FEMA Public Assistance Applicant Eligibility

Applicant Eligibility

SLTT government entities are eligible to apply for PA.  Certain PNP organizations are eligible to apply for PA, including those that own and/or operate medical care facilities.

Private for profit entities, including for profit hospitals, are not eligible for assistance from FEMA under PA.  SLTT government entities may contract with for profit hospitals to carry out eligible emergency protective measures.  FEMA will reimburse the eligible Applicant for the cost of eligible work, and the Applicant will then pay the private entity for the provision of services.

Facility Eligibility

For SLTT governments, evaluating facility eligibility is not necessary for most emergency work.  PNPs are generally not eligible for reimbursement for emergency services because they are not legally responsible for providing those services.

PNPs that own or operate a medical or custodial care facility are eligible for:

  • reimbursement of costs from FEMA related to patient evacuation when such an action is needed.
  • in limited circumstances, reimbursement when essential components of a facility are urgently needed to save lives or protect health and safety, such as an emergency room of a PNP hospital.
  • reimbursement of costs for emergency medical care, as outlined in the Eligible Emergency Medical Care Activities section.

Work Eligibility

FEMA can only provide funding for costs that are a result of COVID-19 and above and beyond what the Applicant usually incurs during its normal course of business. See PAPPG at pp. 21-22, and 41-42.

Key questions for Covid-19 eligibility are:

  • Is the Applicant legally responsible for performing the activities where cost reimbursement is sought?
  • Is the Applicant is a government organization and the state’s, tribe’s, or territory’s constitution or laws delegate jurisdictional powers to the Applicant or/and
  • Does a statute, order, contract, articles of incorporation, charter, or other legal document make the responsible applicant to conduct the activities for the general public.

To determine legal responsibility for Emergency Protective Measures, FEMA evaluates whether the Applicant requesting the assistance either had jurisdiction over the area in which work was performed or the legal authority to conduct the activities. In general, an Applicant only has legal responsibility to conduct Emergency Protective Measures within its jurisdiction. If an Applicant conducts Emergency Protective Measures outside its jurisdiction, it must demonstrate its legal basis and responsibility to conduct those activities. See PAPPG at pp. 20-21, and 41-42.

If it is not clear that a direct threat to life, public health or safety exists, or that the activity is necessary to cope with the threat, FEMA may request documentation to demonstrate that the Applicant conducted the activities at the direction or guidance of public health officials.

Work must be necessary as a direct result of the emergency or major disaster (44 CFR §206.223(a)(1)).Costs must be directly related to COVID-19 cases. For example, emergency medical care costs related to a non-COVID-19 illness or injury are not eligible. 

Costs for personal protective equipment (PPE) for health care providers who are working in a hospital treating COVID-19 patients are eligible, as it is necessary to prevent further spread of the virus and protect health care workers and other patients.  

Cost Eligibility

All assistance provided under PA is subject to standard program eligibility requirements, including reasonable cost, procurement, and duplication of benefits requirements.

 FEMA cannot: 

  • Provide assistance under PA that is covered by another funding source.
  • Duplicate assistance provided by HHS, including the Centers for Disease Control and Prevention (CDC), or other federal agencies.
  • This includes funding provided by 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; and grants available from the HHS Office of the Assistant Secretary for Preparedness and Response. 
  • Provide PA funding for emergency medical care costs if they are covered by another source, including private insurance, Medicare, Medicaid, or a pre-existing private payment agreement.
  • The Applicant must be able to provide documentation verifying that insurance coverage or any other source of funding, including private insurance, Medicaid, or Medicare, has been pursued or does not exist for the costs associated with emergency medical care and emergency medical evacuations.  
  • Each applicant will need to agree to the stipulation in the grant conditions of all FEMA awards that funding is not also being received from another funding source.  FEMA is coordinating with HHS to share information about funding from each agency to assist in the prevention of duplication of benefits.

Other Considerations for Emergency Medical Care Eligibility

When the emergency medical delivery system within a declared area is destroyed, severely compromised, or overwhelmed, FEMA may fund extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care or expanding existing medical care capacity in response to the declared incident. Costs associated with emergency medical care should be customary for the emergency medical services provided. Other eligibility considerations specific to emergency medical care activities as an emergency protective measure under the COVID-19 Declarations are provided in this section.

Time Limitations for Completion of Work

  • Emergency medical care costs are typically only eligible for up to 30 days from the declaration date unless extended by FEMA.
  • Under the COVID-19 Declarations, eligible emergency medical care costs are eligible for the duration of the Public Health Emergency, as determined by HHS.

