivers. Note: This is not an exhaustive list. Health centers are encouraged to reach out to other federal, state, and local partners, including Primary Care Associations, for additional information and resources.

Telehealth flexibilities:

• The Center for Connected Health Policy (a National Telehealth Resource Center).
• State Medicaid & CHIP Telehealth Toolkit (PDF - 1 MB) located on the Medicaid telemedicine webpage.
• CMS memo: End of the COVID-19 Public Health Emergency and the COVID-19 National Emergency and Implications for Medicaid and the Children’s Health Insurance Program (PDF - 353 KB).
• HHS Fact Sheet: Telehealth Flexibilities and Resources and the COVID-19 Public Health Emergency.

Service delivery and administrative flexibilities:

• CMS Guidance for the Expiration of the COVID-19 Public Health Emergency (PDF - 412 KB).
• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (PDF - 521 KB).
• CMS Flexibilities to Fight COVID-19 (PDF - 569 KB): provides information about changes to Rural Health Clinic and Federally Qualified Health Center flexibilities.
• Clinical Laboratory Improvement Amendments (CLIA) Post-Public Health Emergency Guidance (PDF - 381 KB).
• Status of HHS Office for Civil Rights HIPAA enforcement discretion.
• Status of HHS Office of Inspector General enforcement action flexibilities.

(Added: 6/27/2023)

 

HCCNs have established platforms to engage with health centers to collect critical information during and after emergency situations, such as the COVID-19 pandemic. HCCNs can:

• Facilitate important and timely information sharing with health centers through electronic alerts;
• Assist health centers considering how to expand their telehealth services;
• Conduct outreach with health centers in their networks to share challenges and lessons learned from the use of telemedicine and virtual care technologies amongst health centers; and
• Work to ensure that health centers are integrated in regional and state response plans by coordinating with Primary Care Associations (PCAs) on planning and response activities.

Additionally, HCCNs coordinate with the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare and Medicaid Services (CMS), the Health Information and Technology, Evaluation and Quality (HITEQ) Center, and HRSA’s Federal Office of Rural Health Policy (FORHP) to provide training and technical assistance on hardware and/or software, provider education, workflows, patient education, billing and coding, cybersecurity, remote provider education, and policy interpretation.

(Updated: 6/21/2022)