HomeMy WebLinkAboutContract 45811 TX EMTF A 09/25/201
TEXAS EMERGENCY MEDICAL TASK FORMY 8E1CWAW,,
CONTRACT RESOURCE MEMORANDUM OF AGREEMENT
NO.
This Texas Emergency Medical Task Force Memorandum Agreement C'TX EMTF
OA") is entered into by and between a Department of State Health Services-designated
Lead Regional .Advisory Council CLead RAO) North Central Texas Tmuma Regional
.Advisory Council ),properly authorized to do business in e state of Texas,
and City of Fort Worth , as a Resource hereafter referred to as Resource
that wishes to participate as a member of e ency Medical Task Force C ") in
Region 2 (collectively,"the Parties").
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TERM: Ongoing until cancelled by either party with notice to the other.
Purpose:
The purpose of this TX EMTF MOA is to establish a mechanism the utilization and
coordination of emergency medical resources and assets an emergency or
disaster, for training purposes, or any other purpose as determined by the Lead RAC,
EMTF Region, or FMS S. Assets may be those in ss ion of the Hospital
Preparedness ) "Contractoe, or "Subcontractors," as well as others
identified through local regional planning efforts subcontractor agreements.
,Additional purpose statements are included in subsequent sections, appendices, and
addenda of this document that relate to specific equipment,supplies,and personnel.
Activation oe en °o :
Activation
This agreement may be activated for a State tasked deployment, only by
written notification "State Mission AssignmentD the designated SITS
S ®C Director or his/her designees.
This rn t will be activated written notification ( "State Mission
Assignment") designated official.
Activation, pure t to this YX EMTF MOA, occur at any time, day or
night including weekends and/or holidays, only an official written State
Mission Assignment has to designated Agencies contact(s).
The Resource acknowledges that assets and/or resources may be requested for
activation for any purpose in Section 1.
Lead RAC will reimburse the„ .esp.; m ded to the Lead RAC by
FI �f� l
f� RECEIVED AUG - 12014
TX EMIT MOA 09/25/2012
DSHS, after submission of conipleted required documentation per this agreement.
for actual costs allowable by DSHS incurred in order to make the assets and/or
resources ready for deployment and all allowable costs incurred under the State
Mission Assignment, from the time of activation through demobilization as per
the Reimbursement section of this agreement(Section 5).
6) The Resource must acknowledge receipt of the State Mission Assignment
within one (1) hour and must accept or decline the Mission within two (2) hours
of receipt. Upon acceptance ofthe State Mission Assignment,the Assets must be
enroute to the designated mission within the parameters of the State Mission
Assignment.
7) For cost reimbursement purposes, the Mission will start when the Asset is
activated to be "made-ready" for deployment and will conclude at the time the
deployed Asset is ready for re-deployment from its home base after the Lead
RAC issues a Demobilization Order or the terms of the State Mission .Assignmeat:
have been met.
8) The to Mission Assignment will include, at a minirnum,,the following:
(a) Authorization to activate;
(b) List of resources or assets requested;
(c) Number and qualifications of personnel for the activation;
(d) Reimbursement processes for personnel & resources activated, including
backfill as defined in Appendices A-D.
(c) Description of"activities(including Purpose, location to report,etc.); and
(f) Expected duration of the deployment.
B)Documentation Within four (4) hours of acceptance of the activation, the
Resource will receive the offlicial packet containing the State Mission Assignment
and reimbursement forms.
3)Terms & Community Support:
A) Terms
1) The Lead RAC shall:
(a) Activate sufficient In-place assets, to include personnel, to effectively
implement the State Mission Assignment.
(b) Efficiently notify and deploy Agencies as, defined in the to Mission
Assignment,.
(c) Ensure all Agencies have a current, executed TX EMIT MOA in place at
the time of Activation.
(d) Assure detailed records of expenditures and time spent by Deployed and
In-place Assets are complete, accurate,, and have adequate supporting
documentation as determined by DSHS.
(e) F'.stablish and maintain a roster of all deployed pensonnel, and resources to
-facilitate accountability.
(f) Maintain a list of' Resource contacts and back-ups for Activation and
Mutual Aid purposes,, including name, e-snail address, and primary/secondary
phone numbers.
(g) Maintain a list of 24/7 contact inforn-tation for all activated Agencies.
