As previously reported, on March 17, 2020, HRSA released updated Novel Coronavirus (COVID-19) Frequently Asked Questions.  On March 24, 2020, HRSA released newly updated Novel Coronavirus (COVID-19) Frequently Asked Questions.  Highlights are provided below.

Note that this summary is not a comprehensive list of all frequently asked questions, and several HRSA “answers” are abbreviated for ease of review.  Also note that HRSA will likely expand upon and may otherwise modify its current list of frequently asked questions, so it is important to check the link for the latest information.

Funding

• New Funding $100M: On March 24, HRSA announced the release of $100 million in fiscal year 2020 COVID-19 funding provided by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. Health Center Program look-alikes are not eligible for such funding.  HRSA used the following distribution formula:
  • Base value of $50,464, plus
  • $0.50 per patient reported in the 2018 Uniform Data System (UDS), plus
  • $2.50 per uninsured patient reported in the 2018 UDS.

The awards range from approximately $50,000 to more than $300,000, with an average of approximately $70,000 per health center.  HRSA plans to make funds immediately available and then collect budget and activities/costs to be supported by the funding.  The performance period for this funding is 12 months.

• Supplemental Funding:  Health centers may use equipment or supplies purchased using Health Center Program supplemental funding (e.g., SUD-MH or IBHS) to respond to COVID-19.  The requirements for use and disposition of equipment and supplies acquired under the Health Center Program award are governed by the Uniform Administrative Requirements at 45 CFR §75.320 and §75.321.
• Drawdowns:  Health centers may draw grant funding from PMS for expenses in alignment with the health center’s financial and operational policies and procedures and the approved grant budget. Acknowledging that this is an unprecedented time, HRSA advises that health centers consider the pace of their spending to ensure they have sufficient funds to avoid any funding shortfall.  Advance payments to a Health Center Program awardee must be limited to the minimum amounts needed and be timed to be in accordance with the actual, immediate cash requirements of the awardee in carrying out the purpose of the approved program or project (per the Uniform Administrative Requirements at 45 CFR 75.305).

Operational Considerations and General HRSA Compliance

• Availability of Non-Emergency Services:  HRSA advises that health centers follow COVID-19 public health guidelines that impact the delivery of health center services, e.g., directives to cease non-emergency medical or dental services.
• Site Closures: Health centers do not need to request HRSA prior approval via a change in scope in cases where they are temporarily closing a site due to the public health emergency.  Health centers should ensure their patients are made aware of closures and where and how to seek care at other service delivery sites as appropriate.
• Board Meetings:  Where geography or other circumstances make monthly, in-person participation in board meetings burdensome, health centers may conduct monthly meetings by telephone or other means of electronic communication where all parties can both listen and speak to all other parties
• Site Visits:  BPHC will reschedule the postposed OSVs and all other site visits as soon as is practical.

Data Reporting

• UDS and COVID-19 Screenings:  If the only service an individual receives from the health center is a screening, they are not considered a patient of the health center for the purposes of UDS reporting.  If an individual receives additional services with their COVID-19 screening that require independent judgement from a health center provider and the encounter is documented, they may be considered a patient of the health center.

Supplies, Screening/Triage, and Testing

• Supplies:  If a health center’s regular distributors are unable to fulfill orders for critical medical supplies such as personal protective equipment, the first step is to contact the local and/or state public health department for immediate assistance. If the state is unable to provide supplies, state health officials — through the governor or his/her representative — may request federal assistance from HHS.
• Screenings/Triage:  Screening or triage of health center patients performed on behalf of the health center are elements of general primary care as reflected on Form 5A: Services Provided. The Health Center Program views providing screenings and triage to any patient — including both established health center patients and to individuals who are not established patients of the health center – at the health center, outside on its grounds, or elsewhere in the community as within the health center’s scope of project.  This includes providing such screening and triage to patients in the parking lot of the health center or in other community locations.
• Testing:  Health centers that have testing available should prioritize and administer COVID-19 testing consistent with the CDC’s latest guidelines. HRSA also encourages health centers to consider walk-up or drive-through testing, as feasible and appropriate.  Health centers that do not currently have COVID-19 testing capability (e.g., access to tests and/or access to adequate personal protective equipment) are encouraged to coordinate with state and local health departments and others as appropriate to facilitate access to testing.