Public versus PNP Facility

  • Emergency medical care is eligible as an emergency protective measure for public and PNP medical facilities, as long as the facility provides an emergency medical service necessary to save lives and/or protect public health and safety. In this case, emergency medical care related to COVID-19 cases is eligible as an emergency protective measure.

Emergency Medical Care versus Long-Term Medical Treatment 

  • Only emergency medical care that is necessary to save lives and/or protect public health and safety is eligible.

Long-term medical treatment is not eligible. This includes:

  • Medical care costs incurred once a COVID-19 patient is admitted to a medical facility on an inpatient basis.
  • Costs associated with follow-on treatment of COVID-19 patients beyond the duration of the Public Health Emergency, as determined by HHS.
  • Administrative costs associated with the treatment of COVID-19 patients.

 Eligible Emergency Medical Care Activities When Depend on the Applicant Type (State, County, Local,etc) and their Legal Responsibility for the Emergency Services and Directions from Local and State Public Health Authorities.  Eligible emergency response costs may include, but are not limited to the following examples:

Contracts

  • Contracts (existing and procured) to provide Covid-19 support services
  • Costs for contractors performing emergency protective work

Equipment

  • Durable medical equipment necessary for the treatment of Covid-19 
  • Leased or purchased equipment for use in temporary medical care facilities
  • Rented Equipment used to provide emergency Covid-19 services

Facilities 

  • Use or lease of specialized medical equipment necessary to respond to COVID-19 cases
  • Temporary facilities and expansions may be used to treat COVID-19 patients or non-COVID-19 patients, as appropriate. 
  • Temporary facilities, such as tents or portable buildings for treatment of survivors
  • Temporary medical facilities and expanded medical care facility capacity for COVID-19 for facilities overwhelmed by COVID-19 cases 
  • Temporary medical facilities and/or enhanced medical/hospital capacity (for treatment when existing facilities are reasonably forecasted to become overloaded in the near term and cannot accommodate the patient load or to quarantine potentially infected persons)
  • Non‐deferrable medical treatment of infected persons in a shelter or temporary medical  facility.
  • Related medical facility services and supplies.
  • Temporary Relocation of Essential Services

Medical Treatment & Actions

  • Costs associated with isolation of employees exposed to COVID-19 during patient care
  • Labor and supply costs for mass care operations
  • Management, control and reduction of immediate threats to public health and safety:
  • Medical waste disposal related to eligible emergency medical care
  • Other costs incurred as a result of COVID-19
  • Overtime paid to employees caring for COVID-19 patients
  • Security for temporary medical care facilities
  • Emergency medical treatment of COVID-19 patients
  • First-aid assessment and provision of first aid
  • Measures taken to protect patients and staff
  • Treatment, stabilization, and monitoring
  • Triage and medically necessary tests and diagnosis related to COVID-19 cases

Medical Supplies

  • A one-time 30-day supply of prescriptions for acute conditions or to replace maintenance  prescriptions
  • Prescription costs related to COVID-19 treatment
  • Vaccinations for survivors and emergency workers to prevent outbreaks of infectious and communicable diseases
  • Consumable medical supplies that are ingested, injected, or applied or are for one-time use only
  • Costs of PPE associated with COVID-19
  • Materials and Supplies used for Covid-19 by staff or contractors 
  • Purchase of PPE, durable medical equipment, and consumable medical supplies necessary to respond to COVID-19 cases (note that disposition requirements may apply)

Medical Transport

  • Emergency medical transport related to COVID-19
  • Emergency medical transport 
  • Evacuation Including Accessible Transportation and Emergency Medical Transportation
  • Use of ambulances for distributing immunizations and setting up mobile medical units

Donated Resource

  • Donated Resources including materials, supplies, commercial services, volunteers

Current FEMA Guidance on Eligibility of Medical Expenses. Prior to the COVID-19 outbreak, FEMA had published guidance on which costs are, and are not, eligible for assistance when "the emergency medical delivery system within declared area is destroyed, severely compromised or overwhelmed."

The guidance emphasizes that FEMA funding is for "extraordinary"situations – which quite clearly describes the COVID-19 outbreak. FEMA's focus is on using funding only for temporary costs created by the declared event,such as "extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care of survivors…Costs are eligible for up to 30 days from the declaration date unless extended by FEMA." FEMA's Policy includes examples of eligible and ineligible work and costs and is available here at page 63.