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TX I"N'IT' MOA 09/25/2012
2) The Resource shall:
(a) Certify that all assets (pci-sonnel, resources, and equipment) meet all
licensing, training and certification requirements related to his/her/its
particular prof'cssion and/or mission.
(b) Make necessary travel arran"cinents for its deployed assets. Travel
reimbursement will he at State of' Texas rates unless otherwise agreed in
writing prior to deployment.
(C) Ensure deployed personnel are rostered as employees ol'the Resource.
3) Tcrin of.'this ag
,reernent
(a) Term ol'this agreement shall begin on the date TX MOA is signed
by the second ot'the two Parties. This TX MOA may be terminated by
either Party with thirty (30) clays written notice to the other Party.
13) Community Support
1) This agreement is not intended to replace any mutual aid agreements or
compacts that a Resource legally has in place in support of'its community.
4) Legal Liability & General Financial Liability:
A) Legal Liability
1) Resource shall have no right, and does by this agreement waive its right, to file
a claim(s) against DSI IS, the State of"I'exas, and the I,ead RAC for any personal
or property injuries, damages or requests flor State subrogation for any tort that
they may incur during activation or arising therefrom, or any other claims filed
against thetas as a result of' their activities during activation. DSI IS. the State of'
Texas. and the I,ead RAC do not waive any immunity 1rom Suit or liability that
they may have under state/federal laws and the Texas constitution
notwithstandin,, the above. To the extent that Resource is a local governmental
entity, unit of State government, or a Texas political subdivision, the waivers
provided herein are further subject to state law and the Texas constitution which
inay make them unenforceable in whole or in part.
2) Resource shall assume responsibility for liability clairns, malpractice claims.
disability claims, workers' compensation claims, attorneys' flees, and other
incurred costs.
3) Resource shall assume responsibility flor their own acts ot'negligencc.
B) Financial Liahility
1) The Resource shall continue to assume legal and financial responsibility of'the
personnel and equipment during the tune ol'activation or deployment.
TX ENTFMOA 09/25/2012
5) Reimbursement:
A) Summary
DSI IS, in conjunction with the INTI' prograrn, is committed to firriely
reimbursement of INS agencies and other entities that provide resources and
personnel in times ot'disaster activation.
The steps below outline the process t'or DSIIS to reimburse the provider within 45
days after a complete and accepted reimbursement packet is received at DSI IS.
EMS agencies are encouraged to file their reimbursement packets through their
Lead RAC as quickly as possible to ensure timely reimbursement from DSI IS and
no later than 6 (six) months after the demobilization.
The 45 day reimbursement timeline will begin only after a completed and
accepted reimbursement packet is accepted at DS11S.
B) Process
1) The Resource submits reimbursement packet to the bead RAC
2) Lead RAC review the Packet flor completeness
(a) lfcomplete, the Lead RAC will invoice DSI IS and include the packet for
reimbursement
(b) If not complete. the Lead RAC will work with the Resource to complete
the packet then submit and invoice with the packet for reimbursement.
3) DSIIS will review the packet received
(a) If complete, DSIIS will provide reilllhUrsement to the Lead RAC.
(b) If incomplete,
(i) DSFIS will work with the Lead RAC, or directly with the Resource if'
appropriate, to identify the corrective action needed.
(ii) Once complete, DSI IS will provide reimbursement to the Lead RAC.
(c) After receipt of the reimbursement from DSI IS, the Lead RAC will
provide reimbursement to the Resource.
6) Credentialing:
A) The Resource shall certify that all personnel meet all licensing. training and
certification requirements related to his/her particular profession and/or mission.
B) When responding to a licensed hospital/healthcare Facility, the authorized
administrator (or designee), of the requesting,/impacted facility, shall be responsible
flor providing a mechanism flor granting emergency credentialing privileges for
physicians. nurses, and other licensed or certified healthcare providers to provide
services.
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TX FIVITFMOA 09/25/2012
7) Ambulance Strike Tea ms:
A) Purpose:
l) The purpose ofthis section is to establish mechanism to mobilize properly
staffed and equipped Ambulances to be deployed in an Ambulance Strike Team
(AST) configuration (five (5) ambulances and an AST Leader) or other
configurations as deemed appropriate for the mission (i.e. individual ambulance
resources) as provided for in tliis'I'X F.MTF MOA.
