FTCA deeming is the annual HRSA determination that a Health Center Program award recipient or subrecipient is a deemed Federal Public Health Service (PHS) employee for purposes of the Federal Tort Claims Act (FTCA). HRSA explains the effect this way: a covered entity or individual "is immune and will not be financially liable for any claims arising from covered activities" (HRSA, What is the FTCA?). This service is for health centers and their risk managers. Integral Healthcare Solutions (IHS) aligns your risk management and credentialing documents to HRSA's FTCA requirements and drafts the deeming package your center submits.
Last reviewed: October 2026. HRSA sources read on October 2, 2026: Compliance Manual Chapter 21 (date last reviewed December 2025), PAL 2026-01 (February 3, 2026), the FTCA site visit protocol, the FTCA application process page and "What is the FTCA?" (last reviewed October 2022).
What is FTCA deeming?
The legal authority is Section 224(g)-(n) and (q) of the Public Health Service Act (42 U.S.C. 233(g)-(n) and (q)), with regulations at 42 CFR Part 6. HRSA sets out the program's requirements in two current documents:
- HRSA Health Center Program Compliance Manual, Chapter 21: Federal Tort Claims Act (FTCA) Deeming Requirements, date last reviewed December 2025 (Chapter 21).
- Program Assistance Letter (PAL) 2026-01, "Calendar Year 2027 Requirements for Federal Tort Claims Act (FTCA) Coverage for Health Centers and Their Covered Individuals," dated February 3, 2026. It supersedes PAL 2025-01 (PAL 2026-01).
Chapter 21 requires each health center to "submit for approval by HRSA an annual deeming application that demonstrates the health center: Has implemented appropriate policies and procedures to reduce the risk of malpractice and the risk of lawsuits arising out of any health or health-related functions performed by the health center" (Chapter 21).
HRSA describes the purpose: "Congress' intent was to increase the availability of funds to health centers to provide primary health care services by reducing or eliminating health centers' malpractice insurance premiums" (HRSA). Deeming has limits. Chapter 21 states that "A health center's deemed employment status does not imply FTCA coverage in all cases, as health center providers must also comply with statutory individual eligibility requirements, and covered actions must be taken within the scope of deemed PHS employment" (Chapter 21).
Who needs it and what triggers it
Chapter 21 applies to "Health Center Program award recipients and subrecipients (including those defined as subrecipients under the Health Center FTCA Medical Malpractice Program regulations)" (Chapter 21). The work is triggered by one of these events:
- The annual cycle. Deeming is renewed each year. Under PAL 2026-01, "The EHBs system will be available to begin receiving CY 2027 deeming applications on February 27, 2026," and each currently deemed entity "must submit a redeeming application for itself and any subrecipients (as applicable) by June 26, 2026" to be deemed without a gap in coverage (PAL 2026-01, pp. 4 and 6). HRSA's own wording ties this date to "CY 2026" although the PAL is titled for CY 2027. Confirm the coverage year with your FTCA program contact before relying on the date.
- A first application. HRSA lists "Submission of an initial FTCA deeming application" among the reasons for an FTCA site visit (HRSA site visit protocol).
- Credentialing or quality gaps. The center must be "currently compliant with all of the credentialing and privileging requirements of Chapter 5: Clinical Staffing and all requirements within Chapter 10: Quality Improvement/Assurance prior to the deeming determination" (Chapter 21).
- Claims history. HRSA also lists "A history of medical malpractice claims" as a site visit reason (HRSA site visit protocol).
How IHS helps
IHS works from Chapter 21 and the current PAL. The process:
- A gap assessment of your risk management, quality improvement and assurance, credentialing and privileging, and claims management procedures against Chapter 21 and the PAL, supported by questionnaires on risk activities and claims history.
- A crosswalk from each requirement to the evidence your center already holds, with each gap named.
- Drafted procedures where evidence is missing: the quarterly risk assessment process, the annual risk management training plan, the annual report to the board, the claims management procedure and the patient notice language. Clinical risk content goes to your medical director for review and approval.
- A review calendar, so quarterly assessments, annual training and board reporting happen on schedule.
- A mock review of the deeming package before filing, and drafted application text that your center reviews and submits through EHBs.
What you supply: current policies, credentialing and privileging files, risk training records, claims history, and access to your counsel.
The limit: legal judgments on claims and coverage belong to your counsel and to HRSA. HRSA makes the deeming determination. IHS drafts; your center submits.
What to have ready
Each item below ties to Chapter 21 (date last reviewed December 2025) or PAL 2026-01 (February 3, 2026).
- Your policies and procedures "to reduce the risk of malpractice and the risk of lawsuits" (Chapter 21).
- Credentialing and privileging files that meet Compliance Manual Chapter 5 (Chapter 21).
- Quality improvement and assurance records that meet Compliance Manual Chapter 10 (Chapter 21).
- Evidence of "Risk management across the full range of health center health care activities" (Chapter 21).
- Records of "Health care risk management training for health center staff" (Chapter 21).
- Your completed quarterly risk management assessments (Chapter 21).
- Your annual risk management report to the board (Chapter 21).
- The name of the person who "oversees and coordinates the health center's health care risk management activities," and proof that person "completes risk management training annually" (Chapter 21).
- A claims procedure under which "Any service-of-process/summons that the health center or its provider(s) receives relating to any alleged claim or complaint is promptly sent to the HHS Office of the General Counsel, General Law Division" (Chapter 21).
