Volunteer Non-Service Health Care Practitioners

Refer to: OQ

Circular Exhibit 20-07-A, Area Volunteer Policy Template

Circular Exhibit 20-07-B, Collaborative Agreement for Volunteer Services

Circular Exhibit 20-07-C, Designation of Volunteer Non-Service Health care Practitioner as a Federal Employee

1. Purpose. The purpose of this Circular is to authorize the privileging of volunteer non-Service health care practitioners (NSHCP) in the Indian Health Service (IHS or Agency) operated health care facilities and the designation of volunteer NSHCP as federal employees for the purpose of receiving Federal Tort Claims Act (FTCA) coverage pursuant to 25 U.S.C. § 1680c(e) in order to provide health care services during the novel coronavirus disease (COVID-19) pandemic. This circular also delegates specific authority to IHS staff to designate volunteer NSHCP as federal employees for the purpose of receiving FTCA coverage. The volunteer NSHCP authorized by this action are physicians, physician assistants, and advance practice nurses. All NSHCP volunteers must meet all applicable requirements, including those expressed herein and set forth by local policies.
2. Background. In response to the Public Health care Emergency declared by the Secretary of Health and Human Services on January 31, 2020, IHS is implementing policies and guidelines for designating and privileging volunteer NSHCPs. By privileging volunteer NSHCPs, they will be able to provide clinical care to IHS patients and be designated federal employees for the purpose of receiving FTCA coverage in response to the public health emergency caused by the COVID-19 pandemic. These health care providers will increase the quality of patient care, without increasing the Agency’s cost of providing such care, and supplement, rather than displace, personnel employed in the IHS. Ultimately, implementation of this circular will strengthen the delivery of IHS health services, contribute to the comfort and well-being of patients, and expand the services needed in IHS health care facilities located within the 12 Areas of the IHS.
3. Requirements for Designating a Volunteer NSHCP a Federal Employee to Obtain FTCA Coverage.Volunteer NSHCPs must enter into an Area Volunteer Agreement (Exhibit 20-07-A) with the IHS and be granted clinical privileges at an IHS service unit. To complete the privileging process and designate the volunteer NSHCP as a federal employee authorized to receive FTCA coverage (see delegated authority in section 4), the Area Director or the Area Director’s delegate must sign the “Designation of Volunteer Non-Service Health Care Practitioner as a Federal Employee” Form (Exhibit 20-07-B). The volunteer’s application/resume, the Area Volunteer Service Agreement, documentation of the clinical privileges granted, the “Designation of Volunteer Non-Service Health Care Practitioner as a Federal Employee” Form, Letter of Authorization, and Letter of Termination must be kept in the volunteer NSHCP’s official volunteer file.
4. Exclusions. In accordance with 45 C.F.R. Part 57, Volunteer Services, this policy applies to the acceptance of volunteer services for use in the provision of health care in any IHS health care facility. It further defines Health Care Facility as a hospital, clinic, health center, or other facility established for the purpose of providing health care. Therefore, excluded from coverage under this instruction are the Area Office, [examples, the National Supply Service Center and the Office of Environmental Health and Engineering].

   In addition, any paid employee of any non-IHS organization may serve as an IHS volunteer only if his/her services are

   1. outside the scheduled work hours and functions of his/her assignments as an employee of the other organization, and
   2. offered to meet needs under a volunteer service agreement.
5. Related Authorities and References.
   1. 42 U.S.C. § 217b (Volunteer Services for Health Care)
   2. 25 U.S.C. § 1680c(e), implemented by IHS so volunteer licensed independent health care practitioners (also called “NSHCP”) can provide clinical care services to IHS patients and receive FTCA coverage in response to the public health emergency caused by the COVID-19 pandemic.
   3. 45 C.F.R. Part 57 (Regulations Accepting Volunteer Service)
   4. HHS Instruction 930-2 (Accepting Volunteer Service for Use in Providing Health Care)
   5. Office of Personnel Management (OPM) Guide to Processing Personnel Actions, Chapter 33, Documenting Volunteer Service
   6. HHS Instruction 930-2, Accepting Volunteer Service for Use in Providing Health Care
   7. Indian Health Manual Part 3, Chapter 1, Medical Credentials and Privileges Review Process.
   8. References:
      1. Area Volunteer Policy Template. Area staff will refer to policies developed within their respective geographical locations for further guidelines and requirements, as appropriate.
      2. Area Volunteer Agreement Template. C. Designation of Volunteer NCHCP.
6. Delegated Authority. Pursuant to the authority delegated to the Principal Deputy Director, Indian Health Service (IHS), by 42 U.S.C. § 217b and 25 U.S.C. § 1680c(e), The Principal Deputy Director hereby delegates to the individuals holding the positions identified below the authority to, as part of the privileging process, designate volunteer licensed independent health care practitioners (also called “non-Service health care practitioners”) as Federal employees for the purpose of 28 U.S.C. § 1346(b) and §§ 2671-2680 (relating to Federal tort claims), only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such privileges are extended in response to the public health emergency caused by the COVID-19 pandemic.

