[Federal Register Volume 60, Number 185 (Monday, September 25, 1995)]
[Notices]
[Pages 49417-49418]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-23601]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Notice Regarding the Federally Supported Health Centers 
Assistance Act of 1992

AGENCY: Health Resources and Services Administration.

ACTION: Notice.

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SUMMARY: On May 8, 1995, the Secretary of Health and Human Services 
published a final rule implementing certain provisions of the Federally 
Supported Health Centers Assistance Act of 1992 (the Act). The Act 
provides for liability protection for certain grantees of the Public 
Health Service and for certain individuals associated with these 
grantees. The Health Resources and Services Administration is the 
agency within the Department responsible for administering certain 
aspects of the Act. This notice provides further guidance regarding the 
final rule.

FOR FURTHER INFORMATION CONTACT: Richard C. Bohrer, Director, Division 
of Community and Migrant Health, Bureau of Primary Health Care, Health 
Resources and Services Administration, 4350 East West Highway, 
Bethesda, Maryland 20814, Phone: (301) 594-4300.

SUPPLEMENTARY INFORMATION: Section 224(a) of the Public Health Service 
(PHS) Act (42 U.S.C. 233 (a) provides that the remedy against the 
United States provided under the Federal Tort Claims Act (FTCA) 
resulting from the 

[[Page 49418]]
performance of medical, surgical, dental or related functions by any 
commissioned officer or employee of the PHS while acting within the 
scope of his office or employment shall be exclusive of any other civil 
action or proceeding. The Federally Supported Health Centers Assistance 
Act of 1992 (Public Law 102-501) provides that, subject to its 
provisions, certain entities and officers, employees and contractors of 
entities shall be deemed to be employees of the PHS within exclusive 
remedy provision of section 224 (a).
    The final rule implementing Public Law 102-501 was published in the 
Federal Register (60 FR 22530) on May 8, 1995, and adds a new Part 6 to 
42 CFR Chapter 1. Part 6 describes the eligible entities and the 
covered individuals who are within the scope of the FTCA protection 
afforded by the Act.
    Section 6.6 of the final rule describes the acts and omissions that 
are covered by the Act. Paragraph (d) of that section states that only 
acts and omissions related to the grant-supported activity of covered 
entities are covered. That paragraph goes on to provide that:
    Acts and omissions related to services provided to individuals who 
are not patients of a covered entity will be covered only if the 
Secretary determines that
    (1) The provision of the services to such individuals benefits 
patients of the entity and general populations that could be served by 
the entity through community-wide intervention efforts within the 
communities served by such entity;
    (2) The provision of the services to such individuals facilitates 
the provision of services to patients of the entity; or
    (3) Such services are otherwise required to be provided to such 
individuals under an employment contract or similar arrangement between 
the entity and the covered individual.
    Paragraph (e) of 6.6 provides examples of situations within the 
scope of paragraph (d). Questions have been raised, however, about the 
specific situations encompassed by 6.6(d) and about the process for the 
Secretary to make the determinations provided by that paragraph. The 
purpose of this notice is to address those questions.
    We have decided that it would be impractical and burdensome to 
require a separate application and determination of coverage for the 
situations described in the examples set forth in 6.6(e). Accordingly, 
for the specific cases described in those examples, and discussed 
further below, the Department hereby determines that coverage is 
provided under 6.6(d), without the need for specific application. (This 
determination assumes, of course, that other requirements of coverage 
have been met, such as a determination that the entity is a covered 
entity and a determination that the individual is a covered individual. 
Furthermore, we reiterate the statement in the preamble to the final 
rule that acts or omissions by individuals that are not within the 
scope of employment, e.g., moonlighting activities, are not covered.)
    While the situations described below have hereby been determined to 
be within the scope of 6.6(d), covered entities may apply for specific 
determinations of coverage under that section. If, for example, the 
covered entity is unsure whether its particular arrangement falls 
within the scope of example 2, it may apply for a particularized 
determination as to that arrangement. Entities should be painstakingly 
exact in this regard. If any element of the activity or arrangement in 
question does not fit squarely into the examples below, a 
particularized determination on coverage should be sought. As to 
situations that may fall within the scope of 6.6(d), but are not 
described in the three examples, covered entities are expected to apply 
for particularized determinations.

Example I. Community-Wide Interventions

    (a) School-Based Clinics: Health center staff provide primary and 
preventive health care services at a facility located in a school or on 
school grounds. The health center has a written affiliation agreement 
with the school.
    (b) School-Linked Clinics: Health center staff provide primary and 
preventive health care services, at a site not located on school 
grounds, to students of one or more schools. The health center has a 
written affiliation agreement with each school.
    (c) Health Fairs: Health center staff conduct an event to attract 
community members for purposes of performing health assessments. Such 
events may be held in the health center, outside on its grounds, or 
elsewhere in the community.
    (d) Immunization Campaign: Health center staff conduct an event to 
immunize children against infectious childhood illnesses. The event may 
be held at the health center, schools, or elsewhere in the community.
    (e) Migrant Camp Outreach: Health center staff travel to a migrant 
farmworker residence camp to conduct intake screening to determine 
those in need of clinic services (which may mean health care is 
provided at the time of such intake activity or during subsequent 
clinic staff visits to the camp).
    (f) 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 (which may mean health care is provided at the time of 
such intake activity or during subsequent clinic staff visits to that 
location).

Example II. 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 also be documentation for the 
particular health care provider that this coverage is a condition of 
employment at the health center.

Example III. Coverage-Related Activities

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

    Dated: September 19, 1995.
Ciro V. Sumaya,
Administrator.
[FR Doc. 95-23601 Filed 9-22-95; 8:45 am]
BILLING CODE 4160-15-P