Glossary of Term Use

Agent - A person or organization that is authorized to act on behalf of, or represent, another person or organization.

BPHC - The Bureau of Primary Health Care is the entity under which Community and Migrant Health Centers, and other programs are organized. The Bureau's mission is "to increase access to comprehensive primary and preventive health care and to improve the health status of underserved and vulnerable populations." BPHC is organized under the Health Resources and Services Administration, Public Health Service, Department of Health and Human Services (see Appendix D Organization Chart).

CHC - Community Health Centers are non-profit, community based primary care centers in Medically Underserved Areas, which receive some of their funding from the Bureau of Primary Health Care. Community Health Centers have community/user based governing boards, sliding discounts for the uninsured, community needs-based service mixes, and strategies to improve community health measures through increased access to family practice, internal medicine, obstetrical, gynecological, pediatric, dental and mental health providers. Community governing boards are expected to consider the needs in their community and focus on primary care, prevention, education and public health strategies to improve the community's health. CHCs submit periodic applications as a condition of their funding, which are called project period renewal grant applications. These applications identify the needs of the community and propose a strategy and business plan to address those needs.

Claims Made Policy - A malpractice insurance policy that only covers the individual for those claims that are filed during the term of the policy. This is in contrast to an occurrence policy that covers acts and omissions that occur during the term of a policy regardless of when they are filed. Clinicians who were covered by a claims made policy prior to protection under FTCA should obtain "tail" coverage, because FTCA only covers those acts and omissions that occur while under the protection of the Act.

Contractor - An individual who performs work for a Health Center but is not an employee of that organization. Health and Human Services Office of the General Counsel may use the IRS (23 - part test) definition to differentiate contractors and employees. Essentially, if a Health Center issues a 1099 to an individual, then that individual is probably a contractor.

Credentialing - A process for verifying that a provider is appropriately licensed or certified, and for evaluating the quality of that provider's work history. Most health plans and hospitals credential providers that practice with or for their organization. The Federally Supported Health Centers Assistance Act of 1992 requires, and PIN 2001-16 reiterates that each deemed Health Center that participates in the FTCA must credential all its physicians and all other licensed or certified health care practitioners. Specifically "A Health Center must verify that its licensed or certified health care practitioners possess the requisite skills and expertise to manage and treat patients and to perform the medical procedures that are required to provide the authorized services. It is incumbent on the Health Centers to assure their users that Health Center practitioners have met standards of practice and training that enable them to manage and treat patients and/or perform procedures and practices with a level of proficiency which minimizes the risk of causing harm. The organization must adopt its own policy that outlines specific privileging requirements and the periodicity of the review of privileges for all licensed or certified health care practitioners." For further information see PIN 2001-16, contact your Primary Care Association, or your Field Office FTCA Coordinator.

Deeming Process - An application process that an eligible Health Center must undertake in order to activate and maintain its FTCA malpractice protection. The law allows only organizations funded under section 330 of the Public Health Service Act to be deemed. The deeming process, while not onerous, does have some basic requirements. Health Centers that wish to participate must assure the Bureau of Primary Health Care that they conduct complete and thorough credentialing of their providers, including a query of the National Practitioner Data Bank. Participating Health Centers must maintain clinical protocols, tracking systems, medical record reviews and active quality assurance programs. Once deemed, eligibility is maintained through project period renewal grant applications.

Employee - FTCA Administration utilizes the IRS definition (23-part test) of an employee. Essentially, if a Health Center issues a W-2 to an individual and pays all withholding taxes, then that individual is an employee.

Field Office - One of 10 regionally located offices of the Health Resources and Services Administration. Each of these offices has an individual who acts as a regional FTCA Coordinator.

FTCA -The Federal Tort Claims Act (FTCA) can be defined as the federal law that, among other things, enables malpractice protection for individuals who are acting within their scope of employment, and within the scope of project of a deemed Health Center.

Gap Coverage - In this handbook, gap coverage refers to a malpractice insurance policy that covers those clinical activities that are not provided malpractice immunity under FTCA (sometimes called wrap-around insurance).

Health Center - The term utilized in this book to identify an entity eligible for FTCA Protection. "Health Centers" are funded by the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, under Section 330 of the Public Health Service Act. These grantees submit a periodic application as a condition of their funding which is called the project period renewal grant application.

Indemnification - Legal exemption, for a third party, from attachment to a malpractice claim. FTCA does not provide a statutory basis for entities affiliated with Health Centers to be indemnified or "held harmless".

