Evacuation, Medical Care and Sheltering, Legal Responsibility

Appeal Brief Appeal Letter Appeal Analysis

Appeal Brief

Disaster	4464
Applicant	South Carolina Department of Health and Environmental Control
Appeal Type	Second
PA ID#	000-UXXQQ-00
PW ID#	PW 131/ GMP 120503
Date Signed	2023-04-05T16:00:00

Summary Paragraph

During August 31 – September 6, 2019, Hurricane Dorian caused damage in South Carolina. The South Carolina Department of Health and Environmental Control (Applicant) requested $124,958.53 in Public Assistance (PA) for staff travel, shelters, ambulatory services, meals, and commodities/supplies costs. In a Determination Memorandum, FEMA denied the total claimed cost, stating it could not validate that the costs were incurred in the performance of eligible work. The Applicant appealed for the amount of $117,312.89 and stated that it had properly documented costs incurred during Hurricane Dorian for evacuations, EOC meals, staff travel expenses, the purchase of cots, a ramp, oxygen, and television service. The Recipient supported the appeal. The Applicant’s second appeal requests $80,558.79. The Applicant provides its travel policy, meal invoices, oxygen receipts, merchandise receipts, shelter receipts and other documentation in support of the incident costs. The Applicant states it did not have a policy in place to feed shelter workers or employees during a disaster. The Recipient supports the appeal and recommends FEMA approval.

Authorities and Second Appeals

• Stafford § 403(a)(3).
• 44 C.F.R. § 206.225(a)(1).
• PAPPG, at 28, 62, 63, 64, 66, 67, 68, 133.

Headnotes

• • To be eligible for reimbursement, emergency protective measures costs must be directly tied to the performance of eligible work and adequately documented.

• • In this case, the Applicant did not provide detailed documentation to support that the employee-performed work was emergency work.

• • FEMA requires applicants to take reasonable steps to provide documentation on a patient-by-patient basis verifying that insurance coverage or any other source of funding has been pursued and does not exist for the costs associated with emergency medical care and emergency medical evacuations.
• Here, the Applicant did not take reasonable efforts to verify that other sources of funding, including private insurance, Medicaid, or Medicare, were pursued and did not exist for the costs associated with emergency medical care and emergency medical evacuations.

Conclusion

The Applicant has not demonstrated that certain costs were directly tied to eligible emergency work, except in the amount of $1,332.00 for previously approved patient meal costs, which are ineligible because the costs are below the minimum threshold amount of $3,200.00 for 2019. In addition, the Applicant did not take reasonable efforts to verify that other sources of funding, including private insurance, Medicaid, or Medicare, have been pursued and do not exist for the costs associated with emergency medical care and emergency medical evacuations. Therefore, this appeal is denied.

Appeal Letter

Appeal Analysis

Background

From August 31 through September 6, 2019, South Carolina experienced severe storms and flooding from Hurricane Dorian.[1] Under the authority of South Carolina’s Emergency Operations Plans (specifically part Annex 8), the South Carolina Department of Health and Environmental Control (Applicant) supported mandatory evacuation operations and medical transport during the disaster. The Applicant requested Public Assistance (PA) reimbursement for $124,958.53 in expenses it stated were associated with various emergency protective measures, including: supplies and commodities and meals for its shelters and Emergency Operations Center (EOC),[2] travel expenses (vehicle mileage for staff commuting to and from the EOC and shelters), ambulatory services to relocate 66 patients from evacuated nursing homes to shelters, the purchase of oxygen for the shelter, and a ramp to help transport a generator to a residence. FEMA created Grants Manager Project 120503/Project Worksheet 131 to address the Applicant’s request.

In a Determination Memorandum signed on December 9, 2022, FEMA denied the total project cost of $124,958.53. FEMA found that the Applicant did not demonstrate that the supplies and commodities, EOC meals, and staff travel expenses were related to the performance of eligible emergency protective measures in response to the incident. Additionally, FEMA found that the Applicant did not demonstrate that PA reimbursement for ambulatory services would not be a duplication of benefits. Finally, FEMA stated that $1,332.00 in meals provided to shelter evacuees may be eligible, but since this amount was below the minimum project threshold ($3,200.00), the total project cost was denied.

