Leveraging federal dollars for COVID-19 response

Mar 31, 2020
How state and local governments can take advantage of public assistance funding from FEMA and HHS

COVID-19 is an unprecedented public health emergency that has placed tremendous stress on the United States. As the crisis unfolds, with new information coming out daily, many state and local governments are left wondering what to do. What costs will the federal government cover, and how should you manage your emergency response efforts to make sure you get the funding you desperately need? These are urgent questions and there’s not a second to waste.

Unlike a hurricane or a tornado, the coronavirus has new implications for how federal funding is managed and how reimbursement is tracked. The Robert T. Stafford Disaster Relief and Emergency Assistance Act under the Public Assistance program has a number of eligible activities—some of which are not relevant to COVID-19, and others that are. State and local governments and private nonprofits determined to be eligible can take advantage of the program’s current flexibility to get reimbursed for a wide range of activities.

In this podcast, hear from three of ICF’s emergency management experts as they break down the federal funding options available to state and local governments and eligible private nonprofits for COVID-19 response. Moderated by Marko Bourne, former director of policy at FEMA, the conversation focuses on:

  • Types of costs that emergency management and hospital officials should be tracking that are potentially eligible for funding.
  • The most common challenges state and local governments face when tracking FEMA’s Public Assistance program (Category B) costs.
  • Potential funding opportunities from HHS to assist the public health and healthcare system in their response. 

Full transcript below:

Marko: Hello, and welcome to a podcast from ICF’s disaster management and public health experts about COVID-19 and what's happening to the emergency management and medical community, and how to address the challenges that are facing them when it comes to a number of issues – first of all, public assistance that is available from the Federal Emergency Management Agency, under the Stafford Disaster Relief Act. We'll also discuss a little bit about the public health community, and the hospitals, and the HHS programs that are being put in place now to support them.

There will be a series of podcasts, ranging on a number of different subjects beyond public assistance from FEMA, to include: more public health information and HHS activities, individual assistance under a major disaster declaration that many states have received already, mitigation opportunities that are made available by the funding of the federal government through the Robert T. Stafford Disaster Relief Act, as well as continuity of operations, both for government and business. So this series of podcasts, which we are pulling together over the next several days and weeks, hopefully will prepare both federal, state, and local clients of ICF, those that are interested in these subjects, and the public, in some ways, to get a better understanding of what your emergency management officials and public health officials are doing to address these challenges – and to make sure that they're maximizing the available federal dollars that are coming to them in order to support both the COVID-19 response, the recovery, and long-term mitigation against future outbreaks.

COVID-19 has certainly placed a tremendous stress on the United States, the public health community, and a new stress on emergency management officials who traditionally may be used to things like hurricanes, tornadoes, and earthquakes, as well as terrorism events. But in this case, we're looking at a public health emergency, which has relatively broader but also new implications to how the funding is managed, how reimbursement is tracked. And we wanted to give you an opportunity to understand a little bit more in depth about what some of those challenges are, how state and local government should be tracking costs, how they should understand what's eligible and what's not eligible in a program that is evolving.

The Robert T. Stafford Disaster Relief Act, under the public assistance programs specifically, has a number of eligible activities, some of which are not going to be relevant to COVID-19, others which are very relevant. And one of the things that is important to understand is how flexible state and local governments can be, and how the program is being flexed to account for costs that may not have ever been paid for under these programs in the past, but are still eligible activities. As we learn more, we'll share more with you. I have two experts with me today who have spent many, many years in emergency management. I have 35 years in emergency management at the local, state, and federal level, including being the former director of policy at FEMA and a deputy director. And I have also with me, Martin Altman. Marty is a 40-year emergency manager who has worked at all levels of government and the private sector. He has been involved with countless disasters in his career and is a public assistance expert.