21) The Lead RAC has been tasked to enter Into MOU/MOAs with F,MS Agencies
to provide a minimuni of five (5)ASTs from its VNITF regional area.
B) Terms for Agencies;
1) The Resource and its assets must meet the following criteria:
(a) Must be DSI IS Licensed FMS Provider
(b) Must have at least twelve(12) months of experience providing local
and/or long distance emergency medical services to live human bein-s in the
State of"I'exas.
(c) Must maintain a business off ice within the boundaries of the State
of"I'exas.
(d) Must adhere and abide by all federal, state and local laws and must
adhere and abide by the'Texas I lealth & Safety Code, Chapter 773,
Emergency Medical Services and the Texas Administrative Code,
itle 25: health Services, Chapter 157: Emergency Medical Care
during the time of its deployment to provide mutual aid in a pending or
actual disaster and must adhere and abide by all laws and rules at all
tirnes.
(e) Must keep detailed records (utilizing the DSI IS and/or Lead RAC
packet of documents/Forms) of'the services requested and fulfilled, and
provide those records, as requested, to the Lead RAC to include, but
not be limited to:
(i) Patient Care Records:
(ii) Patient demographics, including patient(s) insurance
inf'ormation.
(iii) A Time Log Record form ot'activities
(f) Must keel) all receipts of expenditures during deployment, and
submit all requested infix cation f')r reimbursement on the provided
documentation ffir prompt reimbursement under this TX EMTF MOA.
(g) Must be required to be Self-sufficient tier 72 hours and should be
aware that personnel Could be living in austere field conditions.
(h) Resource must meet DSI IS requirements flor minimum, lawful
staffing, per that DSI IS licensed ambulance level.
(i) '['his 'YX ENTF MOA calls fir each ambulance to have the
minimum number of'individUal crew members as required by license.
per vehicle deployed. Additional crew or support staff`members, and
any vehicles they may require, must be included in the State Mission
Assignment to be eligible fur reimbursement.
(j) The DSI IS Licensed ambulance provider must bill primary sources of'
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'[XlM [PM()/\ 09/25/20l2
' Such um Medicaid, Medicare, private insurances or third purt}
providers before euodioo uninvoice to the Lead RAC. The DS}{SLicensed
ambulance provider must submit Aothe Lead RAC vvbbio oinn1� (YU) dayn
pnoo[o[dooiuL prxol'ol'puynionLor request for reimbursement for each
patient that iutransported. ** This requirement cuav only hu excused by
|]S[I'S imwuiog, u statement oc memorandum of'suob10 the Lead RAC for this
activation. The provider must reimburse IN IS if0«n/ receive primary source
oc third party neimburscmcnt after receiving payment bnmCSRS.
(k) F,MG Provider will be rrinzhurxedud the rates in Appendix A.
8) Professional Stuff:
A) Purpose:
The purpose ol'this section is to establish a mechanism whereby certified or
licensed professional medical or support staffmay be deployed to provide various
clinical nr support services as requested by the Lead RAC.
13) Description
i) Aa the Lead RAC enters into Mot VM(V\o with D8Il8 ENS Providers for
ENS The f'ollowing list is representative n[1ho principle tasks ENS
Personnel might hc activated 1naccomplish:
bd K4*dico| support provided oil buses (coach hqpc bus orschool hum)
designated 1nevacuate individuals with medical needs (estimated 0nbe from 2
1n5 EMS }`crxoxnou} and/or nursing y&uO[perbux). Bus evacuees will
primaril y be Omro bompltu|u' nursing homes, or are the general public who
have medical needs and require medical oversight during evacuation, but dn
not meet ambulance transport criteria.
(b) Field Supervision orASTl.o who will manage Ambulance Strike teams
comprised ol'5-7 ambulances and orAM0l1S(cx) and will report tnthe
appropriate Incident Command structure.
(u) Uniquely tasked FMS personnel who will serve at any level in the
Governor's Division ofFniergency Management Incident Command structure
as assigned. This could include aoair/around coordination team in L}I)C'
Medical looidon1 8uppor1'[eam (M-IS[) members. the State Operations
('enter or Medical Operations ('enter, u Regional Medical Operations ('enter.
or in the disaster zone, and will he rcuVonmihb: for managing strike team
leaders. task 60rueu` and nuoio individual ambulance assets.