When the emergency medical delivery system within a declared area is destroyed, severely compromised or overwhelmed, FEMAmay fund extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care of survivors. Costs associated with emergency medical care should be customary for the emergency medical services provided.

More examples of possible eligible emergency medical costs may include, but not limited to:

Labor

  • Daily time records will need to be developed and kept for employees generating incremental costs of labor due to the incident.
  • This will include OT of non-exempt staff caused by COVID-19, hired per diem or non-exempt staff to backfill a paid non-productive employee, new hires to fill COVID-19 responsibilities or to backfill due to the impact of COVID-19, or extra activities of non-exempt staff (e.g. pharmacy staff time to compound/mix medications that cannot be purchased pre-mixed, the time of IT staff to set up laptops for work at home, staff to man ED tent triaging, added security staff time due to visitor policy change, etc.)
  • Will need to keep logs of activities individuals are performing. It will not be enough to only state “COVID-19 related” or “caused by COVID-19”.
  • We do NOT recommend tracking time for Directors, Managers, VPs—who are paid 80 hours per cycle regardless of hours worked (salaried employees) as these are not incremental costs.
  • Tracking of any donated labor resources to a similar level of detail.
  • Kronos (or alike payroll system) approvals, accompanied with additional comments or comment codes, should be the trigger or means by which to identify the individuals to pursue (immediately upon the close of each pay cycle), the detail of hours worked by day on COVID-19 related matters, or induced by the COVID-19 incident. Need to use a “best-efforts” basis to recall and notate this specificity, working with employees and supervisor/timekeepers, and also garner further helpful supporting documentation such as activity logs kept by schedulers or the employee.

Supplies & Other COVID-19 Caused Expenses

  • Any PPE and/or specific medical supplies related to the incident should be charged to a newly created COVID-19 cost center.
  • Any other supply item or service (handwashing agents, remote working technology, contracted labor, etc.) associated with a COVID-19 matter, or incurred to support patient care or patient/employee safety during this event—should be charged to this same newly created COVID-19 cost center. Further examples:
  • Tent rental
  • Newly hired or re-hired staff employed temporarily as contracted labor/on 1099
  • Computers purchased for work from home mandate
  • Licensing of telehealth IT platform
  • Tracking of any donated supplies or equipment to a similar level of detail.
  • Maintaining procurement files—POs, copies of invoices, associated with COVID-19 procured services, equipment, supplies or other purchases.
  • Supplies from stock will be quantified to determine incremental level of spend vs. historical norms.

“Surge Hospital” – or Opened New Units

  • The full operating costs for this facility or these designated new units, as it is, or they are, being renovated and operated to separate non-COVID-19 patients from those that require the more intensive and isolated care.
  • Actual renovation and preparation costs for units.

Lost Revenues/Business Interruption

  • Impact of COVID-19 on elective procedure revenue.
  • An analysis to perform and evaluate drops in volumes occurring in surgery, cardiac, orthopedics…and other services (relative to historic norms), and quantify impact using average payment rates and payer mix.
  • Further guidance under the CARES Act still forthcoming.

Personal Protection Equipment (PPE)

  • Surgical/Procedure Masks
  • N95/N99 Form Fitting Respirators
  • Face masks with integrated shield
  • Powered Air Purifying Respirator, PAPRs
  • Alcohol Based Hand Rub

Hospital Supplies

  • Ventilators with PEEP Functionality
  • Ventilator Circuits
  • Endotracheal Tubes
  • Hospital Gowns

Lab Supplies

  • UVT 3 mL with flocked flex minitip
  • Nasopharyngeal (NP) flocked swabs and viral transport media tubes (1-3 mL)

Diagnostics Supplies and Instruments

  • Roche MagNA Pure 96 DNA and Viral NA Small Volume Kits
  • Roche MagNA Pure 96 System Fluid and Tips
  • Roche MagNA Pure 96 External Lysis Buffer
  • Biomerieux NuciSENS EasyMAG extraction system and supplies

Medical sheltering (e.g., when existing facilities are reasonably forecasted to become overloaded in the near future and cannot accommodate needs)

  • All sheltering must be conducted in accordance with standards and/or guidance approved by HHS/CDC and must be implemented in a manner that incorporates social distancing measures.
  • Non‐congregate medical sheltering may also be eligible, subject to prior approval by FEMA. 
  • Examples include sheltering for those who test positive for COVID-19 who do not require hospitalization but need isolation (including those exiting from hospitals); those who have been exposed to COVID-19 who do not require hospitalization; and asymptomatic high-risk individuals needing social distancing as a precautionary measure, such as people over 65 or with certain underlying health conditions (respiratory, compromised immunities, chronic disease).
  • Sheltering specific populations in non-congregate shelters should be determined by a public health official’s direction or in accordance with the direction or guidance of health officials by the appropriate state or local entities.  The request should specify the populations to be sheltered. 