   Authority Delegated to:

   Deputy Director for Field Operations
   Chief Medical Officer
   Area Directors
   Service Unit Chief Executive Officers

   This authority shall be exercised in accordance with legislative, statutory, regulatory, policy, and procedural provisions, including but not limited to, any Area policies regarding volunteer service programs for health care professionals. The authorities herein may be delegated by the Area Director to other Area staff as appropriate.

7. Responsibilities.
   1. Director IHS
      1. Activating the authorities under 25 U.S.C. § 1680c(e) on behalf of the Agency
      2. Activating these authorities to address the COVID-19 pandemic
   2. Area Director
      1. Ensuring each Area Office create and establish Area specific policies and procedures to implement these authorities (Exhibit 20-07-C)
      2. Appointing at least one Volunteer Service Program Coordinator.
   3. Area Chief Medical Officer
      1. Supervising the health care providers program providing direct medical care or telehealth consultation services
      2. Designing and implementing a process for creating and maintaining official records for the volunteer, in accordance with records management policies
   4. Service Unit Chief Executive Officer
      1. Coordinating volunteer staff
      2. Creating facility specific policies and process for volunteers
      3. Coordinating and overseeing clinical privileges in accordance with IHS’ appropriate category of clinical privileges and Area or Service Unit medical staff bylaws
      4. Ensuring that volunteer agreements and signed “Designation of Volunteer Non-Service Health Care Practitioner As A Federal Employee” Forms are in place
   5. Area Volunteer Service Program Coordinator
      1. Establishing and maintaining contact with various volunteer organizations and other organizations for the purpose of informing them about the volunteer program in soliciting services of potential volunteers
      2. Accepting applications from volunteer organizations and individuals
      3. Informing supervisors and managers of volunteer service program requirements. As requested, solicit applications for volunteers and place volunteers with various departments throughout the Service Units.
      4. Assuring that a Volunteer Service Program Agreement is established with each organization or individual providing volunteer service. This agreement must include:
         1. A description of the services to be provided by the volunteers;
         2. Information concerning the source of the volunteers (i.e., a voluntary organization or individual);
         3. A description of how the volunteer service program will be administered (i.e., how volunteers will be selected, whether physical qualifications apply, what supervision will be provided to the volunteers and by whom, how volunteer work will be scheduled to ensure proper supervision, what services/benefits will be provided to the volunteers);
         4. Plans for providing appropriate recognition to volunteers;
         5. A description of records that will be maintained for each volunteer; and the length of the voluntary assignment.
      5. Preparing reports on use of volunteers as required
   6. Volunteers
      1. The volunteer must adhere to established background investigation requirements, including a preclearance check prior to beginning work. Additionally, for any volunteer who will have regular contact with, or control over, Indian children, a State Criminal History Repositories check is required pursuant to the Indian Child Protection and Family Violence Prevention Act, 25 U.S.C. §§ 3201-3210, and the Crime Control Act of 1990, Subtitle E, Child Care Worker Employee Background Checks, 34 U.S.C. § 20351, as well as all regulations promulgated pursuant to such laws.
      2. A background investigation will not be required for any health care licensed volunteer whose services are limited to telehealth consultations. If these volunteers have logical access to the IHS network (D1 account), they also must undergo a background check.
      3. Until the background investigation is completed and a favorable determination is made, the volunteer must be within sight and under the supervision of a staff person who has favorable background investigation that includes the additional state checks during times when the volunteer has contact with or control over Indian Children. See 34 U.S.C. § 20351(b)(3).
      4. Agree to and sign the Area specific volunteer agreement
8. Effective Date. This Circular becomes effective on the date signed.
9. Supersedure. None.