First Appeal

The Applicant appealed for $117,312.89[3] and stated that it had properly documented costs for supplies and commodities, staff travel expenses, ambulatory services to evacuate/relocate patients, oxygen, and the ramp for transporting a generator. Regarding meals for EOC staff, the Applicant stated that it provided meals for its staff at the EOC because conditions constituted a level of severity that required employees to work abnormal, extended work hours without a reasonable amount of time to provide their own meals or leave the facility to obtain them. Additionally, the Applicant explained that the television service it purchased for its EOC was the cheapest and fastest way to get the Weather Channel. The Applicant also stated it was claiming staff travel expenses for nurses who live more than 50 miles from the shelters at which they were working, consistent with its travel policy in place at the time of the disaster.

Regarding ambulatory evacuations, the Applicant relied on Annex 8’s authority to support the Applicant’s relocation of nursing home patients to a shelter. In response to FEMA’s concern about whether the Applicant collected patient insurance information ensure that services were not covered by another source, the Applicant provided proof of its payment for ambulatory services to demonstrate it does not use insurance for them. It also noted it purchased a ramp for an infant patient on a ventilator who needed to shelter in place, after the Applicant exhausted all options to transport the patient. The ramp was necessary to load an urgently needed 800-pound generator to the infant’s residence to ensure continued operation of the ventilator. The South Carolina Emergency Management Division (Recipient) supported the appeal and recommended FEMA approval.

The FEMA Region 4 Regional Administrator denied the appeal. FEMA determined the Applicant did not demonstrate its employees performed eligible work required as a direct result of the disaster. FEMA also found the Applicant did not demonstrate it had the legal responsibility for its EOC and shelters, associated supply and commodity costs, or for assisting an individual patient with the purchase of a ramp. Further, FEMA found that the Applicant did not demonstrate that it was required to provide meals at its EOC based on its labor policy, or that meals were not readily available. FEMA also determined that the Applicant did not tie travel expenses to eligible emergency work. Finally, FEMA found that the Applicant did not demonstrate that PA reimbursement for ambulatory services would not be a duplication of benefits.

Second Appeal

The Applicant submits a second appeal in the amount of $80,558.79.[4] The Applicant states that it was legally responsible for its EOC and shelters as outlined by Annex 8 in the South Carolina Emergency Operations Plan.[5] In support of the meals purchased for its EOC staff, the Applicant stated that it provided a summary of each meal claimed and the logged hours of personnel. The Applicant also states its travel policy requires the Applicant to reimburse travel expenses for employees’ mileage to the EOC and shelters. Regarding the ambulatory services, the Applicant submitted its emergency operations plan, which it claims makes it responsible to provide patient transportation assistance. The Applicant explains that its emergency operations plan did not require it to collect insurance information. The Applicant states its operation plan required it to provide a ramp to transport a generator for an infant on a ventilator and who could not be moved and had to shelter in place. The Recipient supports the appeal and recommends FEMA approval.

 

Discussion

Legal Responsibility

To be eligible for financial assistance, an item of work must be the legal responsibility of an eligible applicant.[6] Emergency services are usually the responsibility of State, Territorial, Tribal, or local governments.[7] To determine legal responsibility for emergency work, including evacuation, sheltering, and EOC-related costs, FEMA evaluates whether the Applicant requesting the assistance either had jurisdiction over the area or the legal authority to conduct the work related to the request at the time of the incident.[8]

The Applicant submitted Annex 8 (stating its purpose is to organize the capability to provide medical care, public health, behavioral health, fatality management, medical transport, and healthcare facility evacuation in disaster situations) to show it was legally responsible for the emergency work related to sheltering and EOC. Though it is dated post-disaster, the agreement and other documentation reviewed show that the Applicant is not a separate entity from the State of South Carolina, but rather is a component or agency under the State.^[9] Based on the documentation provided and the relationship between the Applicant and the State of South Carolina, the Applicant has demonstrated it had legal authority to establish an EOC and shelters, conduct evacuations, and incur emergency-related costs during the disaster.

Financial Accounting & Reconciliation, Evacuation, Medical Care, and Sheltering

FEMA may provide assistance for emergency protective measures implemented to save lives and reduce immediate threats to public health and safety, such as sheltering and EOC-related costs.^[10] Eligible emergency protective measures and costs include the provision of meals for employees and volunteers engaged in eligible emergency work under limited circumstances, and EOC sand shelter supplies and commodities, including basic cable service.[11]  FEMA also provides funding for medical care, including ambulatory services, oxygen, and other medical equipment, but only for costs not covered by private insurance, Medicare, Medicaid, or a pre-existing private payment agreement.^[12] FEMA requires the applicant to take reasonable steps to provide documentation on a patient-by-patient basis verifying that insurance coverage or any other source of funding has been pursued and does not exist for the costs associated with emergency medical care and emergency medical evacuations.^[13] To be eligible, all costs must be directly tied to the performance of eligible work and adequately documented.[14] If an applicant does not provide sufficient documentation to support its claim as eligible, FEMA cannot provide PA reimbursement for the work.[15]

