Immediate Threat

Appeal Brief

Summary Paragraph

The coronavirus (COVID-19) pandemic resulted in a major disaster declaration for the state of Mississippi on April 5, 2020, with an incident period of January 20, 2020, to May 11, 2023. Lawrence County (Applicant) operates a correctional facility and requested PA funding for healthcare costs for an inmate’s COVID-19 medical care at an off-site hospital and force account labor (FAL) overtime (OT) costs for a guard to monitor the inmate at the hospital. FEMA prepared Grants Manager Project 332844, documenting claimed costs of $35,115.68, incurred from January 1 through January 22, 2021. FEMA issued a Determination Memo on January 5, 2022, denying the entire project, finding the Applicant did not demonstrate that the medical care bills were not covered by the Applicant’s insurance policy and therefore FEMA funding would constitute a potential duplication of benefits. FEMA found the remaining $1,186.82, the cost of guarding the prisoner, ineligible as it fell below the minimum project threshold. The Applicant appealed, stating it ensured there was no duplication of benefits, and it is legally responsible for the inmate’s medical care costs which are eligible under FEMA’s Medical Care Policy. The Mississippi Emergency Management Agency (Recipient) supports the appeal. FEMA’s Regional Administrator denied the appeal finding no duplication of benefits, but that the medical care costs are not eligible under the Medical Care Policy because the Applicant did not provide the medical care through its own facility and it does not enable FEMA to fund medical care through a facility not operated by the Applicant, and that the costs are increased operating costs because the Applicant is responsible for providing medical care to incarcerated individuals regardless of a pandemic. FEMA found the remaining $1,186.82 FAL costs ineligible because the amount falls below the minimum project threshold of $3,330.00. The Applicant submitted a second appeal, arguing that a local government only needs to be legally responsible for the medical care under the Medical Care Policy. 

Authorities

• Stafford Act §403(a)(3).
• 2 CFR § 200.403(g); 44 CFR §§ 206.223(a)(1), 206.225(a)(3)(i), 
• PAPPG, at 19. 
• COVID-19 Medical Care Policy, at 2-4.
• Franciscan Alliance, Inc., FEMA-4489-DR-IL, at 2 (Aug. 30, 2023).

Headnotes

• The FEMA Medical Care Policy allows for funding of eligible medical care activities and associated costs in primary medical care facilities. 
  • While the Applicant requests FEMA treat this instance similar to a contractor providing services after a disaster, it has not contracted with a medical provider to carry out eligible work as, again, the Applicant did not perform eligible work in an eligible facility under this policy.

Conclusion

The Applicant has not demonstrated that claimed medical care and FAL OT costs are eligible emergency protective measures in response to COVID-19. Therefore, this appeal is denied.

Appeal Letter

Appeal Analysis

Background

The coronavirus (COVID-19) pandemic resulted in a major disaster declaration for the state of Mississippi on April 5, 2020, with an incident period of January 20, 2020, to May 11, 2023. Lawrence County (Applicant) operates a correctional facility and requested PA funding for healthcare costs for an inmate’s COVID-19 medical care at an off-site hospital and force account labor (FAL) overtime (OT) costs for a guard to monitor the inmate at the hospital. FEMA prepared Grants Manager Project 332844, documenting claimed costs of $35,115.68, incurred from January 1 through January 22, 2021. 

FEMA issued a Determination Memorandum on January 5, 2022, denying all costs. FEMA found that the Applicant did not demonstrate that the medical care bills were not covered by the Applicant’s insurance policy and therefore FEMA funding would constitute a potential duplication of benefits. FEMA found the remaining $1,186.82 claimed for FAL OT was ineligible as it fell below the minimum project threshold. 

First Appeal 

The Applicant filed a first appeal in a letter dated February 25, 2022. The Applicant stated there was no duplication of benefits, and that it was legally responsible for paying the inmate’s medical care costs. The Applicant cited to FEMA Policy 104-21-0004, Coronavirus (COVID-19) Pandemic: Medical Care Eligible for Public Assistance (Interim) (Version 2) (Medical Care Policy).[1] In a letter dated March 17, 2022, the Mississippi Emergency Management Agency (Recipient) forwarded the appeal in support of the Applicant’s position.

In a letter dated July 24, 2023, the FEMA Region 4 Regional Administrator denied the Applicant’s appeal, finding that although there was no duplication of benefits, the medical care costs were not eligible under the Medical Care Policy as they were incurred by the Applicant through a facility it did not operate. FEMA also found that the medical costs were ineligible increased operating costs because the Applicant was responsible for providing medical care to incarcerated individuals. FEMA found that the FAL amount of $1,186.82 was ineligible because it fell below the minimum project threshold of $3,330.00.

Second Appeal

The Applicant filed a second appeal in a letter dated September 21, 2023, appealing a total of $34,433.58.[2] The Applicant argues that the Medical Care Policy only requires that an applicant be an eligible local government and not a primary medical care provider for primary medical care costs to be eligible. The Applicant argues FEMA should view the use of an outside medical provider similar to a contractor providing services. The Recipient forwarded the second appeal in a letter dated October 26, 2023, in support of the Applicant’s position.

Discussion

FEMA may provide funding for emergency protective measures to save lives and protect public health and safety.[3] For emergency protective measures to be eligible, the Applicant is responsible for showing the work is required due to an immediate threat resulting from the declared incident.[4] In response to COVID-19, eligible medical care activities and associated costs in primary medical care facilities include emergency and inpatient clinical care for COVID-19 patients and certain labor costs associated with medical staff providing treatment to COVID-19 patients.[5] A primary medical care facility is a facility owned or operated by an eligible applicant that provides medical care services such as a licensed hospital, outpatient facility, rehabilitation facility, or facility for long-term care.[6] State, local, tribal, and territorial governments may contract with medical providers, including private entities, to carry out any eligible activity as described in the Medical Care Policy.[7] To be eligible, costs must be directly tied to the performance of eligible work.[8]

Here, the Applicant requests reimbursement of COVID-19 medical care costs for an inmate it transferred from its correctional facility to an off-site hospital to receive treatment. The Applicant itself did not operate the medical care facility that provided the inmate’s medical treatment, nor did the Applicant otherwise provide eligible medical care in an eligible facility in accordance with FEMA’s Medical Care Policy. While the Applicant requests FEMA treat this instance similar to a contractor providing services after a disaster, it has not contracted with a medical provider to carry out eligible work as, again, the Applicant did not perform eligible work in an eligible facility under this policy.[9] The cost of guarding the inmate is likewise not eligible as it is neither associated with medical staff providing treatment to COVID-19 patients nor directly tied to the performance of eligible work. Therefore, the claimed medical care and FAL OT costs are not eligible under the Medical Care Policy.

Conclusion

The Applicant has not demonstrated that claimed medical care and FAL OT costs are eligible emergency protective measures in response to COVID-19. Therefore, this appeal is denied.