And I also have with me Meghan Treber. Meghan was a former paramedic, public health official, both at the state level and local level, and has been involved in emergency management preparedness also for many years. And I'll spend some time, as I introduce them, giving you a little bit more about their background. But first, we'd like to start about what's happening in the public health community, the hospitals, and what HHS is thinking about right now, and pre-staging a little bit what we think will be coming down the road with Meghan. Meghan Treber, as I said, is a long-time public health official, paramedic, emergency official, and has been involved for many years with both the Commonwealth of Pennsylvania, the Department of Health and Human Services, and leads our public health and national resilience activities here at ICF. Meghan, welcome. And if you could, give us a little bit about what you're seeing from the work that we're doing to support HHS, but more importantly, what you're seeing around the medical and public health community with regards to COVID-19, and how this funding from the federal government is looking like it's going to start to shake out.

Regulatory relief for hospitals and health care entities across the country

Meghan: Absolutely. Thanks Marco. So this is a virus and a disease that we haven't had a lot of time with. The novel coronavirus was first identified in Wuhan, China in the November/December time frame, in late 2019. First case was confirmed in the United States on January 21st. The World Health Organization declared SARS CoV-2, the virus that causes COVID-19 disease, on March 11th. So that's not a lot of time, even though it feels like it's been the longest year we've experienced this last three months. The Secretary of the Department of Health and Human Services declared the novel coronavirus a public health emergency on January 31st. And the president made dual National Emergency Act and Stafford Act declarations on March 13th. These HHS and presidential declarations provide certain regulatory relief for hospitals and health care entities across the country, which was absolutely necessary, and makes funding available to states from the Disaster Relief Fund.

In addition to those funds, separate supplemental funding provided to HHS by Congress is also being made available through funding opportunities from the CDC and from the Assistant Secretary for Preparedness and Response, or ASPR, through their existing public health emergency preparedness and hospital preparedness program cooperative agreements. Final funding opportunity announcements are still being developed. And state health departments and state emergency management agencies will need to work together closely to review applications for the use of public assistance funding to ensure there's no duplication of coverage between all available funding sources. At this point, applications for funding and requests for federal assistance in this disaster are being handled exactly as they would be for any other disaster or emergency where FEMA has activated the national response framework and those associated coordinating structures.

So, requests from health care facilities should be routed through their local emergency management agencies, through those health and medical or emergency support function aid desks, and then up to the state emergency management agency. Federal officials and clinicians across the country are still working to develop pandemic surge strategies to meet the needs of communities that are facing potential waves of patients. Just for some perspective, as of this morning, there are 142,037 cases of COVID-19 in the United States, with 2,415 deaths. So, we have a lot of work ahead of us.

Marko: Thanks Meghan, appreciate it. One of the things that's important, especially for our viewers and listeners, is to understand that all of the information that we're presenting today and in future podcasts will be available on ICF's website at www.icf.com, and we will have a number of materials that will be available for you to view, and also, additional podcast information as it develops. There'll also be links to some of our federal partners that are putting out information on a regular basis. Meghan, one of the questions that I think a lot of...both emergency management officials as well as hospital officials are going to have are, what are some of the things that they should be thinking about in terms of what kind of costs should they be tracking, from a hospital perspective and a medical perspective, that are potentially eligible for the public assistance program, but more importantly all of the funding that's available?

Costs emergency management officials and hospital officials should track

Meghan: Right. So I think the very first step is to track all of your costs, and then figure out later what can get reimbursed by where. But tracking all of your costs over time: staffing, equipment purchases, supply purchases, everything that you are spending needs to be tracked. And so the most...I think the most effective way is for state emergency management agencies to communicate early, now, with health care facilities, clearly about how you want them to track their costs, what process you'd like them to use, if there's any specific paper work or processes because this process is new to many of these health care facilities. Every state has a, it depends on the state how they're named, but every state has a hospital or a health system association, and they have a State Health Department. Use those entities to help reach out to your hospitals now, as tracking early and properly will save everybody time and frustration later on.

Also, the hospital associations and the state health departments are cooperative agreement recipients from HHS. So coordinating now, and coordinating early, with these entities can ensure there's no supplantation or overlap of funding requests and unmet needs requests. And there's also the added benefit that if you coordinate now on funding, it can also help you coordinate better on those unmet needs requirements and requests that are going to come through the exact same process. Hospital incident command systems are structured very similarly to traditional ICS systems, so they have administrative and financial units there to track. And they're set up to track these.