(d) Ambulance stagio��uanagcnuoo1and support.
2> As the Lead RA(` co<erx into subcontracts with other entities or individuals tn
provide professional ooediuo| stalling (physicians, oucuua, other medical
prV[exxiuouix), technical and support services that would be used intile
deployment ufuny asset requested hyl]S1 IS. the FM'l`y Region. orthe |.cud
RAC the following list ix representative ofthe types o[uxxc1x that might ho
activated to accomplish the mission:
(a) Mobile Medical l/ods (K4Ml)o) as outlined in this ugrccmuo1.
(h) Other nnoihi)u shelters, vehicles, oc trailers that may be used for command,
communications. storage, and any other identified reason in support o[tbo
noixmiou identified 6vD98S-
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TX F.MTFMOA 09/25/2012
C) Ternis for Resource;
1) The Resource and its assets must meet the billowing criteria:
(a) If the Prollessional Staff is deployed to provide patient care, his or her
organization must have at least 12 months of continuing experience providing
medical services to live human beings in the State of Texas or being an
employee of'an existing hospital providing direct patient care.
(b) Must maintain a business office within the boundaries of the State of
Texas.
(c) Must abide by all fiederal, state, and local laws.
(d) Will only deploy staff upon receipt and Linder the terms of the State
Mission Assignment as described in Section 2: Activations& Documentation.
(e) Will only deploy Resource employed stall'as ((allows:
(i) EMS personnel Must be currently certified or licensed in Texas at the
ENT-Basic level or above and who have no disciplinary actions pending
or under investigation that the Resource is aware of.
(ii) Registered Nurses must be currently and routinely practicing in an
acute care environment providing direct patient care and who have no
disciplinary actions pending or Linder investigation that the Resource is
aware of
(iii) Physicians must be affiliated with a healthcare Resource (either
directly or a physician
through group) and have no disciplinary actions
In
pending or under investigation that the Resource is aware of'
(iv) Any other clinical staffinust be employed by a healthcare Resource in
a position with the same scope of'practice as their role in the activation
and have no disciplinary actions pending or under investigation that the
Resource is aware of.
(v) Any non-clinical staff must be also employed by the Resource.
(1) Will deploy the personnel ordered by I)SI IS in configurations designated
by the State Mission Assignment.
Medical procedures undertaken by deployed ENS staff will be according
to protocols approved by the RcSOUrce's Medical Director. The MMU will be
under the direction of physician on site.
(h) Must assure detailed records of expend itUres and time spent by deployed
staff are complete, accurate, and have adequate supporting documentation.
(i) Will ensure deployed personnel are self-sufficient fir 72 hours or as
detailed in the State Mission Assignment and Should be aware that they could
be living in field conditions.
0) Must ensure that all deployed staff carries prool'ot'his or hers individual
certifications and/or licenses as aTexas healthcare prollessional and a Forrn of'
Picture identification with them at all times.
(k) Must assume responsibility For liability claims, malpractice claims,
disability claims. workers compensation claims, attorneys' fees, and other
incurred costs.
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TX FIMTFMOA 09/25/2012
9) Mobile Medical Units, Equipment, and Supplies:
A) Purpose:
1) The purpose ofthis section is to establish a mechanism For Mobile Medical
Units ("MMUs"), which may include clinical personnel, support personnel,
equipment or any combination ofthe above per the State Mission Assignment, to
be deployed for any purpose defined in the TX F.MTF MOA
B) Description:
1) The Lead RAC may enter into Subcontracts with other RACs, hospitals,
governments. or other entities to provide one or more MMUs to meet the PUrpOSe
of this TX I,,MTFMOA including:
(a) Non-critical care capability
(b) 1:mergent care capability
(c) 'Temporary healthcare infrastructure
(d) Isolation capability, or as a
(e) Physical structural asset
Minimum requirements for a fully staffed MMU:
1) (Clinical and Support staffing) are:
(a) Sixteen bed capacity
(b) Staffing of teams sufficient to support MMU operations based on
capability as defined in the State Mission Assignment
(c) Minimum staffing per shift for each team includes clinical and logistics
staffing as defined ror the primary mission in the State Mission Assignment
and consistent with DSIJS typing.
