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Medical Cost for Evacuees
Appeal Brief
| Disaster | FEMA-3223-EM |
| Applicant | Utah Department of Human Services |
| Appeal Type | Second |
| PA ID# | 000-UE3RB-00 |
| PW ID# | 13 |
| Date Signed | 2006-09-22T04:00:00 |
Citation:
FEMA-3223-EM-UT; Utah Department of Human Services
Cross-reference:
Medical Costs; Sheltering
Summary:
The State of Utah Department of Human Services (Applicant) sheltered evacuees from Hurricane Katrina and Rita from September 4 through September 28, 2005, at Camp William. The Applicant provided medical treatment for the evacuees while they stayed at the mass shelter. Five of the evacuees were determined to need hospital care. Two of the evacuees were admitted to the Utah State Hospital and three were admitted to the State Development Center. The five patients continued to receive hospital care beyond the mass sheltering efforts of September 28, 2005. Project Worksheet (PW) #13 was written to reimburse the Applicant for the sheltering and the medical costs incurred while the mass shelter was operating. The hospital cost beyond September 28, 2005, for the five hospitalized evacuees, was deducted from the PW. The Applicant’s first appeal, submitted February 27, 2006, argues that the guidance it received from the Region VIII tracking report dated September 10, 2005, was that short term hospitalization was a reimbursable expense. FEMA Region VIII denied this appeal stating that guidance issued on September 9, 2005, clarified medical treatment, including hospitalization costs, was limited to the time the mass shelter was in operation. The Applicant submitted its second appeal May 2, 2006, contending the guidance was not issued in a timely manner and, therefore, the costs should be eligible.
Issues:
Are evacuee hospitalization costs eligible beyond the time a mass shelter is in operation?
Findings:
No.
Rationale:
Disaster Specific Guidance #2 – Hurricane Katrina, Eligible Cost for Emergency Sheltering Declarations, September 9, 2005
Hurricane Katrina, Fact Sheet, Frequently Asked Questions, Section 403 Sheltering
Appeal Letter
September 22, 2006
Mr. Verdi White II, Director
Department of Public Safety
1110 State Office Building
Post Office Box 141710
Salt Lake City, UT 84114-1710
Re: Second Appeal–Utah Department of Human Services, PA ID#000-UE3RB-00, Medical Cost for Evacuees, FEMA-3223-EM-UT, Project Worksheet #13
Dear Mr. White:
This is in response to a letter from your office dated April 4, 2005, transmitting the referenced second appeal on behalf of the State of Utah Department of Human Services (Applicant). The Applicant is appealing the Federal Emergency Management Agency’s (FEMA’s) denial of $20,744 in evacuees’ hospitalization cost beyond the operation of the mass sheltering operation.
The Applicant operated a mass shelter, Camp Williams, for Hurricane Katrina and Rita evacuees from September 4 through September 28, 2005. The Applicant determined five of the evacuees required hospital care. The hospital stays extended beyond the date the mass shelter was open. Project Worksheet (PW) #13 was originally written for $70,975.63 to reimburse the Applicant for medical care of evacuees at Camp Williams. The PW was reduced to only reimburse the Applicant for the hospital costs during the mass shelter operation. The obligated PW total was $50,231.35.
The Applicant’s first appeal, submitted on February 13, 2006, provided its reasons for hospitalizing the five evacuees and summarized the hospital costs for each evacuee. The Applicant also referenced the guidance it was given with respect to reimbursable medical and hospital costs; and asserted that the “short term” language used in the guidance was arbitrary. FEMA’s Regional Director denied the first appeal on February 27, 2006, based on the Disaster Specific Guidance #2 (DSG #2) – Hurricane Katrina, Eligible Costs for Emergency Sheltering Declaration, issued on September 9, 2005. The Regional Director cited a number of provisions in DSG #2, which explain that only medical costs at the mass shelters and, if necessary, the costs related to transporting an evacuee to a hospital, diagnosis, testing, and stabilization of that evacuee are eligible. The Regional Director further supported his denial by referencing Hurricane Katrina Fact Sheet, Frequently Asked Questions, Section 403 Sheltering (FAQs) questions 16 and 18, which clarify that eligible costs are limited to emergency medical care while an evacuee is in a mass shelter.
The Applicant’s second appeal dated April 4, 2006, contends that the FAQs were not issued until September 29, 2005, a day after its mass shelter was closed. The Applicant argues that the FAQs were the first guidance issued stating that emergency medical treatment was limited to the mass sheltering operations.
DSG #2 was issued September 9, 2005, during the Applicant’s mass sheltering operations. The guidance of “the costs associated with the transportation, diagnosis, testing, and stabilization of that evacuee is eligible,” explains that FEMA will provide funding for the costs of getting an evacuee into a medical facility and under a doctor’s care. Once the evacuee is within a hospital and doctor’s custody, the medical care costs are no longer eligible expenses.
In accordance with DSG #2, I have determined the $20,744 is not eligible for reimbursement. Therefore, I am denying this appeal.
We note that the applicant has also not indicated whether it availed itself of the relief provided by the Secretary of Health and Human Services to waive or modify certain Medicare, Medicaid, or State Children’s Health Insurance Program requirements pursuant to the Social Security Act Section 1135 waiver granted to Utah in the late summer or fall of 2005.
Please inform the Applicant of my decision. My determination constitutes the final decision on this matter as set forth in 44 CFR § 206.206.
Sincerely,
/ s /
John R. D’Araujo, Jr.Director of Recovery
cc: Robert L. Flowers
Regional Director
FEMA Region VIII