Using funding to deliver critical supplies and set up alternate sites

Marko: As you look at what hospitals are doing, but more importantly even, the broader community in the health world, with regards to medical supply chain and some of the costs that are associated with that, what is HHS contemplating in their support of both the supply chain, as well as how some of this funding is going to get used to help augment the delivery of critical supplies?

Meghan: Yes. So we're still waiting for a little bit of clarity for exactly what is going to be covered by the different funding streams. But at the moment, HHS follows their existing process. So they work directly with state health departments to release resources from the Strategic National Stockpile, or their other vendor-managed inventory. So, they are, despite the pandemic situation that we're in, still following normal disaster processes to request and release supplies. So, that's still your best option, is to request what you need in very specific terms, and then see what would be available and which is the best source to fulfill that need. And that's all being coordinated at the federal level between HHS and FEMA.

Marko: Obviously, as COVID-19 is stressing hospitals and stressing emergency rooms, and the ability for folks to be able to quarantine under medical care, one of the things that I know has been talked about in the public health preparedness community for years and has also been part of the national preparedness plans for bio defense, include the ability and the need potentially to set up alternative medical care sites. Obviously, we are getting to the point where hospitals are starting to feel stress. I don't think that's going to end any time in the near future. What are some of the things that state and local governments should be thinking about when it comes to working with their public health and their medical community to try to determine what alternate sites, or what alternate capabilities, might be brought to bear?

Meghan: So, many states have been working for years on building their own inherent capabilities for alternate sites, community surge sites. Everybody has a slightly different name, depending on how they've structured the [inaudible 00:12:39]. We know that HHS and the federal [inaudible 00:12:40] agency are working on alternate care site strategies. Again, your best option is to reach out to your local emergency management agencies, to your state emergency management agencies, who can then connect you to the regional HHS representatives and regional FEMA representatives, so that they can meet your need very directly. As opposed to asking for a specific resource, it's best to explain the need that you have. And then, you can work together to figure out what the best resource match is. It's not always a plug and play resource. It might be a combination of resources available. It might be just [inaudible 00:13:33], how to surge within your facilities.

Because ultimately, your best options are to take care of patients inside of hospitals. So whatever we can do to surge and increase your capacity and capability inside the walls of an existing facility is your best option. Once there is a need for some sort of an alternate care site, or community surge, communicating that need up the emergency management chain or structure is your [inaudible 00:13:59] is the best [inaudible 00:14:00]. And then, everybody along the line understands the surge and the stress that you're under—and can see what can be done to support you.

Marko: Thank you Meghan, appreciate it. We'll come back to you here in a couple of minutes. Again, for our listeners and our viewers, we are all working remotely here at ICF, at all of our offices, from our folks who are at home, our folks are with our clients where appropriate, and taking steps to not only social distance, but also to continue to be able to work in this environment. That's why, this podcast, occasionally you may see some glitches in technology. We are learning just as you are learning how to deal with the environment, where thankfully the electronics we have today allow us to communicate far more easily than they have in the past.

I'd like to bring in Marty Altman now. Marty has over 40 years in emergency management, worked at FEMA, has worked at state and local levels, and has been supporting as the vice president of our recovery work for a number of years, and is a public assistance leader in the field. Marty, welcome. And thank you for joining us this morning. I think one of the first questions that comes to mind for anybody who is involved in this process now is, the entire nation has received an emergency declaration under the Stafford Act by the President of the United States. Many states, about a dozen or so and more I'm sure to follow, have received major declarations. Each one of those designations brings a different aspect to the equation when it comes to the relief programs that are available. Under the emergency declaration process, public assistance for emergency protective measures is made eligible, which we've commonly referred to as Category B.

Category B is all of those life-saving activities that take place, that a government manages at all levels of government. As we look at Category B, and we'll certainly talk about the major declaration process later...Category B, what are some of the significant items and things that the state and local governments should really be watching closely now, tracking costs on, when it comes to emergency protective measures?