(d) Clinical Staff may include Ml)/I)()s, RNs. Paramedics/1',MTs, MJ,Ps
(PAs/APRNs), I'liarmacy'Fcchnicians, clerks, etc.
(c) Logistics/Support StafTtO Support maintenance, electrical, I IVAC,
communications. transportation, Set-LIP, and demobilization as agreed to by
DS1 IS at the time of'mobilization
(f) Supplies sufficient to Fulfill primary mission per the State Mission
Assignment for 72 hours
(g) The Resource will schedule its MMI J assets and estimated deployment
costs in Appendix 1).
10) AMBUS(es)
A) Purpose:
1) The purpose ofthis section is to establish a inechanisin whereby properly
staffed and equipped AMBUS(es) may be deployed fior mass transportation and/or
care of'sick and/or injured persons or to provide aid in a pending or actual disaster
as provided in this TX FN/ITFMOA.
B) Description:
1) The Lead RAC may enter into MOU/MOAs with I'VIS Providers, hospitals,
RACs or governmental entities which:
(a) Possess an AMBUS(es).
(b) The AMBI IS will be licensed as a Specialty FMS Vehicle by DSI IS.
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'[}{ DMT[ M{]/\ 09/25/2012
(o) '[be &MBl}S will bcx1uOed with baiocdundcrcdondulcdotaD[xuUlcico1
10 maintain operations
(d) Tbc minimum staffing pccxh\fturc:
(i) Properly licensed vehicle driver
(ii) Crew Chief
(ill) 2—Paramedics
(iv) 2 —E.M'[x or above
(c) The Resource will provide its /\MBUS uxnc1(s) list and estimated
deployment cost with Appendix H.
11) Miscellaneous
AJ State Law. {[state law applicable to the relationship hutvvceo 8uxnurco and l.oud
RAC contains additional or more stringent requirements than federal law regarding
any aspect ofPl{l privacy, then the Parties agree 1u comply with the higher standard
contained in applicable x1utc law.
00 Consideration. Fucb Party recognizes that the promises it has made in this
Agreement shall, henceforth. be relied upon by the other Party in choosing to
continue or commence u business relationship with the other Party.
Q Modification. This Agreement may only he inodified through a writing signed by
the Parties and, thus, no oral modiflication hereofshall be permitted. The Parties agree
to take such action as is necessary to amend this Agreement from time to time as may
ho required hy federal ocstate law.
D> Acceptance nf Mission. FluohParty understands and agrees that u Resource has
the ability 1n accept nc reject u Mission.
E) Notice to Lead RAC, Any oniicu required under this /\�rcmncn1 to be given 1n
the l.uadResource shall he made in writing to:
{.oud RAC: NortbCcn1ra| l`uxux '[osumu Regional Advisory Council
/\ttn' 1o: Executive Director
Address: h00 Six Flags l]hvc` Suite )h0
City, State: /\diogtonz. 'leuay
Zip: 700\ 1
With copy to: The Remington i.avvGroup, P\\c
&1bn. 1n: VViUiao) 11. Remington
Address: 416 West 8~' Street
City. State: !}uUux' '[cxxx
Zip: 75208
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TX FMTF MOA 09/25/2012
F) Notice to Resource. Any notice required under this Agreement to be given
Resource shall be made in writing to:
City of Fort Worth: City Manager
1000 Throckmorton Street
Fort Worth,TX 76102
With copy to:
Fort Worth Fire Department: Fire Chief
1000 Throckmorton Street
Fort Worth, TX 76102
(x) Governing Law. '['his Agreement will be goverried by and construed in
accordance with the laws of the State ofTexas without regard to choice of law.
H) Transfer or Assignment
I) This agreement may be assigned or transferred, if a new Lead RAC is assigned,
without requiring the Agency to resign the agreement. The newly designated
Lead RAC will send a notice to the Resource with a current. printed copy of the
MOA and a NoTWE' advisin(, the Resource of'the new Lead RAC.
2) The NOTI('E. will include the new Lead RAC` iriffirmation (SECTION 11-1?)
)) The NOTICE; will also include a new Signature section as executed by the new
Lead RAC
4) Otherwise, neither party may assign., transfier, delegate, or sublicense any of its
rights or obligations under this Agreement without the prior written consent of the
other party
1) Entire Agreement. This Agreement constitutes the complete agreement between
the Parties relating to the matters specified in this Agreement, and supersedes all prior
representations or agreements. whether oral or written, with respect to such matters.