COST TRACKING IS CRITICAL TO REIMBURSEMENT

During this process, it is necessary to get as much funding as possible to cover additional costs incurred by the extra time and effort put forth including the larger quantity of supplies being utilized. The recent passage of the Federal Stimulus Bill had three relief packages, the third of which is The Coronavirus Aid, Relief and Economic Security (CARES) Act, passed on March 25th. Under this package, healthcare organizations have the opportunity to submit their incremental costs to obtain relief funding. These are costs that are in addition to the normal operating costs that are either “COVID-19 related” or “COVID-19 induced”. For example, extra PPE supplies fall into the former and opening new units to cohort non-COVID-19 patients would fall into the latter category.

The good news is that substantial funding is available. However, governmental rules and requirements around this funding will require an extreme degree of specificity, documentation, organization, and comprehensiveness – in order to actually receive this relief funding. This is somewhat akin to clinical documentation. If organizations don’t record their expenditures with sufficient specificity and have the backup data to support the claims, they will not be paid the correct amount, the amount they deserve.

‍Procurement requirements differ between state versus non-state entities and by normal versus emergency/exigent circumstances. Procurement requirements for the COVID-19 Declarations are:

  • States and territorial governments are required to follow their own procurement procedures as well as the Federal requirements for procurement of recovered materials and inclusion of required contract provisions per 2 C.F.R. §§ 200.317, 200.322, and 200.326.
  • In accordance with the March 17, 2020, memorandum from David Bibo, Acting Associate Administrator for the Office of Response and Recovery, for the duration of the Public Health Emergency, as determined by the U.S. Department of Health and Human Services (HHS), local governments, tribal governments, nonprofits, and other non-state entities may proceed with new and existing non-competitively procured contracts.
  • SLTT governments may contract with medical providers, including private for-profit hospitals, to carry out any eligible activity described in the Eligible Emergency Medical Care Activities section below.
  • The aforementioned memorandum and other information related to exigent and emergency circumstances procurement is available on the FEMA website at www.fema.gov/news-release/2020/03/20/procurement-under-grants-under-exigent-or-emergency-circumstances.

Emergency responses and urgent public health responses are critical priorities. However, financial disaster recovery from the Covid-19 Pandemic response actions will become an essential budget issue in light of reducing tax revenues and increased demand for services.

Accounting Considerations -Tracking and Managing Coronavirus Recovery Costs

Recognizing the logistical and bureaucratic challenges this unprecedented response effort will bring, FEMA is actively working to develop a simplified application and funding process. Your experience with the FEMA Public Assistance Covid-19 Simplified Grant Process will be materially less administratively painful with smoother quicker reimbursement of costs:

 If you accurately track and document COVID-19 response expenditures, 

 It is essential to consistently use activity/cost codes for COVD19 on all purchases of material, labor, supplies, contracts, services, and equipment that are directly related to responding to the COVID-19 pandemic.

 ü  The cost coding systems used by your entity will depend on your supporting technology for operations accounting for payroll, materials/supplies, contracts, and purchasing order protocols.

 

FEMA Public Assistance program is a REIMBURSEMENT program.

Applicants for Public Assistance MUST TAKE IMMEDIATE PROACTIVE ACCOUNTING MEASURES

To help you proactively navigate the complex FEMA programs and track eligible costs incurred, the information available here is provided as a PUBLIC SERVICE so that you and your teams can better track Covid-19 disaster-related costs for financial recovery.

EMERGENCY COVID-19 RESPONSE FIRST, BUT TRACK & DOCUMENT COSTS

CONSISTENT COST TRACKING AND DOCUMENTATION OF COVID-19 RESPONSE COSTS WILL MAKE A REIMBURSEMENT DIFFERENCE

 Emergency responses and urgent public health responses are critical priorities. However, financial disaster recovery from the Covid-19 Pandemic response actions will become an essential budget issue in light of reducing tax revenues and increased demand for services.

Accounting Considerations -Tracking and Managing Coronavirus Recovery Costs

Recognizing the logistical and bureaucratic challenges this unprecedented response effort will bring, FEMA is actively working to develop a simplified application and funding process.