Tracking emergency protective measures (Category B)

Marty: Yeah. Thanks Marco. With what's happened, this is an unprecedented event. And things are changing by the day, and especially with what FEMA is going to allow as far as what reimbursements are. The initial emergency declaration that came out, that all states received one from the president, was focused on working with the health care industry and the hospitals in order to provide funding mechanism to reimburse them for costs that are going to be in abundance of what they need, such things as working with, as Meghan mentioned previously, with setting up the emergency operation centers, training for the declared event, because they're going to be bringing a lot of different resources in. And some of those folks may need to be trained, especially when it gets into the processes of decontamination. Those costs are all reimbursable by this declaration, as well as putting disinfection and cleaning up facilities in order to expand their operation within the system.

And then, the emergency medical care position with everything, which is a non-deferrable treatment of the infected person into a shelter or a temporary shelter, like we see that's going on everywhere... Take New York, for example. New York has a tremendous amount of patient care that needs to be taken. The hospitals are being overcome by patients. And so, they have to find out other resources in order to put medical facilities in, or temporary facilities. So all those costs are reimbursable. And then, what happened over a period of time, was we went into looking at the costs, you know, for supplies and labor, the employment that comes with. And one of the key things is this is a 75/25 disaster right now, 75% federal share...

Now, what's happening also is there are a lot of volunteers coming out and helping, you know, from different aspects of the response recovery. And a key thing to that is to be able to track each and every one of those individuals and what they're doing, by the name and the tasks that they were at, because that will help the locals to offset their 25% cost share. You know, we have to focus on that at this period of time too, because, you know, this is an unprecedented event. We know the millions and billions of dollars it's going to cost throughout this whole incident. And for 25% for...a local might share, it can devastate some of the budgets. So it's critical to find ways and understand what is eligible, what isn't eligible, so that these funds can maximize whatever they have in place.

FEMA’s simplified application process

One of the things FEMA has recently done, they put out last week, is they're looking at what they're calling a simplified application process. And that process is...what FEMA did was eliminate some of the things that are a bottleneck when it comes to applying for reimbursement. Such things that they're eliminating in this whole process... Everything's going to be done online. But they're eliminating the exploratory cause they have, their recovery spoken meetings, and even doing site inspections because we can't get near a lot of people, as well as reducing the documentation requirements to minimize the needed support in order to receive the funding quickly. FEMA's put out there that what they're looking to be able to do is, once this information is uploaded and the proper messaging with it, you know, the documentation supports these costs, they will expedite those funds to the locals, which is going to be a critical thing for the locals, in order to survive. We don't know how long this is going to be. So the emergency protective management in the beginning was strictly helping the medical industry, you know, the medical field, the hospitals, the health care institutions, and the local emergency responders to this incident.

And it helps offset a lot of those costs, if anything else. It's a very complex process, even though FEMA is going to reduce some of the documentation and everything else. If you do not document and track everything the way it needs to be, you could jeopardize the opportunity to receive those funds. There are going to be multiple funding sources. So, just as Meghan says, you have to track everything. It doesn't matter what you're doing. If it's related to the COVID-19 virus response, you want to track everything, no matter what it is. It's labor. It's equipment. It's supplies. It's donated resources, everything that's taken place. And in the end, yes, it's going to be complex in order to separate who's paying... What bucket is that funding coming from? So the better you document that and track that, the better off you're going to be.

Marko: Thanks Marty. One of the things that certainly is important with this is states that have received a major declaration are also going to be eligible potentially for other categories of public assistance beyond just Category B. We will probably do a podcast specifically on the other categories because it can be complicated when you're talking about infrastructure cost, as opposed to emergency cost. But one of the things on the emergency cost side that is important to kind of tease out is, beyond the application being simplified, normally when we think of emergency costs for Category B, we think in terms of police and fire overtime, those things like emergency medical services overtime, not normal operations. How do we make sure, and how do our state and local clients, and governments, think in terms of how to make sure they understand how they're tracking those costs from the perspective of what is a normal operational duty, versus what is eligible under COVID-19's declaration process?