FTCA

• FTCA and Telehealth:  When in-scope services are provided through telehealth on behalf of a deemed health center to individuals who are not patients of the health center, and all other FTCA Program requirements are met, such services are eligible for liability protections.  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.
• Volunteers:  Under FTCA, liability protections extend to Volunteer Health Professionals (VHPs) for the performance of medical, surgical, dental, and related functions at health centers. However, VHPs are not automatically eligible for liability protections under the Health Center FTCA Program. Deemed health centers must apply for such protections for their individual volunteers through a VHP deeming sponsorship application. See PAL 2019-03: Calendar Year 2020 Volunteer Health Professional Federal Tort Claims Act (FTCA) Deeming Sponsorship Application Instructions.
• Temporary Credentialing & Privileging:  FTCA guidance related to temporary credentialing and privileging during a declared emergency is set forth in PAL 2017-07: Temporary Privileging of Clinical Providers by Federal Tort Claims Act (FTCA) Deemed Health Centers in Response to Certain Declared Emergency Situations for guidance.
• Temporary Sites: In light of the declaration of a public health emergency, health centers may set up “temporary sites (that) are within the health center’s service area or neighboring counties, parishes, or other political subdivisions adjacent to the health center’s service area” (for in-scope services) with notification made to BPHC within 15 days. See PAL 2014-05 for full details and requirements “to ensure that the emergency response at temporary locations is considered part of the center’s scope of project.” Also see the FTCA Health Center Policy Manual which states in part: “To meet the FTCA requirement of providing services to health center patients, a patient-provider relationship must be established. For the purposes of FSHCAA/FTCA coverage, the patient-provider relationship is established when: …Health center triage services are provided by telephone or in person, even when the patient is not yet registered with the covered entity but is intended to be registered.”

Telehealth

• Triage: Triage services may be conducted by health center providers either in person or by telehealth, consistent with applicable standards of practice.
• Telehealth and Home Visits:  Health centers may use telehealth to provide services to a patient at a location that is not an in-scope service site as long as: 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; and 3) the individual receiving the service is a health center patient.  Review PAL 2020-01: Telehealth and Health Center Scope of Project for more information.  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.
• Telehealth and New Patients:  Health center providers may deliver in-scope services via telehealth to individuals who have not previously presented for care at a health center site and who are not current patients of the health center for the duration of this public health emergency. Telehealth visits are within the scope of project if:
  • The individual receives an in-scope required or additional health service;
  • The provider documents the service in a patient medical record consistent with applicable standards of practice; and
  • The provider is physically located at a health center service site or at some other location on behalf of the health center (e.g., provider’s home, emergency operations center).
• Telehealth and Non-Service Sites:  A health center may use telehealth to provide services if neither the health center provider nor the patient is at an in-scope service site (e.g., both the provider and patient are at their respective homes) if:
  • The service being provided via telehealth is within the health center’s approved scope of project (recorded on Form 5A);
  • The clinician delivering the service is a health center provider; and
  • The individual receiving the service is a health center patient.

Health centers do not need to request a change in scope to deliver in-scope services on behalf of the health center from the provider’s home or from another location that is not a Form 5B Service Site.

• Telehealth Policies and Procedures:  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. Review PAL 2020-01: Telehealth and Health Center Scope of Project for more information.
• Changes in Scope:  HRSA approval is not required for the provision of in-scope health center services at the following locations already within the approved scope of project:
  • An approved health center service site (on Form 5B), including the addition of any modular units or trailers on the grounds of the 5B site;
  • Mobile units (on Form 5B), including driving mobile units to additional locations in the health center’s service area;
  • Home visits (on Form 5C) to health center patients, including visiting health center patients in assisted living facilities and nursing homes;
  • Portable clinical care (on Form 5C), where health center staff conduct clinical care outside of health center sites (for example, conducting screenings and consultations in a parking lot, on the street to individuals experiencing homelessness).

This list of locations is not exhaustive. Health centers should review their scope of project documentation in the EHBs to ensure that Form 5B and Form 5C are up to date.

• Service Area:  Health centers should focus services provided by telehealth on serving patients and other individuals located inside their service area or with areas adjacent to the covered entity’s service area. HRSA recognizes that patients outside these areas may seek health center screenings and triage by telehealth. Health centers that continue to maintain services for target populations in their service area and provide occasional in-scope services via telehealth to individuals outside these areas would be providing services within the Health Center Program scope of project for all such activities.