No oral modification or waiver of'any of'the provisions of'this Agreement shall be
binding on either Party.
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TX E TF MOA 09/25/2012
IN WITNESS WEEREOF and acknowledging acceptance and agreement of the
foregoing,the Parties affix their signatures hereto
Lead C: NCTTRAC OF roe*
North Central Texas Trauma Regional
Advilgly Council
Lead RAC Legal e urce:Legal Name
,r.
Signature AjEature
Printed Name Printed Name "
i" 9
"Title
� Title
a....w. ..,.. ., "
Date Date
P r 4 0 a-
City S , �� ,
Cj
.. Nytl
a.b
, 'Qi�47IX.A4btl'b4&��'�
FOFF'ICIAL 11 F 7
T. T
TX FIN4'rF MOA 09/25/2012
APPENDIXA
ThcTX f,"M'I"t j,-eit,nburseniet-it rates elective during the term of t1iis Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
1)Allowable costs for EMS Assets:
A) Lead RAC will coordinate reimbursement of a base rate for:
BLS, ALS, and MI CU ambulances as per the current fee schedule.
B)with Volunteer Personnel:
1) Lead RAC will reimburse:
(a) Labor Rate of.
(i) $20.00 for' .raa6r"r.edic,,,
00 $17.50 fbr EMI' lnterrnediate,
(iii) $13.50 for ENT basic
for each hour the staff are deployed,plus overtime at tirne and a half the
established rate for any hours worked over 8 within each 24 hour period.
(b) Personal Cost: Mauxii-num of$50,00 per crew member per deployment
(I"otal of$100.00 per two rnernber crew) for items needed for the crew to be
self-sufficient during the deployment. "I'liese items may include food, water,
and personal care items, 'nie DSITS EMS Licensed Provider must keep
receipts for these iterns and must submit them-to the Lead RAC -when the
DSTIS EMS Licensed Provider subinits an invoice to the Lead RAC.
Q Resource with Paid Personnel:
1) Lead RAC will reimburse:
(a) Actual labor costs
(b) Fringe benefits for two (2)crew members per ground arribulanw.
(c) The overtime cost(1/2,time of staff required to fill the regular schCdUled
shift of staff deployed.
(d) Personal Cost: Maximum of$50.00 per crew member per deployment
(Towl of$100.00 per two trieniber crew)for items needed for the crew to be
self-sufficient during the deployment, These items may include Food, water,
and personal care items. The DSI IS F"MS I icensed Provider must keep
receipts for these iterns and must submit them to the Lead RAC when the
DSi IS EMS Licensed Provider submits an invoice to the Lead RAC
(e) Repair of damaged equipment; if applicable,
Ambulance Reimbursement Table
Item Metric BLS A MI CU
Vehicle m one Ambulance Per,hoLw $3500 $40.00 $40 00
Per Diern--based"onS35.00 per day/per person of a two person Per hour $2.92 $2.92
Amb.crew,or six peTSon AMBUS crew
Medical Supplies do'-st—Based on daily rates(BLS$240.00 per Per hour $10.00 $12.00 $15,00
day each)(ALS $2,88.00 per day each)(MIO 3 or AM131 IS
�60.00 perjay eaoh)
...... ........ �47 92 $54.92, $57.92;1'
Reirn6ursernent Rates Per hour
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TX FMTFMOA 09/25/2012
APPENDIX 13
The TX E'WITreirribursement rates effective during the term of this Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
1) Allowable costs for AM131JS Assets:
A) Lead RAC will Reimburse:
1) Uncompensated salary osts of staff to "make ready`" the Assets for
y I
deployment once the State Mission Assignment has been issued. documentation
must be submitted for proof of`payment;
2) Actual hourly labor costs ot'deployed staff plus fringe benefits
3) The overtime cost (1/2 time) of'staffreqUircd to backfill the regular scheduled
shift of staff deployed
4) Fuel;
5) Shipping/transportation fees;
6) Daily usage flee:
7) Actual cost for food and lodging will be reirnbursed at the rates established by
the State Comptroller;
8) Personal mileage from home to deployment site and return at a rate per mile as
published by the State Comptroller for the time period specified or other specific
travel costs',
9) Use of'rented vehicles will only be reimbursed at the rental rate as established
by the State Comptroller or as approved in the State Mission Assignment:
10) Use of personal vehicles will only he reimbursed for mileage using the
mileage rates Currently In effect at the time ot'deployment as published by the
State Comptroller's office. No other expenses related to the use of personal
vehicles will be reimbursed:
11) Repair of damaged equipment, if applicable.