The Applicant’s documentation does not provide enough detail to show that its employees were engaged in eligible emergency work at the EOC. The Applicant submitted a spreadsheet that noted the staff hours worked, however, the spreadsheet did not include a description of the work being conducted by each staff member.^[16] Therefore, the Applicant has not demonstrated that costs of staff meals and other EOC-related costs (including television services) are directly tied to the performance of eligible emergency work. Similarly, the documentation submitted by the Applicant did not provide a detailed description of the emergency work conducted that is associated with the travel expenses claimed including expenses for its employees’ personal car mileage, as well as meal costs and lodging for employees when they were more than a certain distance their assigned location and residence. Therefore, the travel expenses are also ineligible for PA.

The Applicant provides invoices showing it paid contractors for the costs of the ambulatory services and oxygen, as well as a receipt for the purchase of a ramp, however, the Applicant advises that it did not request payment from the individual insurance companies. Therefore, the Applicant did not take reasonable efforts to verify that other sources of funding, including private insurance, Medicaid, or Medicare, were pursued and did not exist for the costs associated with emergency medical care and emergency medical evacuations. Accordingly, the costs for ambulatory services, oxygen, and a ramp, are ineligible for PA.[17]

 

Conclusion

The Applicant has not demonstrated that certain costs were directly tied to eligible emergency work, except in the amount of $1,332.00 for previously approved patient meal costs, which are ineligible because the costs are below the minimum threshold amount of $3,200.00 for 2019. In addition, the Applicant did not take reasonable efforts to verify that other sources of funding, including private insurance, Medicaid, or Medicare, have been pursued and do not exist for the costs associated with emergency medical care and emergency medical evacuations. Therefore, this appeal is denied.

 

[1] The President issued a major disaster declaration on September 30, 2019.

[2] These supplies and commodities, which the Applicant categorized as materials, included cots, oxygen, miscellaneous supplies, and a television service.

[3] The Applicant did not provide an explanation for appealing less than the total amount denied. On first appeal, the Applicant requested the following costs: $5,170.36 for meals; $16,656.41 for travel; $77,902.00 for ambulatory services; $56.00 for a television service; $16,895.00 for cots; and $633.12 for a ramp.

[4] The Applicant did not appeal FEMA’s denial for the cost of cots ($16,895.00) and did not clarify why the second appeal amount was decreased. The Applicant acknowledges that the purchase of cots for the shelter was not an eligible cost.

[5] See ANNEX 8 ESF-8- Health and Medical Services - April 2020. The Applicant states Annex 8 provides the Applicant authority to conduct emergency response activities, including coordinating activation and deployment of emergency medical services, medical needs shelters, and maintaining its emergency operations center.

[6] Title 44 Code of Federal Regulations (44 C.F.R.) § 206.223(a)(3) (2018).

[7] Public Assistance Program and Policy Guide, FP 104-009-2, at 60 (Apr. 2018) [hereinafter PAPPG].

[8] PAPPG, at 20, 58.

[9] South Carolina Emergency Management Division: https://www.scemd.org/em-professionals/plans/emergency-operations-plan/ (last visited April 3, 2023); South Carolina Emergency Operations Plan, Annex 8, at 8-1.

[10] Robert T. Stafford Disaster Relief and Emergency Assistance (Stafford) Act § 403(a)(3), Title 42, United States Code (U.S.C.) § 5170b(a)(3) (2018); 44 C.F.R. § 206.225(a)(1), (a)(3)(i); PAPPG, at 19, 57-58.

[11] PAPPG, at 28, 62-63, 67-68.

[12] Stafford Act § 312, 42 U.S.C. § 5155; PAPPG, at 64, 66.

[13] PAPPG, at 64.

[14] Title 2 Code of Federal Regulations § 200.403(g) (2019); PAPPG, at 21.

[15] PAPPG, at 133.

[16] PCAS Reports - Staff Receiving Meals During Dorian; Meals Recipients – Hours (Jun. 14, 2022).

[17] The Applicant also requests the cost of meals for a patient in isolation during treatment in non-congregate sheltering. While these costs were previously found eligible, the amount of $1,332.00 is beneath the FEMA minimum threshold of $3,200.00 and is therefore, ineligible.