FEMA recently released additional guidance regarding COVID-19 medical care costs eligible for Public Assistance. FEMA has expanded its definition of Emergency Medical care to include inpatient care and related services for both confirmed and suspected cases of COVID-19.

FEMA’s new policy provides several clarifications to promote consistency across all COVID-19 declarations, and, specifically, to clarify costs associated with Temporary and Expanded Medical Facilities, and Labor Costs.

That FEMA has opened the door to reimbursement of medical care costs testifies to the severity of the crisis. This action on FEMA’s part does, indeed, represent a departure from historical practice.

Advis continually monitors updates and ongoing guidance from FEMA. A summary of key cost eligibility changes and clarifications is listed below.

Inpatient Care

  • Medical care costs incurred after a COVID-19 patient is admitted to inpatient care are now eligible for FEMA reimbursement.
  • FEMA provides reimbursement for uncompensated medical care provided to both COVID-19 patients and suspected cases of COVID-19.
  • Medicare rates will be used as the basis to determine cost reasonableness for eligible care not covered by alternative funding sources.

Temporary and Expanded Medical Facilities

  • FEMA provides reimbursement for medical care activities and associated costs related to treating both COVID-19 and non-COVID-19 patients in a temporary or expanded medical facility.  Coverage may include the following:
  • Lease, purchase, or construction costs (Subject to disposition requirements);
  • Mobilization and demobilization costs associated with setting up and closing a temporary or expanded facility;
  • Operating costs, including equipment, supplies, staffing, and support services; and
  • Maintenance of temporary or expanded medical facilities in an operationally ready but unused status available for surge capacity for COVID-19 readiness and response.

Costs must be reasonable and necessary based on the actual or projected need.

Contracts for related work must include a termination for convenience clause that will be implemented if the site is ultimately not needed, or if actual needs are less than projected.         

Permanent Renovations to Medical Facilities

  • In most cases, permanent renovations are not eligible unless the applicant can demonstrate that the work was completed in time to address COVID-19 capacity needs and is the most cost-effective option.
  • Permanent renovations are subject to real property disposition requirements.

Labor Costs

  • FEMA has expanded eligibility to the following costs incurred for both confirmed and suspected COVID-19 cases:
    • Overtime for budgeted medical staff providing treatment to COVID-19 patients;
    • Straight time and Overtime for unbudgeted temporary medical staff providing treatment to COVID-19 patients;
    • Contractual costs associated with unbudgeted temporary medical staff providing treatment to COVID-19 patients; including:
      • Travel;
      • Lodging; and
      • Per Diem for contracted medical staff from outside the local commuting area.

Any labor costs for medical staff that are included in patient billing and/or otherwise covered by another funding source are NOT eligible for reimbursement.

Completion of Work Timeline

  • Costs for eligible medical care are limited to costs incurred within 6 months of the declaration date or the end of the COVID-19 Public Health Emergency, whichever comes first.
  • It is unclear whether this applies to the start of the incident period (January 20th) or date of the Presidential emergency declaration (March 13th).
  • In either case, FEMA may extend this deadline should the Public Health Emergency extend beyond 6 months.
  • Many states have also begun to provide specific timelines for filing, or have otherwise indicated that the eligibility period will continue until the end of the emergency declaration.

Duplication of Benefits

  • FEMA cannot provide funding for clinical care costs funded by another source, including the CARES Act Uninsured Program.
  • Applicants will be required to certify that it has not received and does not anticipate receiving assistance from other available sources of funding for the same work or costs.
  • FEMA offers the following list of potential duplicate funding sources:
    • The Public Health Emergency Preparedness Cooperative Agreement Program;
    • The Public Health Crisis Response Cooperative Agreement;
    • The Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases;
    • The Hospital Preparedness Program Cooperative Agreement;
    • The Regional Ebola and Other Special Pathogen Treatment Centers Cooperative Agreement;
    • The National Emerging Special Pathogens Training and Education Center Cooperative Agreement;
    • The Hospital Association COVID-19 Preparedness and Response Activities Cooperative Agreement;
    • The Coronavirus Relief Fund and the Provider Relief Fund;
    • The COVID-19 Uninsured Program; and
    • The Paycheck Protection Program.

Please contact our COVID-19 Task Force for guidance regarding FEMA Public Assistance.

Published: May 15, 2020