What are the new eligibility rules of FEMA’s reimbursement for medical care expenses (Medical Care Eligible for Public Assistance, March 22, 2021)?

The Federal Emergency Management Agency (“FEMA”) issued a new version of the COVID-19 Interim Medical Care Policy, Coronavirus (COVID-19) Pandemic: Medical Care Eligible for Public Assistance (Interim) (Version 2) FEMA Policy #104-21-0004, on March 16, 2021.[1] This update supersedes the previous version of this policy, which was issued on May 9, 2020. General eligibility remains the same, as the policy applies to the COVID-19 pandemic incident periods beginning January 20, 2020. Eligible Public Assistance (“PA”) applicants include state, local, tribal, and territorial government entities and private non-profit organizations that own or operate medical facilities. The following are some of the noteworthy changes and considerations in the policy:

• The revised policy includes the update of the federal cost-share to 100 percent for eligible COVID-19 emergency protective measures, consistent with the President’s January 21, 2021, Memorandum to Extend Federal Support to Governors’ Use of the National Guard to Respond to COVID-19 and to Increase Reimbursement and Other Assistance Provided to States.[2]
• The revised policy includes a detailed list of eligible vaccination scope; policy Section C.3 provides a list of scope items. The vaccination scope list included elaborates on FEMA’s earlier vaccination scope list in its November 19, 2020, Vaccination Planning FAQ. Newly identified scope items include but are not limited to resources to support mobile COVID-19 vaccination in remote areas and/or transportation support for individuals with limited mobility or lack of access to transportation, Federally Qualified Health Center vaccine-related costs, information technology costs “when reasonable and necessary,” and training related to COVID-19 vaccinations.
• The revised policy includes a focus on equity, consistent with the President’s January 21, 2021, Executive Order on Ensuring an Equitable Pandemic Response and Recovery[3]; refer to policy Section B.3. The policy states that applicants “must focus the use of FEMA funding on the highest-risk communities and underserved populations as determined by established measures of social and economic disadvantage (e.g., the CDC Social Vulnerability Index). Failure to adhere to this policy could result in funding reductions and/or delays.”[4] 
• In relation to equitable response, the revised policy includes requirements for vaccination sites to collect data on race, ethnicity, disability status, and other person-level information. The policy also includes requirements to demonstrate equitability in vaccination site locations and processes, which must be reported to FEMA every 30 days following project obligation. Refer to Section C.3.k for detailed reporting requirements. One step municipalities can take is to prioritize the review of these documentation requirements and move quickly to establish and initiate processes for collecting data, if not already in place.[5]
• The revised policy includes new language regarding expectations for applicants in medical care billing practices and fee collection. The revised policy notes that it will not require applicants to create a new billing process at certain temporary medical facilities; however, the policy also states that all work conducted and costs incurred in Primary Medical Care Facilities should follow a facility’s standard billing practice. Suppose a Primary Medical Care Facility did not follow its standard billing practice; in that case, the applicant must demonstrate why following such practices would have contributed to an immediate threat to life and demonstrate that all costs not reimbursed by FEMA followed the same procedures. Refer to Section D.1.c for further language. As one method to protect municipalities in case of a future audit, municipalities should consider taking the time now to prepare and retain robust documentation and justification of billing procedures taken. [6]
• The revised policy incorporates language regarding procurement requirements for COVID-19 declarations; refer to Section D.3. The language is consistent with FEMA’s previously released March 17, 2020, Procurement Under Grants Conducted Under Exigent or Emergency Circumstances for COVID-19 Memorandum and subsequent Fact Sheet.[7]

In addition, FEMA published the Coronavirus (COVID-19) Pandemic: Safe Opening and Operation Work Eligible for Public Assistance (Interim) FEMA Policy 104-21-0003, Version 2 on September 9, 2021.[8] It retroactively extended the period of work eligibility to the beginning of the incident period. It also specified that work conducted from the beginning of the incident period through December 31, 2021, will be reimbursed at a federal cost share of 100 percent. Work conducted after December 31, 2021, will be reimbursed at the federal cost-share established at that time, which continues to be 100 percent through July 1, 2022.[9] The Safe Opening and Operation work available to eligible PA applicants includes the following:

• Purchase and distribution of face masks, including cloth face coverings and personal protective equipment (PPE).
• Cleaning and disinfection, including the purchase and provision of necessary supplies and equipment in excess of the applicant’s regularly budgeted costs.
• COVID-19 diagnostic testing.
• Screening and temperature scanning, including, but not limited to, the purchase and distribution of hand-held temperature measuring devices or temperature screening equipment.
• Acquisition and installation of temporary physical barriers, such as plexiglass barriers and screens/dividers, and signage to support social distancing, such as floor decals.
• Purchase and storage of PPE and other supplies listed here should be based on projected needs for the safe opening and operation of the facility.[10]

Last Revised: March 31, 2022