 Your experience with the FEMA Public Assistance Covid-19 Simplified Grant Process will be materially less administratively painful with smoother quicker reimbursement of costs, IF YOU

  1. Accurately track and document all COVID-19 response expenditures
  2. Consistently use activity/cost codes for COVD19 on all purchases of material, labor, supplies, contracts, services, and equipment that are directly related to responding to the COVID-19 pandemic.
  3. ADD NEW COST CODES for operations accounting for payroll, materials/supplies, contracts, and purchasing order protocols regardless of the supporting technology, even if you must use Excel spreadsheets

 FEMA Public Assistance program is a REIMBURSEMENT program.

 Applicants for Public Assistance MUST TAKE IMMEDIATE PROACTIVE ACCOUNTING MEASURES

To help you proactively navigate the complex FEMA programs and track eligible costs incurred, the information available here is provided as a PUBLIC SERVICE so that you and your teams can better track Covid-19 disaster-related costs for financial recovery.

IMPORTANT – ONLY FEMA CAN MAKE ELIGIBILITY AND COST DETERMINATIONS

The current FEMA PA Policy & Procedures Guide provides information on emergency work for traditional natural disasters.

FEMA HQ will most likely provide Covid-19 Disaster Specific Guidance in near future




State Governments

Exhibit shows each State Emergency Management Agency. NOTE: State agencies and divisions including hospitals and universities have different eligibility issues. State and Territorial governments, including the District of Columbia, American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands, are eligible Applicants.


Contact Your State Emergency Management Agency for Public Assistance Portal Setup & Applicant Briefings

Coronavirus (COVID-19) Pandemic: Private Nonprofit Organizations

All 50 states, the District of Columbia, five territories, and numerous tribes are working directly with FEMA under President Trump’s March 13, 2020, nationwide emergency declaration for COVID-19. Under this emergency declaration, and subsequent major disaster declarations, certain private non-profit (PNP) organizations are eligible to apply for funding through FEMA’s Public Assistance program. This fact sheet provides guidance for determining the eligibility of PNP applicants and work performed in accordance with the COVID-19 emergency and major disaster declarations.

PNP Applicant Eligibility

To be an eligible applicant, the PNP must show that it has:

  • A current ruling letter from the U.S. Internal Revenue Service granting tax exemption under Section 501(c), (d) or (e) of the Internal Revenue Code of 1954; or
  • Documentation from the state substantiating it is a non-revenue-producing nonprofit entity organized or doing business under state law.[44 C.F.R. § 203.221(f)]

 Additionally, prior to determining whether the PNP is eligible, FEMA must first determine whether the PNP owns or operates an eligible facility. For PNPs, an eligible facility is one that provides eligible services, including:

  • A critical service, which is defined as education, utility, emergency or medical;[44 C.F.R. § 206.221(e)]
  • A facility that provides noncritical but essential social services AND provides these services to the general public;[44 C.F.R. § 206.221(e)(7)] or
  • Certain types of facilities such as senior centers that restrict access in a manner clearly related to the nature of the facility but that are still considered to provide essential social services to the general public.

State EM Applicants Briefing will provide more specifics for their state but the following helpful examples of eligible PNPs.

Critical PNPs include:

  • Nursing Homes
  • Laboratories
  • Rehab Centers That Provide Medical Care
  • Hospitals and Emergency Care Facilities
  • Fire/Rescue Emergency Services
  • Educational Facilities (public or private) Including Colleges

Essential/Noncritical PNPs include:

  • Community Centers
  • Child Care Facilities
  • Food Assistance Programs
  • Performing Arts Facilities
  • Senior Citizen Centers
  • Homeless Shelters
  • Houses of Worship

However, it is important to note that these lists are not exhaustive and there may be other types of PNPs that are potentially eligible.

What work and costs are eligible for FEMA PA Program funding?