Malpractice - A dereliction of professional duty through reprehensible ignorance or negligence - especially when injury or loss follows (Webster). The Public Health Service booklet "Medical Malpractice Claims", states that negligence is the predominant theory of liability in medical malpractice litigation. Professional negligence occurs when a practitioner's care falls below the standard of care established by the medical community. To meet the standard of care the provider must exercise the knowledge and skills that a reasonable practitioner would use under similar circumstances. National standards have become the benchmark.

The mere assertion of a claim or the fact that an injury or adverse complication resulted from a medical, surgical, nursing or dental procedure does not in and of itself constitute malpractice. The facts must prove that there was a deviation from the established standard of care required under the circumstances and that this departure directly caused the alleged injury.

Malpractice Claim - An assertion that a provider has not followed the standard for care, and that the claimant is therefore due compensation.

Medically Underserved Areas - An area that meets federal standards designed to indicate a need for primary care services. The complex index is a mix of morbidity, mortality, and primary care access measures.

NACHC - The National Association of Community Health Centers. NACHC is a membership organization that provides communication, education, training, consulting, networking, group purchasing and advocacy services at a national level for community based and Bureau of Primary Health Care supported clinics.

National Practitioner Data Bank (NPDB) - A federal clearinghouse to collect and release information concerning payments made on behalf of physicians, dentists and other licensed health care practitioners as a result of malpractice actions and claims and to maintain information concerning certain adverse actions regarding their licenses and clinical privileges. Information is released only to those organizations legally entitled to receive it. Information in the NPDB is not released to the public.

Occurrence Policy - An insurance policy that provides coverage for actions and omissions that took place during the time of the policy - regardless of when the claim is made. This is in contrast to a claims made policy that covers the individual for those claims that are filed during the term of the policy.

FTCA malpractice immunity is similar to an occurrence policy. Those protected under FTCA are immune from malpractice liability for those acts that occurred while they were under protection - regardless of when a claim is made.

PCA - Primary Care Associations are state and regional membership organizations, which are supported, in part, by the Bureau of Primary Health Care. PCAs provide communication, education, training, networking, consulting, group purchasing and advocacy services at a state level for primary care, community based, Bureau of Primary Health Care supported clinics, organizations and clinicians.

PCO - Primary Care Offices are state government based cooperative agreements that receive funding from the Bureau of Primary Health Care. PCOs typically serve a variety of functions that promote primary care, community-based care and public health in their state. PCO functions could include (but are not limited to) liaison with federal offices, needs assessments, clinical recruiting, collection and reporting of morbidity and mortality data, oversight of state funding of primary care and administration of local National Health Service Corps programs.

Peer Review - A process where a Health Center's provider staff review the qualifications, outcomes and professional conduct of individual providers and provider applicants to that Health Center to determine whether the individuals reviewed should practice there, and to determine the parameters for doing so. Most states have given some form of immunity to participants in a peer review process and protect discussions, findings, decisions and reports of such reviews as information privileged from judicial disclosure. This protection can vary significantly from state to state.

Privileging - A process for authorizing a provider for a defined scope of clinical services based on an analysis of that provider's credentials, experience and performance. Most health plans and hospitals privilege providers that practice with or for their organization. The Federally Supported Health Centers Assistance Act of 1992 requires, and PIN 2001-16 reiterates that each deemed Health Center that participates in the FTCA must credential, and subsequently privilege, all its physicians and all other licensed or certified health care practitioners. In addition to credentialing, the Health Center "must adopt its own policy that outlines specific privileging requirements and the periodicity of the review of privileges for all licensed or certified health care practitioners." For further information see PIN 2001-16, contact your Primary Care Association, or your Field Office FTCA Coordinator.

Scope of Employment - The duties and responsibilities of an employee or contractor as identified by a job description or contract and other related performance responsibility documents.

Scope of Project - A Health Center's scope of project is the Bureau of Primary Health Care approved domain described in certain segments of its grant application. Those segments include a description of the Health Center's populations served, the list of services provided, list of service delivery sites, Health Center affiliations, and work-plan. A Health Center can update its scope of project by adjusting those fundamental documents and seeking approval for such change from the Bureau of Primary Health Care.

Statute of Limitations - The statute of limitations for filing a FTCA claim is two years.

Sunset Provisions - Scheduled periodic review for consideration of continuation of certain government programs, without which the program is discontinued. FTCA is an abiding program without a sunset provision.

Tail Coverage - A medical malpractice insurance product designed to cover individuals who move from a claims made policy to an occurrence policy. Clinicians who move from a claims made type of policy to FTCA should obtain tail coverage.

Vicarious Liability - Indirect legal responsibility that an entity has, concerning the acts of agents. Hospitals and HMOs, for example, may insure themselves against the vicarious liability that might result from a provider's actions.

Work Plan - A section of the federal grant application on which Health Centers describe goals, objective, tasks, responsibilities and timetables for improving the health of their community.