Marty: The easiest way to track that is by tracking everything, no matter what time goes in and everything else, looking at their time sheets, how they're tracking their time. How do their payroll policies line up? But my advice to everybody is track it. If it's somebody working their daytime hours right now, track everything. And let's sort it out after the event in order to make sure you can get reimbursed for what you can, because it can become complex. And some of the applicants that have different payroll policies, you’ve got to know the language that's in that and how it's going to be able to be applied for this. Then, on top of it, we don't know what's going to happen as this event continues to go on, because FEMA could come out and say we're going to do something completely different. And maybe there's a possibility that they'll cover everything, because of the economic impact it's having on communities right now. So, the best advice is to track every single hour somebody's working. And then, make sure you track what you paid them, and what your payroll time is, and the tasks that they did.

You just can't say, for an example, Marco punched the clock today, put his daily work in and that was it. Okay. But what did he do? And how does the task he did relate to this disaster, to this event? Because that's going to be a key thing too.

Marko: And Meghan, I would assume that, for the purposes of the health care community, the same kind of rules would apply to them in terms of tracking their time also.

Meghan: Yeah. It's the same rules. And I can tell you anecdotally, from my time at the state, one of the things that we did was to create, in the back end of our financial systems, a separate charge code. That was the easiest and fastest way for us to be able to track how and who was spending time on what. And so, everything was tracked. Equipment purchases, labor, supplies, everything was just coded with that code. We also had to provide some regular accounting of what our...at least our grant-funded, our cooperative agreement-funded staff were working on. And so, those administrative controls were already in place. So, that would apply to the hospitals as well, to try and assign separate charge codes, or put a checkbox, or whatever control you have in your accounting system that makes it just as easy as possible.

Marko: For both of you actually, and I'm sure there are two different perspectives on this, with the public assistance program and this disaster relief funding, there are certain entities that are eligible, and there are some that are not eligible, and there are some that, well, they fall in that middle ground area. The difference between a governmental activity, like a local government, or fire, or police, EMS department, or in the cases of private nonprofits, they're eligible under public assistance. And specifically, many hospitals are nonprofit entities, or they are utilities in many ways, or they're community-owned. But then, some are also privately-owned as well. Can you talk a little bit about the differences between the private, purely private, for profits, and the nonprofits, and how that plays into some of this relief?

Marty: Sure. I'll take that first step with this. With FEMA, the public assistance program, you have to be an eligible applicant, and you have to be a not-for- profit organization. And there's also, when you get into the not-for-profits, there are critical facilities and there are non-critical facilities. And with the declaration, it has to be with the critical facilities that can apply for the funding. FEMA will not reimburse a private entity or an applicant for funding, because they figure, in the process, that's what they have budgets for in order to do that. And so, if it's for-profit, it's not eligible under the FEMA public assistance program. I'm not saying, we may not see a different change with this event because as big as it is. But that's where we have to rely on the other funding sources as well, to see where they fall in line with that, with the HHS, the CDC, and whatever other funding is going to come out.

With what was passed in the Senate’s recent bill last week, there's funding in there, even though it's very concerning that the little bit of money they put in there for the health care institute, it's very little, for all the many resources they have to put out there. But those are the things we've got to look at. Some of the things with going from the original emergency declaration to the major declaration that the president put out for...I think it's up around 15 right now, is it opens that window of opportunity for a lot more applicants to be able to apply for Category B. It hasn't opened up the door for all categories. It's still strictly a major declaration for Category B. And so, what that does is add a lot more applicants that can apply for the funding, such as all your critical facilities, which is going to include your utilities. And you brought that up.

And part of that, if they're tracking their activities that it's strictly related to this event, it could be eligible. Educational institutions that were...where schools are being shut down, or if they're purchasing equipment in order for students to be able to work at home, those costs are reimbursable. But there are some things that tie into that and how it has to look when the event's over. But it's opening those doorways up for additional opportunities for the local entities that can apply for this funding. But again, if it's a for-profit organization, they're ineligible at this time to apply for FEMA funding.

Potential funding opportunities from HHS

Marko: Meghan, just to kind of build on that a little bit, we know that the relief bill has passed, the first of what will likely be several. Of course, a tremendous amount of funding in it, some of which will be going to replenish the disaster relief fund at FEMA to fund a lot of these emergency protective measures, whether they be hospital-based or government-based. Secondly, there's a tremendous amount of money, I believe, in there for research and for supply chain activities as well. How do you envision that money's going to be utilized in the short term? And where do you think HHS and others will start to really focus their energies beyond the containment of this at this point?

