Been Through a Disaster? There is Help for Recovery

By A.J. Plunkett

Your hospital, urgent care center, nursing home, laboratory or other healthcare facility has just survived a hurricane. Or a wildfire. Or a tornado. Or any other disaster. Now you need help with recovery.

If you are affiliated with a state, tribal, territorial or local government operation, or are a non-profit providing critical healthcare services in a declared disaster area, the Federal Emergency Management Agency (FEMA) has a public assistance program ready to help.

“Private non-profit (PNP) and state or county-operated healthcare facilities are eligible for reimbursement if they are located in the declared disaster area and provide emergency medical care (diagnosis or treatment) of mental or physical injury or disease,” according to a “Guide to Federal Recovery Programs for Healthcare Organizations” published on the Department of Health and Human Services’ (HHS) Technical Resources, Assistance Center, and Information Exchange (TRACIE).

For-profit organizations may be eligible for assistance through the Small Business Administration, notes the 14-page guide, which also encourages to facilities to review disaster insurance coverage and explore options through the U.S. Department of Housing and Urban Development.

For non-profits, FEMA can provide grants to help with hazard mitigation during recovery. The grants are generally provided to a state or regional agency, that then administers subgrants to eligible facilities.

Those facilities can include:

• Clinics
• Facilities that provide in-patient care for convalescent or chronic disease patients
• Hospices and nursing homes
• Hospitals and related facilities such as:

Central service facilities operated in connection with hospitals

Extended-care facilities

Facilities related to home-health services

Laboratories

Self-care units

Storage, administration and record areas

• Long-term care facilities
• Outpatient facilities
• Rehabilitation centers that provide medical care

You can find out more information about available resources and how to apply for help through your local healthcare coalition. Among other things, you will likely be asked to present documentation about disaster-related damage and what emergency work needs to be done.

What’s work is eligible?

FEMA reimbursement is available for eligible work, which can include, according to the TRACIE booklet:

Category A: Debris Removal

• Debris removal activities such as clearance, removal, and disposal. These activities will count if they  are in the public interest, meaning it:

Eliminates immediate threats to lives, public health, and safety;

Eliminates immediate threats of significant damage to improved public or private property; and/or

Ensures economic recovery of the affected community to the benefit of the community at large.

• For a PNP, eligible debris removal is limited to that associated with an eligible facility, including debris on the property of the eligible facility

Category B: Emergency Protective Measures

• Emergency evacuations
• Labor costs for emergency mass care or shelter operations
• Overtime pay for permanent, reassigned or temporary employees doing emergency work

• Regular and overtime pay for contractors doing emergency work

• Temporary repairs to the facility or equipment, keeping it functional until permanent repairs can be made

• Emergency protective measures (e.g., provision of shelters/emergency care, sandbagging, bracing/shoring structures, emergency repairs or emergency demolition, and removal of safety hazards)

• Temporary generators

Category E: Buildings and Equipment

FEMA reimbursement will only cover eligible repair costs for items that were damaged by the event. Proving so is a comprehensive process dependent on thorough documentation, assessments, and inspection by FEMA representatives to examine repairs. Reimbursement for damaged or destroyed equipment and supplies is permitted if the equivalent items are similar in age, condition, and capacity.

Repairs could include:

• Facility repairs and any required increased code compliance
• Facility repair costs if they exceed 50% of the replacement cost
• Overtime labor costs, specific to construction
• Permanent work to bring the facility back to pre-disaster condition

If equipment is not repairable, FEMA uses “blue book” values or similar price guides to estimate eligible costs.

Category Z: Management Costs

Management costs are indirect costs, administrative expenses, and other expenses incurred through the administration and management of public assistance awards that are not directly chargeable to a specific project.

You must have prepared prior to event

The booklet summarizes other aid that may be available but notes in several places that healthcare facilities are expected to have participated in emergency management.

Hospitals deemed eligible for Medicare through The Joint Commission have long been required to show emergency preparedness activities, and since 2016 other healthcare facilities have also been required to do the same under CMS Conditions of Participation (CoP) and Conditions of Coverage.

Such preparations will help facilities put together requests for disaster assistance, notes the TRACIE booklet:

“Prior to any event, it is imperative that healthcare facilities develop policies and procedures for capturing disaster-related expenses such a staff labor costs, supplemental materials, volunteer hours (such as NGOs) and assessing, documenting and photographing (where appropriate) damages.

“Having a process in place to quickly set up disaster-specific cost centers or having pre-printed or electronic disaster purchase orders will assist greatly in tracking and documenting expenses and improve the chance of reimbursement.

“Facilities should also document ‘normal’ daily expenditures and usage to ensure there is adequate justification for ‘disaster-related’ costs when seeking reimbursement. An estimated scope of work and timelines for completion of proposed projects can also help prepare for reimbursement.”

The 14-page guide also includes dozens of links to various other online resources, including such things as a Healthcare Coalition Recovery Plan template and Yale New Haven Health System’s A Quick Guide FEMA Reimbursement for Acute Care Hospitals.

You can find the guide here.