AM131JS Reinibursement'fable
Item I)er I[our Iler Day
AMBUS $40.00 $960.00
Per Diem—based on$35.00 per day/per person $8.75 $210.00
o t'a six person A M 13 1 JS crew
Supplies $15.00 $360.00
$
Reimbursement Rates $63.75 1530.00
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IX ENTrFMOA 09125/2012
APPE NDIX C
The YX EMIT reimbursement rates efl"eclive during the ten-n, of thisAgreetnent for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment,
1) Allowable costs for Professional Staff Assets:
A) Lead RAC will reiTnburse.
1) Paid staff:
(a) Actual hourly labor cost of deployed staff plus fringe benefits.
(b) Personal mileage from home to deployment site and return at a rate per
mile as published by the State(''''ornptroller R)r the time period specified or
other specific travel costs (airfille travel, rental vehicle, parking,etc.).
(c) "'rho overtime cost (1/2 time)of staff'required to fill the regular scheduled
shift of staffdeployed.
2) Vehicles
(a) Resource-owned vehicles that will be used during deployment for field
supervision or team leaders will be reirnhursed at daily FE MA established rate
per hour for vehicle type.
(b) Use of rented vehicles will only be reimbursed at the rental rate as
established by the State, ;omplroller or as approved in the State Mission
Assignment;
(c) Use f'personal vehicles will only be reimbursed for mileage using the
mileage rates currently in effiect at the time of deployment as published by the
State Comptroller's office. No other expenses related to the use of'p,ersonal
vehicles will be reimbursed,
3) Support trailers or,Vehicles
(a) Resource owned vehicles or trailers that are not SLIPCIVisor vehicles may
be used by deployed personnel if approved on the State Mission Assignment.
Reimbursement flor these Assets shall be reirnbursed at the current FFMA
published rate.
4) Repair fdamaged equipment; if applicable.
14
TX EVIT MOA 09/25/2012
APPE'NDIX 1)
"fire,f imn reimburseme-rit,rates efibetive during the'temi of this Agreement-for the
various Assets described are listed below. Any Asset not described or any deviation frorn
these aniounts should be specifically included in the State Mission Assignment at the
time of the deployment.
1) Aflowable costs for MMIJ Assets:
A) Lead R. AC will Reimburse:
1) Uncompensated salary ccwL% of staff" to rnakc ready" t1le Assets for
deployment once the State Missk)n Assignaient, has been issued; documentation
must be submitted for proof of paynient;
2) Uncompensated salary costs of staff deployed with assets for set up and
inanagenient; documentation must be submitted for proof of payment;
3)Actual hourly labor costs ofdeployed staff plus fringe berieflts;
4) The overtime cost(112,time)of staff if required to backfill the regular
scheduled shift of staff deployed.
5) Fuel,;
6) Si,iippiii /t¢-atisporta'tioti fees;
7) Daily usage fee;
8) Actuat cost for food and lodging will be rt!imbursed at the rates established by
the State Comptroller;
9) Personal mileage from home to deployment site and return at a rate per mile as
published by the State C',ompfroller f6r the time period specified or other specific
travel costs;
10) Use of'rented vehicles will only be reimbursed at the rental rate as established
by the State Cbmptroller or as approved in the Suate Mission Assignment;
11) Use of personal vehicles will only be reimbursed for mileage using the
Mileage rates cuiTently in effect at the time of deployinent ass published by the
State Comptroller's office. No other expenses related to the use of'personal
vehicles will be reirribursed
12) Supplies used; and
13) Repair ot'darriaged equipmeatl- if applicable.
15
TX INTFIVIOA 09/25/2012
Appendix E
DEFINITIONS
Ambulance--an ENS vehicle that is licensed as an"ambulance" in the State of`Texas to
the level designated or an INS vehicle from another state that has been given legal
authority by the State of Texas to operate as licensed ambulance in Texas during the
current event.