Meghan: Sure. So I think containment, as you mentioned right now, and mitigation and management of the spread of the disease is certainly the focus. I think managing patient care is HHS's focus, so focusing on supplies and equipment, getting those packages out to the states of whatever it is they're asking for—if it's personal protective equipment, if it's medical supplies, if it's packages of alternate care sites, if it's staffing— all of the things, bringing things to the states that ask for them. HHS does have some funding that will be pushed out to the states and to the hospitals through a couple of different mechanisms that I talked about earlier, through the Public Health Emergency Preparedness Cooperative Agreement, and through the Hospital Preparedness Program Cooperative Agreement.

We're still waiting on some specific language and specific guidance for how that's going to go out. But that funding doesn't have the same restrictions that FEMA's funding does. So, private hospitals and healthcare industries can be recipients of that funding. It just depends on how the state is envisioning that they will execute those funds.

Creative ways to meet your cost share match

Marko: Marty, one of the things that is important, I think, Meghan, this will be true for the public health side of this, is the 75/25 federal/non-federal match. And when we say non-federal match, that actually has some pretty broad parameters based on the state people are in. In some cases, some states will pay the full 25% out of state funds. In other cases, it's passed entirely to the local governments, and in some cases, shared. Given that, I'm assuming we're going to encourage our clients to understand the rules that their state is operating under. More importantly, how can creative ways be developed and thought of in terms of how to meet that cost share match? You've mentioned a couple up front.

Marty: Again, you know, the biggest part of it is to meet that match. What is the cost that they put out locally with the entity? Again, donated resources such as...it could be materials or supplies coming in. It could be the labor force coming in. It could be donating other things that are needed for the disaster itself. Of, if a local entity...they have done this before in the past, you know, they would take some of their own time and everything else within their jurisdiction, and apply it to that, where they wouldn't charge FEMA for it. But they'll tie it and say, "Okay. We're going to dedicate this much toward the federal cost share."

There are states that do split just cost share. Florida is one of them. They've split it 50/50. New York, it just depends on...and I think what we're going to see in New York, it'll be 100%. The state will pick up the cost share. That's what he's talking about right now. But those are the things that they can do. That's why it's critical. And I can't say this enough, you've got to document everything, everything you're doing toward this event. And then, like we're going to tell our clients...we're going to sit down with them and help them sort through what are the funding sources out there, where can this be applied, how can we offset what's coming out of their pocket and what they've donated to those resources?

Insurance and avoiding duplication of benefits

Marko: You talked a little bit about donated services and donated activities of both people and material. How does insurance play into this as well?

Marty: I was just going to go there. Thanks for bringing that up. It's understanding your insurance policies, because understanding, with the FEMA public assistance program or any program, you can't have duplicated benefits. And you have to understand what's in your insurance policy, because there could be in the insurance policy to pick up a lot of some of this cost as well. I think that's what makes it difficult when you start looking at your health care facilities and everything else, or what's in their insurance policies. Meghan might be able to touch a little bit more on that. But one of the things FEMA's going to do, they're going to request their insurance policy, so they can see what coverage is inside of that insurance policy. And whatever it is, they're going to deduct it off the cost of the eligible cost that they come up with for what they're submitting to FEMA for reimbursement.

Meghan: And this disaster is a little different. Right? So, in your sort of...I hate to say the word "typical" but in previous disasters that we have the most experience with, like national disasters, there is typically insurance coverage for this. I think we'll be hard-pressed to find widespread insurance coverage for pandemic costs. I think this is one of those act of God and force majeure sort of clauses that you'll see in insurance. But they're going to want to look at it anyway. And in terms of medical costs, this is a difficult situation because there are...there's costs that health care entities and governments [inaudible 00:35:27] conditions for activities in advance, and not directly related to the costs of providing medical care.

