Was your FTCA Application submission this year…stressful?

If you are like most health centers this year, you may have been overwhelmed with the changes in the FTCA (Federal Tort Claims Act) requirements. You may have felt the changes were unclear and you were confused about how to meet the requirements. Or maybe you had significant turnover in your staff and some of your quarterly Risk Management Assessments or risk management trainings fell through the cracks. The submission deadline may have crept up on you amidst summer vacations, EMR “go-lives”, and budgetary struggles. If any of this describes your experience, you’re not alone.

But the silver lining in all of this is that you made it through and now is the time to put the systems in place so next year’s application is much less stressful! In the following article, we will share strategies for moving toward continuous FTCA compliance.

Quarterly Risk Management Assessments

Time after time this year, we heard of health centers that had some trouble throughout the year where they forgot to complete a formal risk assessment each quarter and as they came to the FTCA application process, they panicked because that time had passed and they were unable to go back and re-create those assessments. The best solution is to put systems in place that ensure that even when things come up (and they will always come up), these important assessments are not missed or forgotten.

The first essential strategy to solve this challenge is to plan ahead. Sit down with a calendar and mark out the week each quarter you are going to dedicate to completing the quarterly Risk Management Assessment.

A second strategy is to have some sort of safety net or check and balance so if (and when) some part of the plan breaks (the Risk Manager is out on leave for emergency surgery, the EHR goes down due to a cyber-attack, etc.), another level of check and balance will catch that this was missed and the team can complete the assessment before too much time elapses. An example of this check and balance is to add this report to your monthly Quality Meeting agenda where the Quality Team reports on quarterly Risk Management Assessments each month. Then, if it is missed one month, the quality team will note this discrepancy and quickly complete it.

A third strategy is to simplify the Risk Management Assessment. Many health centers fall into the trap of creating an elaborate risk management tool that is clunky, cumbersome, and unsustainable. So, all it takes is a slightly busier-than-normal week and the Risk Management Assessment process falls apart. It is far better to have a simple but sustainable Risk Management Assessment process than one that is complex and unsustainable. Develop a simple form that allows you to input assessment questions each quarter that are pertinent and responsive to the current risks in your organization. For example, maybe in the last few months, you received several near-miss incident reports with needle-stick injuries. Using a simple form, you can type in some questions that direct your team to train appropriate staff on the various sharps devices and how to safely empty the sharps containers, etc. With each assessment question that yields some concern or finding, make sure you document a mitigating action step to lower the risk of that specific finding.

Credentialing and Privileging

The HRSA Site Visit Protocol currently states that it is up to the health center to determine the frequency of re-credentialing and re-privileging. However, this year FTCA instituted the requirement of every two years as that frequency for FTCA-deemed health centers. We received many questions about this and how this affected their credentialing list within the FTCA application. HRSA (and specifically FTCA) wants every Licensed Independent Practitioner (LIP), Other Licensed or Certified Practitioner (OLCP), and Other Clinical Staff (OCS) to have been credentialed within the last two years from the date of the submission of the FTCA application.

This means that if the health center submits the application on June 24, 2024, a health center staff member’s last credentialing and privileging date of June 22, 2022, would be non-compliant.

From time to time, health centers will have trouble getting certain documentation for re-appointment and will go past the intended deadline. Delays should be expected! So, build in a cushion for yourself so that if (and again, “when”) there are delays, these interruptions will not result in non-compliance. Set deadlines for yourself that are 2-3 months ahead of the actual 2-year deadline. Also, any re-credentialing deadlines that fall within the months of May, June, and July (the months of the FTCA application submission period) should receive special attention. Consider working to move up the re-appointment deadlines to April to ensure all credentialing and privileging files are up to date well in advance of the FTCA application submission date.

Risk Management Training, Planning, and Tracking

Probably the most confusing part of this year’s application was the documentation surrounding Risk Management Training. Though this year is considered a “transition year” and FTCA has said it will be flexible, next year’s application must follow the new requirements. When health centers apply for FTCA deeming in June of 2025, they will be expected to demonstrate that they followed a Risk Management Training cycle that was aligned with the calendar year 2024. This means that we are already halfway through what your health center will need to report on in 2025. It’s important for your health center to look at the 2024 Risk Management Training Plan and ensure all required trainings are scheduled to be completed during the calendar year 2024. Any training that is not completed timely and falls in 2025 will be considered non-compliant and could result in next year’s FTCA application being disapproved. So, we recommend that each health center set its training deadlines a few months before the end of the year (October 31, 2024) so that if (and when) a health center has trouble getting some of its staff to complete their training, they will have time to resolve any issues. As required this year, next year will again require that the health center trains all appropriate staff on HIPAA, infection control, obstetrics risk management, and at least one other high-risk area.

Policies and Procedures

There are several policies that are required to be submitted for each year’s FTCA application and each policy is required to contain certain elements. Those include tracking procedures (referral, hospitalization, and diagnostic tracking), credentialing and privileging procedures, and claims management procedures. Most of these procedures are also required for HRSA Operational Site Visits so the annual FTCA application cycle is a great opportunity to ensure these procedures are compliant.

Each of these procedures is required to be board-approved at least every three years so changes cannot be made last minute. We recommend health centers review FTCA-related policies and procedures in March and April of each year. The reason we chose those months is that typically, FTCA will release the next year’s FTCA application in the form of a Program Assistance Letter or “PAL” in January or February and the FTCA application cycle is typically May through July – so March through April is a great time to look at the new PAL and make sure the policies are ready before submitting for FTCA.

There are some helpful HRSA documents that can guide health centers in document compliance:

• Tracking Policies: HRSA’s FTCA Deeming Application Tracking Policies document provides a helpful checklist for required referral, hospitalization, and diagnostic tracking policies.

• Credentialing & Privileging Policies: Chapter 5: Clinical Staffing of HRSA’s Site Visit Protocol contains the requirements for health center credentialing and privileging policies. RegLantern also has a helpful Credentialing and Privileging Checklist on its Resources Page.

• Claims Policies: The FTCA Site Visit Protocol describes in detail the requirements that must be included in the Claims Policy.

While the pain of this year’s FTCA application is still fresh on your mind, we encourage you to get a plan together today for next year’s application. Below we give an example of what that work plan might look like.

As you can see, we are already almost to July in this “Current Calendar Year”, so go back and look at January through June of this “Current Calendar Year” on this work plan and make sure you already have two quarterly Risk Management Assessments completed (Q1 and Q2) with associated action plans and that you are current on all your required trainings according to this year’s Risk Management Training Plan (including training for your Risk Manager, as well as all staff on the required trainings of HIPAA, infection control, OB, and at least one other area of high-risk).

With a little planning ahead, and following the recommendations we suggested in this article, we’re confident next year’s FTCA application will be your easiest yet. But if you need a little extra help, contact RegLantern’s HRSA and FTCA compliance experts today.

This author (and RegLantern LLC) are not employed by or speaking on behalf of HRSA or FTCA. None of this article should be considered legal advice. Depending on when you read this article, regulations may change. Always consult the most recent HRSA/FTCA guidance to ensure this information is still up-to-date. For specific HRSA/FTCA questions, please submit them to HRSA/BPHC through the BPHC Contact Form or call 877-464-4772, option 1, 8 a.m. to 5:30 p.m. ET, Monday-Friday (except federal holidays).