Circular Exhibit 20-07-A

1. PURPOSE This policy establishes the Volunteer Health Services Program for [Specific] Area Indian Health Service and provides procedures and guidelines for accepting volunteer health care services by licensed health care providers for use in providing health care in any health care facility in the [Specific] Area. The purpose of the Volunteer Health Services Program is to broaden and strengthen the delivery of health services, to contribute to the comfort and well-being of patients in [Specific] Area hospitals and clinics, and to expand the services needed in a health care facility of the [Specific] Area.
2. AUTHORITIES
   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 “non-Service health care practitioners”) can provide clinical care services to IHS patients and receive Federal Tort Claims Act (FTCA) coverage in response to the public health emergency caused by the Coronavirus Disease 2019 (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 1, Chapter 6
3. 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 health care facility of the [Specific] Area. 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 [Specific] 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.

4. VOLUNTEER SERVICES PROGRAM
   1. Volunteers may be used to supplement, but not take the place of, personnel hired through the usual employment procedures. Volunteer services may be provided on-site, or by telehealth in circumstances where certain physicians and other health care professionals provide consultation services by telephone.
   2. Volunteer service programs must be conducted under the supervision and control of [Specific] Area officials. The services of volunteers may be accepted only in accordance with an established volunteer service program.
   3. The Area Director will appoint at least one Volunteer Service Program Coordinator. However, the Service Unit Clinical Director will be the supervisor of the health care providers providing direct medical care or telehealth consultation services. The Volunteer Service Program Coordinator will:
      1. Establish and maintain 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. Accept applications from volunteer organizations as well as individuals.
      3. Inform 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. Assure 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
         6. The length of the voluntary assignment.
      5. Prepare reports on use of volunteers as required.
   4. Selection of Volunteers
      1. Initial selection of volunteers who are members of voluntary organizations is the responsibility of that voluntary organization. Final selection and placement of volunteers who are members of organizations, and of individual volunteers, is the responsibility of the Service Unit officials.
      2. Service Unit officials may require evidence of satisfactory medical condition of volunteers.
      3. Except for volunteers in child care worker positions, volunteers are not subject to the investigative requirements of Executive Order 10450, “Security Requirements for Government Employment.” However, the same tests as to character, reputation, and fitness applicable to regular Federal employees should be considered in accepting volunteers.
      4. Volunteers are covered by the Standards of Conduct provisions of Executive Order 11222.
      5. Volunteers are not required to be U.S. citizens.
5. COMPENSATION, AUTHORIZATION OF SERVICE, AND TERMINATION
   1. Volunteer service programs must be on a “without compensation” basis. This precludes monetary payments or any other form of compensation by the IHS, including Service Unit or Area Office.
   2. Volunteers will be authorized to serve by a letter of authorization (Exhibit B) signed by an authorized Service Unit official. Two copies of the letter will be sent to the volunteer, who keeps the original and returns a signed copy to the Service Unit official.
   3. Volunteer service agreements may be terminated at any time by either party to the agreement and for any reason.
6. RECORDS TO BE MAINTAINED
   1. The [Specific] Area is responsible for determining how to document volunteer service (e.g., self-developed forms, letters). An SF-50 cannot be used to document volunteer appointments. The following records will be maintained for each volunteer:
      1. Resume or application.
      2. Volunteer Service Agreement, which delineates the expectations of both parties in relation to length of time commitment, confidentiality, and adherence to the organization’s policies and procedures and must be signed by an official authorized to accept volunteer services and the volunteer. Exhibit A is the appropriate Volunteer Service Program Agreement for Healthcare Professionals. Service Units should consult with regional counsel in the Department of Health and Human Services, Office of the General Counsel concerning the circumstances where such agreements are appropriate.
         1. To fulfill the OPM requirement that the Area must clearly inform volunteers of the nature of their appointment with respect to service credit for leave or other employee benefits, the written communication must contain language such as:

            Volunteer service is not creditable for leave or any other employee benefits.

         2. To fulfill the Federal statute requirements regarding background investigations and child protection, the Area must include the following language:

            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 will be 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.

            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 need to go through a background check.

            Alternatively, 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).

         3. To fulfill the Federal statutory requirements regarding the Privacy Act and Health Insurance Portability and Accountability Act, the Area must include the following language:

            The Volunteer shall have training on the (1) Federal Privacy Act and Health Insurance Portability and Accountability Act of 1996 (HIPAA) policies and procedures and (2) the Information Systems Security Awareness (ISSA).

      3. Letter of Authorization must be signed by an official authorized to accept volunteer services and the volunteer prior to such services being performed. (A sample letter is attached as Exhibit B.) This letter includes the following information:
         1. name of agency;
         2. position title;
         3. office title and duty location; and
         4. days/hours on duty.
      4. Letter of Appreciation and Termination will be sent when a Volunteer’s service is concluded. The letter will include the following:
         1. inclusive dates of service;
         2. total hours or days worked; and
         3. guidance on how the Agency may be contacted regarding future requests to obtain documentation of volunteer service.
   2. The servicing human resources office will maintain the official volunteer service records for each volunteer. The [Specific] Area cannot use an Official Personnel Folder for this purpose. Further, the above-referenced volunteer service records must be maintained the longer of (1) the period of the volunteer's service and one year thereafter, or (2) three years after the volunteer’s assignment is terminated.

      OPM’s Government-wide systems of records notice for OPM/GOVT-1 will continue to cover volunteer service records for purposes of the Privacy Act. All records are subject to IHS’s normal records retention policy.