But then, there are treatment costs. This is an expensive disease to manage for patients who are admitted to the hospital. And FEMA covers a small portion of that, potentially, in their...in emergency medical costs, so potentially emergency department visits. But once a patient is admitted or put someplace else, that's ineligible. HHS funding, at this point, does not cover any costs of...and by HHS funding, I mean specifically the cooperative agreement funding. The Centers for Medicare and Medicaid Services, or Medicaid and Medicare, will pay some of these costs for their insured. And then, private insurance will kick in for those that have private insurance. But this is going to be a difficult process for hospitals and health care facilities to muddle through in figuring out who will pay, and how it will get paid. And those will be trailing costs, because, as I said, the HHS cooperative agreement funding will pay for it. And FEMA is a payor of last resort.

So, they'll need to see documentation first. So again, sitting down and having your documentation, and being very clear about what costs are going to what payor is going to be critical. And it's going to take a while to weed through that for health care facilities.

The importance of talking to your federal representatives early

Marko: Meghan, if you had advice to give to both the public health community and its relationship with the emergency management community at large—especially when it comes to understanding how this funding shakes out, how some of these programs operate—what would it be? You mentioned before about getting with them early. What do you think is the best advice that state and locals really need to understand, given this is something they have not traditionally done in the past?

Meghan: Right. The guidance, the advice, still stands. Talk to everybody early. I know everybody is incredibly busy if you are in one of the states that is actively managing patients now, versus preparing for patients to come. Finding the time to have that conversation is going to be difficult, but it needs to happen. So the states and the emergency management agencies, and then the health departments and the hospital associations, should talk with their respective federal representatives. So FEMA has representatives that can talk about public assistance and the disaster relief funding opportunities. HHS has federal project officers and regional emergency coordinators in every FEMA region that can address eligible costs and the process for applications.

Get that information early. And push that down to your potential recipients within your state. The earlier that you can have those conversations, you can hear the pain points, the better you are going to be prepared.

Marko: Marty, where can state and local governments go to get help?

Marty: The key place for them to get help is going to the state emergency management offices. They have a relationship with FEMA and their federal partners. They can help guide that. But also, there are other field expertise individuals that can help guide them through this whole process. It is a complicated process right now. And nobody knows where it's going to end up. But just like Meghan said, they need to get those conversations going early because if they wait too late, it could create a bigger problem for them in the end. I do know, currently, there are a couple of the states putting webinars together for the public assistance program and identifying what is eligible and what isn't eligible. And they need to partake in all that. Then, they can have a true understanding of what FEMA's going to pay for, you know, as the event goes on.

But they need to reach out. Because as complicated as this is, they need to reach out to make sure they follow the line. Dot every I and cross every T. The biggest problem that there is with the FEMA public assistance program, or any program, is, if it's not documented right, you'll lose that opportunity. So if you don't understand something, ask. Find the expertise in order to get your questions answered. That's the critical point right now. And I can see it already starting to develop out there, where we're getting calls about, you know, "What can we do? We don't understand what this new disaster...this unprecedented event. How can we manage this?"

So, that might be the key thing too. But the key is to communicate, communicate, and communicate, and document, document, and document.

Marko: Marty, you certainly have touched on it, you know, ICF has been involved with the disaster and emergency management and public health community for almost 30 years or more now. What's ICF doing to really be prepared itself, but more importantly, how we're helping our clients?

Marty: We are doing a couple of different things. We're reaching out to our clients, for one thing, to ask them how we can assist them to understand the process, and what we can do to help them through and help them maximize their opportunities. The other thing is we've put together a group that we're putting online, that has all the updated information and documentation that would be giving them advice on what's going to happen with every part of the response. But we're here. And with this podcast that's going to be up shortly, it's going to help guide them to where to go with icf.com, where to look for this information. We are reaching out to key entities, key potential entities, to see what they need to help them get through this stage. We've got to look at the most critical right now, to where that help needs to be.

And as it grows and expands, then we reach out that way as well. So, we are doing a lot. We're educating our clients and giving them an understanding of what's there. At the same time, the clients are calling us for advice on how to document certain things.

Marko: And Meghan, from ICF's public health perspective, obviously, we're doing things within the company to take care of our own employees and to make sure that they're taking care of their families, and practicing all of the guidance with regards to being safe and trying to make sure that we minimize the spread. But we're also supporting our public health community as well, both through our work in the federal government and elsewhere. From your perspective on the public health side, what is ICF doing and what more can we be sharing with our public health community clients?

