CLIENT ALERT: Key Takeaways from the HRSA FTCA Deeming Application Clinic

By , | Published On: May 8, 2023

Health center Federal Tort Claims Act (FTCA) annual redeeming applications are due by June 23, 2023. The requirements for redeeming for CY 2024 are described in Program Assistance Letter 2023-01 (PAL 2023-01), “Calendar Year 2024 Requirements for Federal Tort Claims Act (FTCA) Coverage for Health Centers and Their Covered Individuals.” Prior to submitting their redeeming applications, health centers should consider some of the key takeaways obtained through the Health Resources and Services Administration (HRSA)’s “FTCA Deeming Application Clinic” that took place May 3-4, 2023.

The HRSA FTCA Deeming Application Clinic provided clarifications around a number of requirements for redeeming described in PAL 2023-01 including risk management and credentialing and privileging. The Application Clinic also covered the changes made in the April 2023 Site Visit Protocol’s FTCA Section.

During the Deeming Application Clinic, HRSA reported a one hundred percent (100%) increase in findings of noncompliance between the CY 2021 FTCA redeeming applications to the CY 2022 FTCA redeeming applications.1To avoid such noncompliance findings and successfully achieve redeeming for CY 2024, health centers should consider the following key takeaways from the Deeming Application Clinic:

New FTCA-Required Obstetrical Training to Receive FTCA-Deemed Status and Other FTCA-Related Risk Management Training Updates

According to HRSA, one of the most common areas of noncompliance in the CY 2022 FTCA redeeming applications was related to the health center’s annual risk management training plan and ensuring staff complete the FTCA-required risk management trainings as documented through a tracking and documentation tool.

FTCA-Required Obstetrical Training:

This year, the redeeming application introduces a new requirement for obstetrical (OB) training that must be completed by the submission of the CY 2024 deeming application no later than June 23, 2023. Specifically, health centers must ensure staff who have contact with patients of reproductive age for other clinical services receive OB training even if the health center does not provide obstetrical services as part of its HRSA-approved scope of project.

During the Application Clinic, HRSA provided the following clarifications:

  • All required obstetrics training must be completed by the submission of the CY 2024 deeming application.
  • Obstetrics training is required for all clinical staff who may provide services to or have contact with women of reproductive age. This applies to all health center applicants, regardless of how they provide obstetric services (Form 5A column I, II, III). Note that OB training for contracted services (Form 5A, column III) may be provided by the contactor and should be required via the contract.
  • The OB training should be specific to the discipline of the provider. For example, an obstetrician’s training would differ from training provided to a dentist or a social worker.
  • The source, content, and method of the OB training is determined by the health center.
    • Note: according to the Application Clinic, health centers may use the recorded versions of the OB presentations from the HRSA Application Clinic (which are available until February 29, 2024) to satisfy the FTCA OB training.
  • For clinical staff who do not provide direct patient services, for example navigators, health educators, outreach workers, HRSA stated that the health center can determine if their interactions with patients would require them to have OB training. It appears HRSA is providing some flexibility with this group of individuals.
  • According to the Application Clinic, if the health center has contracts with outside organizations to provide obstetric services, the contract should specify that the practitioners who provide services to the health center’s patients receive obstetrics training annually.

FTCA-Required Risk Management Training: HIPAA, Infection Control and Other Areas of High Risk

HRSA also stated that the Application Clinic’s recorded presentations of the cybersecurity training can satisfy the HIPAA training requirement, and the infection control training counts toward the infection control training requirement. These recordings are also available until February 29, 2024.

Other Clarifications about FTCA-Required Risk Management Activities and Policy Updates

During the Application Clinic, HRSA also clarified that quarterly and annual risk management reports to be submitted to HRSA must not include any reports that have been uploaded in previous deeming applications.

HRSA notes that a top area of noncompliance in the CY 2022 applications was failure to submit a complete 12 month annual risk report that was presented to the health center board of directors. As part of the FTCA re-deeming application, health centers must submit their annual risk management report to the Board and quarterly risk management reports.

Credentialing and Privileging and Policy Updates

According to the HRSA Application Clinic, another top area of noncompliance in the CY 2022 re-deeming applications was related to the credentialing and privileging list provided by the health center in the HRSA Electronic Handbook (EHB). Some health centers did not submit information for all members of their clinical staff. While health centers are not required to submit documentation of the provider’s credentialing file, health centers must list all clinical staff in the EHB in accordance with PAL 2023-01. HRSA will notify the health center if additional documentation is requested for a particular provider.

Other clarifications about Credentialing and Privileging provided by HRSA during the Application Clinic are:

  • HRSA added a new data element to the staff list, “Privileging Date” which must be entered for all clinical staff. It is acceptable for the “Privileging Date” to be the same as the “Credentialing Date.”
  • Privileging must be completed at a minimum of every two years. This is a change from the flexibility offered in the Compliance Manual and inconsistent with the Joint Commission’s 3 year requirement.
  • HRSA stated that temporary privileges are limited to instances where there is a declared disaster or emergency (see PAL 2017-07). With the end of the Public Health Emergency declaration the ability to use temporary privileges will end, until such time as another emergency declaration is enacted consistent with PAL 2017-07. Any current staff that are operating under temporary privileges must be fully privileged by the end of the Public Health Emergency.

Other FTCA Policy Updates

COVID Particularized Determination (PD) and Frequently Asked Questions (FAQs)

  • HRSA will provide information regarding the sunset of the COVID-19 PD and FAQs within the upcoming months. We anticipate the PD and FAQs will sunset sometime later this year. HRSA is expected to provide advance notice of these changes.

Naloxone Determination

  • HRSA also discussed the Naloxone Determination. For more information, please visit FTLF’s previous blog post.

Next Steps

If you would like to hear more about the FTCA requirements, please see our recorded webinar “An Overview of the FTCA Redeeming Application for CY 2024.”

If you would like assistance with submitting your FTCA-deeming application, please sign up for FTLF’s “FTCA Re-Deeming Application Review” or call Martin Bree at 202.600.3516.

1 Of note, HRSA did not discuss the CY 2023 redeeming application cycle during the Application Clinic.

Mr. Bree is a member of the New Jersey Bar and is not licensed in Washington, DC. His practice is limited to federal health care matters.