Through the PA Program, FEMA provides grant funding for certain categories of emergency work and permanent work, depending on the type of disaster declared. Emergency work includes the following two categories that address an immediate threat:

  • Category A Debris Removal
  • Category B Emergency Protective Measures

To be eligible, costs must be:

  • Directly tied to the performance of eligible work;
  • Adequately documented;[2 C.F.R. § 200.403(g)]
  • Reduced by all applicable credits, such as insurance proceeds and salvage values;14
  • Authorized and not prohibited under Federal, State, Territorial, Tribal or local government laws or regulations;
  • Consistent with the Applicant’s internal policies, regulations, and procedures that apply uniformly to both Federal awards and other activities of the Applicant; and
  • Necessary and reasonable to accomplish the work properly and efficiently.[2 C.F.R. § 200.403]

The COVID-19 national emergency makes federal PA Program funding available for Category B Emergency Protective Measures. Category B Emergency Protective Measures include actions taken before, during and following a disaster to save lives, protect public health and safety, or eliminate immediate threat of significant damage to improve public health and property.[44 C.F.R. § 206.225(a)(3)]

Private entities, including for profit hospitals or restaurants, are not eligible for assistance from FEMA under Public Assistance. However, state, local, tribal, and territorial government entities may contract with private entities to carry out eligible emergency protective measures. In these cases, FEMA will reimburse the eligible applicant for the cost of eligible work, and the applicant will then pay the private entity for the provision of services.

PNP Work Eligibility

In accordance with sections 403 and 502 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121 et seq. (the “Stafford Act”), eligible emergency protective measures taken to respond to the COVID-19 emergency at the direction or guidance of public health officials may be eligible for reimbursement under category B of FEMA’s Public Assistance program.4 Emergency work is that which is necessary to save lives or protect public health and safety. To be eligible, work must be the legal responsibility of an eligible applicant.5

 Measures to protect life, public health, and safety are generally the responsibility of state, local, tribal, and territorial governments. In some cases, a government entity may be legally responsible to provide services and enter into an agreement with a PNP to provide those services (e.g., sheltering or food distribution). In these cases, Public Assistance funding is provided to the legally responsible government entity, which then pays the PNP for the cost of providing those services under the agreement.6

In limited circumstances, essential components of a facility are urgently needed to save lives or protect health and safety, such as an emergency room of a PNP hospital. In these cases, PNPs that own or operate an eligible facility and perform eligible work, such as providing emergency, medical or custodial care services for which they are legally responsible in response to the COVID-19 incident, may be eligible for reimbursement of costs as a Public Assistance applicant.

For PNPs, operating costs (such as patient care and administrative activities) are generally not eligible even if the services are emergency services, unless the PNP performs an emergency service at the request of and certified by the legally responsible government entity. In such case, FEMA provides Public Assistance funding through that government entity as the eligible applicant.

Local Governments

The following types of local governments are eligible Applicants:

  • Counties and parishes
  • Municipalities, cities, towns, boroughs, and townships
  • Local public authorities
  • School districts
  • Intrastate districts
  • Councils of governments (regardless of whether incorporated as nonprofit corporations
  • under State law)
  • Regional and interstate government entities
  • Agencies or instrumentalities of local governments
  • State-recognized Tribes
  • Special districts established under State law

Private Nonprofit Health Care Organizations’ Guide to FEMA Reimbursement for COVID-19 Related Expenses

While private nonprofit health care organizations can wait to apply, they are encouraged to apply now with their respective states’ emergency management agency.  Further, those intending to seek public assistance funding are strongly encouraged to begin documenting every detail about expenses for which they may seek such funds.

Final reimbursement determinations will be coordinated by FEMA and the Department of Health and Human Services (HHS). Note, private for-profit entities, including for-profit hospitals, are not eligible for assistance from FEMA for public assistance funding.

Hospitals, Outpatient Facilities, Rehabilitation Facilities, and Facilities for Long-Term Care Are Eligible for FEMA Public Assistance Funding

Private nonprofit health care organizations (demonstrated by their production of

(1) an effective letter ruling from the Internal Revenue Service granting tax exemption under sections 501(c), (d), or (e) of the Internal Revenue Code of 1954, or

(2) satisfactory evidence from their respective state that the nonrevenue producing organization or entity is a nonprofit one organized or doing business under state law) which own or operate one of the following private nonprofit health care facilities are eligible for public assistance funding (44 C.F.R. 206.221222):

Hospitals. Hospitals include general, tuberculosis, and other types of hospitals and related facilities, such as laboratories, outpatient departments, nursing home facilities, extended care facilities, facilities related to programs for home health services, self-care units, and central service facilities operated in connection with hospitals. This category also includes education or training facilities for health profession personnel operated as an integral part of a hospital. A medical organization that primarily furnishes home-based care is not considered a hospital under this definition.