Meghan: So we are, as you said, we are supporting our existing clients. We have federal, and state, and private sector clients that we're assisting in preparedness and planning, for both their public-facing responsibilities and their internal continuity of operations planning—and they're internal social distancing, like we're doing at ICF. I think that, as Marty said, we're continuing to get guidance as we find it, and push it out as quickly as we can, so that we can just keep those lines of communication and keep any information that's flowing, as it's flowing up and down the chain, to our clients and out to the public in general.

Marko: I think one of the things that's important for all who are listening today to understand is that the information we're providing today is accurate and to the best of our ability based on the current status of both the response and the declarations. As things continue to evolve, there will be additional information. Things may change. But largely, the basis of these programs is fairly well set. But there may be, as there are in any disasters, nuances and changes of actions that may come. And we will try to share those with you as quickly as we determine them. And I wanted to let you folks know that as we evolve these...both these podcasts and our documentation material that we make available, those are the kinds of things we will try to insert, as much of the latest that we understand and we've learned, and point you to the authoritative sources that really understand. There's a tremendous amount of misinformation out there. And there is a lot of work being done by a number of people.

Meghan: Yes. I think it's probably also important to mention that we are...our advice and our experience is based on our previous responses. I know I've played a role and led my organization through the H1N1 pandemic. But that isn't this. And we have not experienced this kind of an event before. We've been planning for it for 20 plus years. But this is new. I want to be clear that we're speaking from our experience in this space, but we're not speaking on behalf of our clients at all. So this is our opinion. This is ICF's opinion. This is our interpretation of events as they are unfolding now. And we're not at all, in any way, speaking for any of the agencies that we mentioned today.

Marko: Well put. Marty, any last words?

Marty: No. Just, Meghan said it very clear and precisely, you know, this is a new event, you know. It's something that nobody's ever been through before. This is something that's impacting the whole country. It's not just local where, like you mentioned in the beginning Marco, you're typically responding to hurricanes, tornadoes, or minor pandemic incidents. And this is something that's capturing everybody. It's not only in this nation here, but it's across the globe. It's huge. One of the best pieces of advice I could give right now, to anybody who's listening to this podcast, is, as you are engaging yourself into this event, make sure, one, you keep safe. That's the most critical thing. But the second thing is to make sure you understand what you need to do to ensure yourself that you're going to get reimbursed or have back-up of some way to recoup those costs, no matter what funding sources there are. And work together, in a community, to make a safe community. We'll get through this. It's just a matter of when.

Marko: Thank you Marty. Certainly appreciate that. And for all of you, we want to thank you for joining us today. As a reminder, there will be several other podcasts. They're in the planning stages now. We will air them as quickly as we possibly can. And to further provide a little bit of information, certainly around the public assistance program, with regards to the additional categories, the individual assistance program, which has been opened up for states that have received a major disaster declaration, creates additional opportunities, not just for governments, but quite frankly for individual citizens to obtain certain services of certain relief that they might not otherwise get in the normal course of the day.

And finally, we'll also be working on longer-term mitigation strategies that'll be funded by the results of this funding. And ultimately, we'll also do a podcast on continuity. Continuity of operations during an event like this have become a critical issue for a number of, not only communities, but businesses, as well as utilities and other governmental services, manufacturing, that are affected by labor shortage because folks have to stay at home, or their labor base, and social distancing doesn't allow that to continue. We'll talk a little bit about what it means to plan for that on future podcasts. Needless to say, ICF will continue to provide information as we have it, as we make it, to make it available. We'll do the podcast continuing on many of these subjects and others. And we invite your feedback. We invite your ideas, your questions. And certainly, if there are topics that we should be covering that are related to COVID-19, we will certainly take a look at those as well.

On behalf of ICF, remember please, go to our website, www.icf.com. There will be a link to all of the COVID-19 information that the firm has made available, both to our public-facing folks as well as our clients. And we look forward to being able to support and serve you in the future. Stay safe. Stay at home. And let's all get through this together. Thank you very much to both of you for joining us today. And thank you to all of you who've been listening.

Marty: Thank you.

Meghan: Thank you.

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