Resources: What Healthcare Executives need to know about FEMA disaster recovery funding

Recent media coverage regarding a flood of law suits filed against healthcare organizations connected to the 2005 hurricanes, points to a need for healthcare executives to focus on yet another challenge, Disaster Readiness. The Joint Commission’s latest Emergency Management standards will also act as a stimulus for healthcare disaster readiness.

Most healthcare leaders and their emergency managers know that they must conduct a Hazard Vulnerability Assessment (HVA) to identify facility weaknesses that may increase the impacts a disaster may have on their ability to provide health care and services during a disaster.  I have seen far too many public and non-profit entities prepare for and endure large scale disasters, but not know how to begin the process of recovering the hundreds of thousands of dollars in disaster preparedness and recovery dollars for which healthcare organizations may be eligible. There are a number of administrative policies that FEMA has published which cover a full range of goods and services which may be covered for both preparing for and recovering from a disaster. Collectively, these policies are named the 9500 Series. This paper is intended as merely an introduction to help healthcare executives wrap their minds around FEMA’s policies regarding post-disaster recovery funding.  FEMA refers disaster recovery funding as Public Assistance or PA.

Who is documenting disaster recovery work?

Who is responsible for tracking overtime, emergency contract workers, medical and non-medical supplies before and after the disaster, Emergency Medical Services (EMS) run logs and vehicles that will be used for evacuation and safety during the disaster? These are just a few areas which require documentation. City Managers, Fire and Police Chiefs who have gone through this process will tell you that many organizational leaders had no idea how thorough FEMA would be regarding financial payroll policies, equipment usage logs, and overtime payments.  If you know the policies that guide the process, your agency will have a much higher likelihood of securing funding before your senior staff threatens to resign.

Are Key Staff Members Assigned?

Just as sure as healthcare leaders should write a Business Continuity Plan, they should also assign key staff who will be present during the disaster response and recovery stages.  Some of these individuals (many of whom work in the Finance Department) need to have a reason to care about the FEMA 9500 Series policies.  Time should be dedicated for training these employees on the process of disaster declarations and the required documentation to process grants for disaster recovery funds. 

What is required to optimize healthcare recovery awards?

Preparing for and responding to disasters and enduring the effects they have on physical, emotional and economic stability and even survival of a healthcare organization is staggering in and of itself.  Healthcare leaders may have to wait six months to a year for processing FEMA recovery documentation and the allocation of those funds.  Requirements for staffing, supplies, equipment and services must be built into each agency’s budget or covered by insurance. While restoring healthcare services takes priority, and no one’s job duties decrease, your organization will also be asked to provide a representative to meet with FEMA representatives on a number of key issues. Just a few of these include physical infrastructure and equipment damages, explaining and documenting your payroll and procurement policies, producing your expense receipts for emergency provisions, and explaining what you intend to do with the money that you are requesting.

What else must be considered?

If you have endured one or more disasters, and have been awarded recovery funds from FEMA, be mindful that policies change.  Many agencies amended their pay policies to reflect the eligibility standards of FEMA policies after Hurricane Rita (2005), only to find the policies were not the same for Hurricane Ike (2008). 

Another significant example is Disaster Assistance Policy 9525.4 - Emergency Medical Care and Medical Evacuations. Section VII D.2 states:Ineligible costs include equipment and labor costs incurred during standby times.”   This section of the policy has been debated and interpreted with multiple different findings and outcomes for funding from one disaster to the next.  At one point, there was data that indicated that standby time for ambulances and evacuation vehicles would be eligible.  The financial impact of this policy alone opens debate on many levels.  If an employer deems public service an essential function, and mandates that their employees stay on duty to assist with evacuation, they have to pay the employees for working.  Some would argue that Non-Profit healthcare organizations should be able to bill for all standby time rather than just the hours worked or miles driven during actual transportation of evacuees.  For complete details on FEMA’s grant awards policy on evacuating medical facilities, see: http://www.fema.gov/government/grant/pa/9525_4.shtm

Is there a return on investment (ROI) associated with Preparedness?

An elected official recently told me that they consider Preparedness a “hard-sell risky investment”.  Consider the millions of dollars that could have been the classified as “Return on Investment” had New Orleans invested in mobile hospitals, outpatient clinics and public health facilities.

The major issue is that sometimes we can’t afford not to be disaster-ready. Most importantly, healthcare leaders who take an active part in becoming “Disaster-Ready” will be in the best position to ensure their organizations save lives, continue healthcare operations and recovering all recovery grant dollars authorized under the Stafford Act as interpreted by FEMA. The FEMA 9500 Series Policies are located at: http://www.fema.gov/government/grant/pa/9500toc.shtm

About the author: Ms. Jodie Ryan is the Director for Community Readiness Integration with JVR Health Readiness Inc. She has recently returned from a year-long disaster recovery assignment as a FEMA Public Assistance contractor for Hurricane Ike.  She has extensive experience in all phases of emergency management, including planning, mitigation, response and recovery. She is a certified EMT, Fire/ICS Instructor, an Incident Safety Officer and Community Emergency Response Team Instructor focusing on NIMS compliance through the National Response Framework. She has over 1500 hours of training and response time.
 
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