  1. Outpatient facilities. Outpatient facilities are defined as facilities located in or apart from a hospital for the diagnosis or treatment of patients who are not actually admitted to a hospital. Such a facility may be one operated in connection with a hospital or one in which patient care is under the professional supervision of a doctor licensed in the State.
  2. Rehabilitation facilities. Rehabilitation facilities are defined as facilities that are operated for the purpose of assisting the rehabilitation of disabled persons through a program of medical evaluation and services; and for psychological, social, or vocational evaluation and services that are under competent professional supervision. The major portion of these services should be furnished in the facility.
  3. Facilities for long-term care. Long-term care facilities are defined as facilities providing inpatient care for convalescent or chronic disease patients who require skilled nursing care and related medical services. Such facilities may be in a hospital, operated in connection with a hospital, or be in a location where services performed are under the professional supervision of a doctor licensed in the state (e.g. a nursing home or hospice).

Category B Emergency Protective Measures Taken By Private Nonprofit Health care Facilities Are Eligible for FEMA Public Assistance Funding

Generally, to be eligible for FEMA public assistance funds, the item of work provided by a private nonprofit health care facility must:

  1. Be required as the result of the COVID-19 national emergency (for example, emergency medical care costs related to a non-COVID-19 illness or injury are not eligible); and
  2. Be the legal responsibility of an eligible applicant.

Private nonprofit health care facilities are eligible to receive public assistance funding for their emergency work related to COVID-19 or what are known as “category b – emergency protective measures.” Specifically, emergency protective measures taken to save lives, to protect public health and safety, and to protect improved property are eligible for FEMA’s public assistance. Further, in the pertinent part, these emergency protective measures must eliminate or lessen immediate threats to life, public health or safety. 44 C.F.R. 206.225.

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Coronavirus (COVID-19): FEMA Assistance for Tribal Governments

Release date: March 26, 2020

Release Number: FACT SHEET

Based on the President’s nationwide emergency declaration for the coronavirus (COVID-19) pandemic on March 13, 2020, tribal governments have the option to request Public Assistance from FEMA as either a Recipient or Subrecipient. This fact sheet provides additional information about the assistance FEMA can provide to tribal governments as either Recipients or Subrecipients during the nationwide COVID-19 emergency and replaces FEMA’s March 22, 2020 Coronavirus (COVID-19) Response: Tribal Recipients Fact Sheet. Additional information on the Federal government’s Coronavirus (COVID-19) Response can be found at: https://www.fema.gov/coronavirus.

Tribal Options for Assistance

  • Under the President’s national emergency declaration, states, territories, and tribes are not required to request individual Emergency Declarations, which is typically the case, in order to receive FEMA assistance.
  • A tribal government may choose to receive assistance:
  1. As a Subrecipient under a state: All states are Recipients for Public Assistance; tribes have the option of working with the state(s) that they are located in and requesting assistance as a Subrecipient; or
  2. As a Recipient: Each tribe has the option of signing a FEMA-Tribe Agreement and becoming a Recipient.
  • Tribes that are Recipients will have a direct relationship with FEMA and will receive assistance autonomously from the state or states in which they are located.
  • Tribes may choose to request their own emergency number from FEMA, if desired. However, having a different emergency number will have no practical effect on the provision of assistance or FEMA’s relationship with the tribe.

  • A tribal Subrecipient of FEMA Public Assistance works through the state or states in which the tribal government is located to coordinate assistance.
  • The tribal government will also need to work with the state to complete a Request for Public Assistance and submit it to FEMA through the PA Grants Portal.
  • A Recipient of FEMA Public Assistance, whether they have their own emergency number or not, has direct interactions with FEMA and has additional requirements and responsibilities for program and grant administration.
  • Tribes that have never been Recipients of FEMA assistance should review FEMA’s New Recipients of Disaster Grants Guide and consult with FEMA regional Recovery Division staff to understand the typical administrative requirements of being a Recipient.
  • Currently, due to the incredible burden and stress on all American citizens from this unprecedented event, FEMA is looking to consolidate resources and processes in order to serve as many communities as quickly and efficiently as possible.
  • If appropriate, FEMA encourages tribal governments to work with their respective state or states for assistance. This in no way diminishes the important tribal government role of serving tribal members during this emergency.
  • FEMA understands that for some tribes this may not be possible, and FEMA respects a tribes’ sovereign right of self-governance and will continue to work with closely with tribes during this important time.
  • More information on the Public Assistance grant process can be found in the Coronavirus (COVID-19) Pandemic: Public Assistance Simplified Application Fact Sheet.

