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Source: US Congressional Budget Office

S. 3650 would include Urban Indian Health Programs (UIHPs) and their employees in the pool of entities and individuals that receive liability protection under the Federal Tort Claims Act (FTCA). In addition, S. 3650 would deem the Native Hawaiian Health Care System (NHHCS) and its clinics to be federal agencies for purposes of providing liability protection. Under the FTCA, the federal government pays for court judgments and compromise settlements of lawsuits out of the Judgement Fund. The Judgment Fund is a permanent, indefinite appropriation that is available to pay monetary awards against the United States that are judicially or administratively ordered.

Under current law, UIHPs are health care organizations that are grantees of the Indian Health Service (IHS) but are not considered federal entities; therefore, their employees are not covered under the FTCA. Similarly, the NHHCS comprises five health care clinics that are grantees of the Health Resources and Services Administration (HRSA) that are not considered federal entities. However, unlike the UIHPs, three of the five clinics have FTCA coverage for medical malpractice claims by virtue of receiving certain HRSA grants. S. 3650 would extend FTCA coverage for other types of suits to those three clinics, in addition to providing full FTCA protection to the remaining two clinics that do not have coverage under current law.

For this estimate, CBO used information from the Department of Treasury’s Bureau of the Fiscal Service about the number and amount of payments from the Judgement Fund that were used to settle claims and litigation on behalf of IHS employees. While UIHPs and NHHCSs are not part of IHS, they provide similar services, and CBO expects they would experience a similar rate of lawsuits and settlements.