7. SERVICES AND BENEFITS AVAILABLE TO VOLUNTEERS. In addition to the services and benefits extended to volunteers under 45 C.F.R. § 57.5, volunteers may also receive the following services and benefit (note all Area offices may not have the ability to offer the following benefits):
   1. Volunteers may be considered employees of the Federal Government for the purposes of the benefits provided by 5 U.S.C. § 8101 for work related injuries or diseases.
   2. Volunteers may be entitled to travel and transportation expenses under 5 U.S.C. § 5703.
   3. Volunteers may be authorized to use Government vehicles for official purposes in accordance with established policy. They may be authorized to use a private conveyance for official purposes under 5 U.S.C. § 5704, the Standardized Government Travel Regulations, and department policy.
   4. Volunteers may be provided protective clothing and equipment under 5 U.S.C. § 7903.
   5. Volunteers may use the physical facility, including conference areas, equipment and supplies to provide medical services within the clinical setting.
   6. Volunteers will be orientated to the facility, resources, and records as appropriate.
   7. Volunteers may attend any continuing education programs held at the facility.
   8. Meals may be provided in the health care facility to volunteers without charge when the scheduled assignment extends over an established meal period.
   9. Quarters may be furnished temporarily at no charge to volunteers, in case of emergency or when necessitated by the special nature of the volunteer assignment.
   10. Physical examinations, if considered by the official accepting volunteer services to be necessary for the protection of volunteers or patients, may be administered in Service Unit facilities without charge to the individual. If the services of a private physician are used, however, the volunteer must pay the cost of the examination.
   11. Emergency outpatient treatment in IHS facilities for injuries sustained while performing assigned volunteer services will be provided to volunteers. Volunteers may also be provided temporary care and treatment in Service Unit facilities under the same circumstances and to the same extent such care and treatment are available to paid employees.
   12. Volunteers may be considered employees of the Federal Government for the purposes of permitted disclosure of patient records and other protected health information as needed to perform the assigned clinical duties.
8. TORT COVERAGE AND IMMUNITY.
   1. Non-Service health care practitioner, 25 U.S.C. § 1680c(e). A non-Service health care practitioner is a volunteer physician, physician assistant, or advanced practice nurse (licensed independent health care practitioners or LIPs). LIPs that are privileged at the IHS health care facility and through the facility’s privileging process can been designated a federal employee for purposes of receiving Federal Tort Claims Act (FTCA) coverage pursuant to 28 U.S.C. §§ 2671-2680. Such LIPS may have immunity under Coronavirus Aid, Relief, and Economic Security Act, § 3215 and/or CARES Act. Section 1680c(e) authorizes FTCA coverage and § 3215of CARES Act provides immunity; however, it is the Department of Justice that will make all final determinations of whether FTCA coverage or immunity will apply to the actions of a non-Service health care practitioner. Each non-Service health care practitioner must have a signed Designation of Volunteer Non-Service Health Care Practitioner as a Federal Employee form that must be completed as part of the privileging process.
   2. Volunteers. Volunteer health care professionals shall not be liable under Federal or state law for any harm caused by an act or omission of the professional in the provision of health care services during the public health emergency with respect to COVID-19 pandemic, when requirements of § 3215 have been met. Coronavirus Aid, Relief, and Economic Security Act, § 3215 and/or CARES Act. The liability protections of § 3215 shall only be provided during the public health emergency as declared by the Secretary of the Department of Health and Human Services to combat the COVIC-19 pandemic.
9. CLINICAL PRIVILEGES. Non-Service health care practitioners must obtain clinical privileges in accordance with IHS’ appropriate category of clinical privileges and Area or Service Unit medical staff bylaws. See the IHS Indian Health Manual, Chapter 1, Part 3, § 3-1.5 and ____________________. For those Service Units accredited by The Joint Commission or another accrediting body, medical staff bylaws must meet those accrediting standards.
10. AWARDS AND RECOGNITION Officials responsible for administering volunteer service programs are responsible for developing an appropriate plan to recognize the contribution made by volunteers. Cash awards may not be given, but certificates of service or similar forms of recognition are recommended.
11. SUPERSESSION. This Circular does not supersede any previous [Specific] Area Indian Health Service Circular.
12. EFFECTIVE DATE. This policy is effective immediately.

Dear ___________________:

Having met the requirements for serving under the volunteer service program of the (name of organization) as a:

______ health care volunteer, or

______ non-Service health care practitioner.

During the Coronavirus Disease 2019 (COVID-19) pandemic, you are hereby authorized to serve without compensation as a volunteer at (name and location of health care facility) as (position title). Your acceptance of the opportunity to serve on such a basis means that you waive all claim to pay for services rendered and understand that Volunteer service is not creditable for leave or any other employee benefits.

While serving as a volunteer, you are bound by the Department’s regulations concerning Standards of Conduct and Conflict of Interest.

You understand that you (as a health care volunteer may be covered by § 3215 of the Coronavirus Aid, Relief, and Economic Security Act) (as a non-Service health care practitioner may be covered by the Federal Torts Claims Act and/or § 3215 of the Coronavirus Aid, Relief, and Economic Security Act), but that such determination will be made by either the Department of Justice, the state where your services are provided, or your state of licensure.

(Include paragraph about arrangements, as appropriate, and days/hour on duty.)

Your interest in the health needs of the people we serve is deeply appreciated, and we are grateful for the assistance you are willing to provide in meeting these needs.

Please sign the enclosed copy of this letter in the space provided below and return it to us in the enclosed envelope.

Enclosure

I accept the opportunity to provide volunteer service as offered about and agree to the conditions stated. I understand that this agreement may be terminated at any time either by me or an official of the [Specific] Area Indian Health Service.