Emergency Medical Care

Appeal Brief

Conclusion:  Overtime labor costs in the amounts of $6,970.14 for PW 73 and $16,581.92 for PW 74 are eligible costs in accordance with the FEMA policies in effect at the time of the emergency.  In addition, $206,105.11 in material and supply costs for PW 74 is eligible contingent upon the Applicant’s provision of adequate documentation to support the claimed costs.                       

Authorities Discussed

• DAP 9525.4 , Medical Care and Evacuations (2008)
• DAP 9523.15, Eligible Costs Related to Evacuations & Sheltering (2007)

Appeal Letter

Appeal Analysis

Background

On October 23, 2009, an explosion at the CAPECO fuel storage facilities in Catario, Puerto Rico caused the Puerto Rican government to activate emergency protective measures.  The Puerto Rico Department of Health’s (Applicant) initial assessment of the situation led it to conclude that there would be many injured workers at the CAPECO facility as well as injured civilians in the neighboring area.  The Puerto Rico Emergency Management Agency (Grantee) activated the Health Department Interagency Coordinator.  The Metropolitan Regional Emergency Operation Center and the Applicant coordinated the vaccination of evacuees and emergency personnel at shelters in Guaynabo and Catario, Puerto Rico.  The Applicant also posted personnel in other Emergency Operations Centers (EOC), where they coordinated the vaccination of additional evacuees and emergency personnel. 

FEMA prepared Project Worksheet (PW) 73 for force account labor for the personnel that worked in the Metropolitan Regional EOC as well as materials used in the vaccination and treatment of the disaster survivors in this particular facility.  Also, FEMA prepared PW 74 for force account labor for the personnel that worked in the shelters and other EOCs and materials used in the vaccination and medical care of the evacuees in these facilities. 

FEMA found the force account labor and material costs in PWs 73 and 74 ineligible because the documentation that the Applicant provided failed to support the costs claimed.  Specifically, the Applicant did not document the work performed.  Also, FEMA contended that several line items in PW 73 could not be included as materials and needed to be requested separately.  Ultimately, FEMA denied all of the Applicant’s claimed costs in PWs 73 and 74.

First Appeal

The Applicant submitted its first appeals through the Grantee for PWs 73 and 74 on
September 27, 2010 and September 14, 2010, respectively.  The Applicant requested $6,970 and $222, 687, respectively, in overtime labor costs for employees who worked in the shelters and EOCs and material and supply costs for their treatment of disaster survivors.  In both appeals, the Applicant provided additional documentation to support overtime labor costs.  The Applicant also submitted documentation to support some of the material and supply costs listed in PW 74.

In its first appeal decisions, dated March 23, 2011 (for PW 73) and March 29, 2011 (for PW 74), the FEMA Puerto Rico Disaster Recovery Manager (DRM) applied the 1999 FEMA Disaster Assistance Policy (DAP) 9525.4, Medical Care and Evacuations in denying the appeals.  Though the DRM acknowledged receipt of supporting documentation with both first appeals, including a detailed list of work performed by employees, labor costs, and material receipts, it found the costs claimed to be ineligible according to the DAP 9525.4.

Second Appeal

On June 25, 2012 and July 10, 2012, the Applicant submitted through the Grantee its second appeals for PWs 73 and 74, respectively.  In its appeals, the Applicant asserts that both the $6,970 for labor costs claimed in PW 73 and $222,687 for labor, material, and supply claimed in PW 74 are eligible for FEMA funding in accordance with the DAP 9525.4 Medical Care and Evacuations.  Further, the Applicant included detailed force account labor records and a copy of the 2008 DAP 9525.4 Medical Care and Evacuations, the policy in effect at the time of the emergency. 

Discussion

The 2008 Disaster Assistance Policy (DAP) 9525.4 Medical Care and Evacuations, which was in effect at the time of the emergency, delineates “the extraordinary emergency medical care and medical evacuation expenses that are eligible for reimbursement under the Category B, Emergency Protective Measures provision of the Federal Emergency Management Agency's (FEMA) Public Assistance (PA) Program following an emergency or major disaster declaration.”[1]  In accordance with this policy, eligible emergency medical costs include, but are not limited to:

• Overtime for regular full-time employees performing eligible work within 30 days from the time of the disaster or emergency.
• Treatment and monitoring of disaster survivors requiring emergency medical care, including costs for:
  • Triage, medically necessary testing, and diagnosis.
  • First aid assessment and provision of first aid, including materials (bandages, etc.).
  • Prescription assistance limited up to a one-time 30-day supply for acute conditions and to replace maintenance prescriptions.
  • Durable medical equipment.
• Vaccinations for disaster survivors and emergency workers, including medical staff.

DAP 9523.15 Eligible Costs Related to Evacuations & Sheltering was also in effect at the time of the emergency.[2]  This policy, which identifies the expenses related to State and local emergency evacuation and sheltering activities that are eligible for reimbursement under the Category B, Emergency Protective Measures provisions of FEMA's PA Program, includes the following eligible costs:

• Supplies and Commodities such as food and water.
• Supplies, including X-rays, laboratory and pathology services, and machine diagnostic tests for the period of time that the evacuee/shelteree is housed in congregate sheltering.

In reviewing the first appeal decision and documentation, it is apparent that the DRM based the first appeal decision on DAP 9525.4 (1999), which listed medical treatment, including vaccinations, as ineligible costs and did not detail the eligibility of other items at issue in this appeal.  Application of the 1999 DAP 9525.4 was in error.  The 2008 DAP 9525.4 superseded the 1999 policy and should have been applied to this appeal as it was in effect at the time of the emergency, as was the 2007 DAP 9523.15.  Pursuant to the 2007 and 2008 policies, the overtime labor, material, and supply costs claimed by the Applicant in its second appeal are eligible costs.

The Applicant provided sufficient documentation to support the overtime labor costs claimed in both PWs 73 and 74, including force account labor records and descriptions of the work that employees performed during the disaster.  For PW 74, the Applicant included overtime costs incurred after the 30-day deadline for the emergency in its claim.  As such, only overtime costs through November 23, 2009, totaling $16,581.92, are eligible.  The eligible overtime labor cost for PW 73 is $6,970.14.  The Applicant also requested reimbursement for materials and supplies in PW 74 but did not provide sufficient documentation, such as purchase orders and invoices, to support the costs claimed. As such, FEMA approves the material and supply costs contingent upon the Applicant’s ability to provide the FEMA Region II with sufficient documentation to support its claim. 

Conclusion

Overtime labor costs and the material and supply costs are eligible costs in accordance with the FEMA policies in effect at the time of the emergency.  Thus, costs associated with providing emergency medical care at the EOCs and shelters are eligible.  Overtime labor costs in the amount of $6,970.14 for PW 73 and $16,581.92 for PW 74 are eligible.  The $206,105.11 in material and supply costs for PW 74 is eligible contingent upon the Applicant’s provision of adequate documentation to support the claimed costs to FEMA Region II.