- Your plain-language patient notice that the center "is a deemed Federal PHS employee," shown on your website, in promotional materials or in a patient-visible area (Chapter 21).
- Your current private malpractice policy. Applicants "should therefore maintain private malpractice insurance until they receive an NDA from HRSA" (PAL 2026-01, pp. 6-7).
- Named EHBs contacts who can answer HRSA requests quickly. "If the requested information is not submitted within 10 business days of notification, the FTCA deeming application may be considered incomplete and voided" (PAL 2026-01, p. 6).
To go through the list with IHS, book the introductory call below.
How it compares
FTCA deeming sits alongside other forms of coverage and other FTCA programs. The sources describe them as follows.
| Option | What the sources say |
|---|---|
| Private malpractice insurance | Applicants should keep it "until they receive an NDA from HRSA," and entities that miss the redeeming deadline "should consider purchasing private malpractice liability insurance for CY 2027" (PAL 2026-01). |
| Gap, tail, D&O and general liability coverage | "The health center determines what other types of liability coverage to obtain, such as private "gap" or "tail" insurance, directors and officer insurance, and general liability insurance, for activities that may not be eligible for FTCA coverage" (Chapter 21). |
| Volunteer Health Professional (VHP) deeming | A separate sponsorship application. The entity NDA "does not extend deeming/coverage to volunteers or VHPs" (PAL 2026-01). |
| FTCA Free Clinic Program | A separate FTCA program for free clinics, which "must reapply annually for continued FTCA coverage" through EHBs (HRSA application process). |
| IHS gap assessment and drafting | A crosswalk, drafted procedures, a mock review and drafted application text. It does not replace your counsel, your insurer or HRSA's determination. |
What it costs
HRSA does not publish a fee schedule on the pages we reviewed; fees depend on scope. We found no application fee in Chapter 21, the HRSA application process page or the full text of PAL 2026-01. IHS scopes each engagement after a free introductory call.
What this is not
- This page is not legal advice. IHS is a consulting firm, and questions about coverage of a specific claim belong to your counsel and HRSA.
- IHS does not guarantee a deeming determination. HRSA decides.
- IHS does not submit to, correspond with or represent your center before HRSA. Your center submits through EHBs.
Frequently asked questions
What is FTCA deeming for a health center, and what does it cover?
FTCA deeming is HRSA's annual determination that a health center is a deemed Federal PHS employee under the Federal Tort Claims Act. HRSA states that a covered entity or individual is immune and will not be financially liable for any claims arising from covered activities. Chapter 21 adds that deemed status does not imply coverage in all cases: providers must meet individual eligibility requirements, and actions must fall within the scope of deemed PHS employment.
Which organizations must apply for FTCA deeming?
Chapter 21 applies to Health Center Program award recipients and subrecipients, including those defined as subrecipients under the Health Center FTCA Medical Malpractice Program regulations. Each must submit an annual deeming application for HRSA's approval. Free clinics apply under a separate FTCA Free Clinic Program.
When was the redeeming application due under PAL 2026-01?
PAL 2026-01 opened EHBs to CY 2027 deeming applications on February 27, 2026, and set June 26, 2026 as the date by which each currently deemed entity had to submit a redeeming application for itself and any subrecipients to avoid a gap in coverage. PAL 2026-01 superseded PAL 2025-01, so check the PAL that governs the coverage year you are applying for. HRSA's own wording ties this date to "CY 2026" although the PAL is titled for CY 2027. Confirm the coverage year with your FTCA program contact before relying on the date.
How long does HRSA take to decide an initial FTCA deeming application?
PAL 2026-01 states that HRSA will notify the center's contact person of a final determination through EHBs within 30 days after a complete initial application has been received. An application is not complete until all required documentation has been submitted through EHBs and, if HRSA requires one, a site visit has been completed.
What risk management documents does HRSA expect?
Chapter 21 lists risk management across the full range of health center health care activities, risk management training for staff, quarterly risk management assessments and annual reporting to the board. The center also designates a person, such as a risk manager, who oversees risk management activities and completes risk management training each year.
How do credentialing and privileging affect FTCA deeming?
Chapter 21 requires the center to be currently compliant with all credentialing and privileging requirements of Compliance Manual Chapter 5 and all requirements of Chapter 10 on quality improvement and assurance before the deeming determination. Credentialing gaps therefore affect the deeming application directly.
What happens during an FTCA site visit?
HRSA states that it conducts scheduled FTCA site visits between May and November and that they last 2.5 days. Reasons HRSA lists include the submission of an initial deeming application and a history of medical malpractice claims. For an initial application, the site visit, when required, is part of what makes the application complete.
Should we keep private malpractice insurance while the application is pending?
PAL 2026-01 states that applicants should maintain private malpractice insurance until they receive an NDA from HRSA. It also says entities that miss the redeeming deadline should consider purchasing private malpractice liability insurance for CY 2027.
Does the health center's deeming cover volunteers?
Not through the entity's own deeming. PAL 2026-01 states that the entity's NDA does not extend deeming or coverage to volunteers or Volunteer Health Professionals. Volunteer Health Professional deeming uses a separate sponsorship application.
Why would HRSA treat an application as incomplete?
PAL 2026-01 states that an application is not complete until all required documentation is in EHBs and any required site visit is done. If information HRSA requests is not submitted within 10 business days of notification, the application may be considered incomplete and voided. HRSA does not publish approval or denial rates on the pages we reviewed.