FEMA Role in COVID-19 Pandemic Response

  • FEMA, in coordination with the Department of Health and Human Services (HHS), will assist state, local, tribal, territorial governments and other eligible entities with the health and safety actions they take on behalf of the American public.
  • Tribal governments can express their intent to seek FEMA Public Assistance by notifying the FEMA Regional Administrator in the FEMA regional office in which the tribal government seat is located.
  • As part of the tribal expression of intent, tribal governments should indicate that their emergency plan was executed.
  • Each of the ten FEMA regions has Regional Tribal Liaisons to coordinate with tribes located within that respective region.
  • Regional Tribal Liaisons can connect tribes with FEMA leadership and program subject matter experts, as needed, for information, technical assistance and resources.

Federal Assistance

  • FEMA Public Assistance as a Recipient requires execution of a FEMA-Tribe Agreement (FTA) and execution of an emergency plan.
  • An FTA is submitted to the FEMA Regional Administrator and contains the understandings, commitments, and conditions under which federal disaster assistance will be provided.
  • FEMA regional offices can provide a draft copy to tribal governments for review. Once all parties have reviewed and made edits, a final version will be distributed for signature.
  • A tribal government must confirm activation of its emergency plan to receive assistance as a Recipient. FEMA regulations do not specify legal requirements for emergency plan; only that a tribal government has one and activates it before requesting a declaration.
  • As indicated in the President’s national emergency declaration, FEMA Public Assistance for this nationwide emergency will be provided at a 75 percent Federal/25 percent non-Federal cost share. As direct recipients, Tribal governments, like state and territorial recipients, will be responsible for the 25 percent cost share. Some states choose to share the 25 percent cost share with their Subrecipients to reduce the financial burden on local and tribal governments.
  • Eligible emergency protective measures taken at the direction or guidance of public health officials in response to this emergency, and not provided or funded by the authorities of another federal agency, may be reimbursed under the FEMA Public Assistance program.
  • FEMA encourages officials to take appropriate actions that are necessary to protect public health and safety pursuant to public health guidance.
  • Reimbursable activities for the COVID-19 pandemic fall under Category B of the FEMA Public Assistance program—Emergency Protective Measures—and typically include the activation of State or Tribal Emergency Operations Centers, law enforcement and other measures necessary to protect public health and safety.
  • The Public Assistance Program and Policy Guide (PAPPG) combines FEMA Public Assistance policy into a single volume and provides overview of program implementation process with links to other publications and documents that provide additional process details.
  • More information on reimbursable activities may be found in the PAPPG and in the Coronavirus (COVID-19) Pandemic: Eligible Emergency Protective Measures Fact Sheet.
  • Federal disaster assistance grant programs have additional requirements to complete before FEMA allocates and dispenses grant funds. The FEMA New Recipients of Disaster Grants Guide describes requirements for Recipients in requesting and receiving FEMA disaster assistance grant funding.
  • A tribal government must have a FEMA-approved Public Assistance Administrative Plan before FEMA is able to provide assistance. A tribal-government specific template is available.
  • A Hazard Mitigation Plan is not required for FEMA Emergency Assistance. More information on FEMA’s Hazard Mitigation Plan requirement, a condition for receiving certain types of non- emergency disaster assistance, can be found here: https://www.fema.gov/hazard-mitigation-plan-requirement.
  • Tribal governments that choose to be a Subrecipient to a state(s) for FEMA Public Assistance should coordinate with the state(s).
  • FEMA recognizes that some tribal governments have greater capacity than others. In order to streamline resource requests, it may be more efficient to maintain close coordination with county and state officials. However, tribal assistance can be provided across states and FEMA Regions.

Definitions

Applicant:  A non-federal entity that applies to be a Subrecipient of assistance under a Recipient’s
federal award (e.g., local government agency, housing authority, or private nonprofit organization).

Subrecipient: An Applicant that receives a sub-award from a Recipient to carry out part of a federal program.

Recipient: A non-federal entity that receives an award from a federal agency (e.g., state, territorial, or tribal government) to carry out an activity under a federal program.

More Information

For more information, visit the following websites:

  1. Public Assistance Program and Policy Guide
  2. Coronavirus (COVID-19) Pandemic: Eligible Emergency Protective Measures Fact Sheet
  3. New Recipients of Disaster Grant Guide
  4. Coronavirus (COVID-19) Pandemic: Public Assistance Simplified Application Fact Sheet
  5. FEMA.gov/Coronavirus
  6. Coronavirus (COVID-19) (CDC)

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La Respuesta al Coronavirus (COVID-19): Beneficiarios Tribales

Last Updated:

March 27, 2020 - 18:22

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