Ambulance Strike Team (AST) -a configuration of f i ve I ike-typed Ambulances with an
Ambulance Strike Team Leader, ASTs are typed by capability.
Ambulance Strike Team Leader(ASTL)---an ASTI, credentialed FIVIS individual,
approved by DS I IS, assigned to lunction in a supervisory capacity over EMS resources
(usually ASTs), with appropriate, separate transportation.
AMBUS—an Ambulance Bus which is licensed as a "specialty vehicle" ambulance in the
State of Texas.
Assets—collectively all personnel. equipment, supplies, and services that may be
deployed, utilized, or coordinated by the Parties under this TX EMTFMOA. including
RAC staff.
Contractor -an organization that is a Contractor Nvith IN IS for the purposes of
managing the I lospital Preparedness Program in a TraUrna Service Area.
Deployed Assets --any Asset activated to respond to a State Mission Assignment.
District Disaster Committee -as defined by theTex,,,is Government Code, it is the
coordination point for the disaster districts within the State and the point of local
coordination between an RMOC and the Oovernor's Division ofFniergency
Management Incident Command Structure.
DSI IS—Texas Department oil'State I lealth Services
E,mergency or Disaster---any incident declared as an "emergency" or a."disaster" by the
State ol"Vexas. May be used independently or collectively.
EMS Personnel an INS professional licensed or certified by DS1 IS,to include ENTL
ENT-1, ENT-1) and Licensed Paramedics.
ENS Provider --an agency licensed in the State of Texas to provide ambulance service.
In-place Assets any Asset activated in support ofthe RAC 's ability to implement this
TX INTF MOA.
16
TX FMTF MOA 0912512012
Lead RAC Activation-- the initiation of the terms of this TX FMTFMOA by a State
Mission Assignment From the Lead RAC as authorized in Section 2 A of this document.
Lead RAC State Mission 4 the mobilization paperwork authorizing the
response ofthe Resource as specified in the State Mission Assignment.
n,
Mission -the Asset specified objectives, goals. etc. as outlined in the State Mission
Assignment, including but not limited to destinations,tasks, command support roles, etc.
Mobile Medical Unit (MMU) -a rapidly deployable structure capable of providing
medical care in a 16 bed configuration, to include the infrastructure support and staff for
its set up and operational use. An MMU alone does not automatically include a clinical
staff. A "Staffed Mt J" includes the clinical staff configuration.
Parties-the Parties to this TX ENTF MOA, specifically the designated, signing Lead
rn
RAC and the Resource.
RAC-an authorized Regional Advisory Council designated by 1)S1 IS
Regional Medical Operations ('enter(RMOC)- -a regional medical coordination center,
managed at the RAC or multi-RAC (EMTF region) level, in coordination with the
Governor's Division of I'mergency Management Incident Command Structure to include
local DDCs. the SOC, and the I)SI IS State Medical Operations Center(SMOC).
RN Strike Team (RNST)---a configuration of five like-typed Registered Nurses of which
one will be the RN Strike Yearn Leader. RNSTs are typed by capability.
Staffed MMU -a clinically staffied, 16 bed capable, rapidly deployable Mobile Medical
Unit, utilizing the staffing requirements as approved by DSI IS
State Mission Assignment --paperwork authorizing mobilization response of`Resources
Subcontract(s) --the agreernent(s) made by the RACs to implement this TX F.MTF MOA
or manage 11131" resources.
C
Subcontractor--a Resource that is a subcontractor with a RAC flor the purposes of
implementing this TX FMTF MOA or manaI- "I-ing I It'll resources.
Training Events---an event approved under this TX FMTU MOA to activate Assets for
the purposes of readiness and education of learn members.
TX l`1MTFMOA -this specific Memorandum of Agreement
Warning Order--the initial written notice of a pending State Mission Assignment from
I)SI IS notifying the Lead RAC ol'the possibility of'Activationand possible request to
deten-nine the initial availability of Assets.
17
TX HM'TF MOA 09/25/2012
Appendix F
Asset Information
The following int,ormation is needed for planning purposes only. These number's are not
biriding. Each Agency will ]rave the option to accept or reject each deployment. Each
Agency will also deten-rune the quantity of&ssets available to deploy.
Please do No'r provide minimal numbers but pmvide the most accurate estimate of what
could be deployed when called upon, if in a see nario that will have mininial inipact
locally.
"Fhe planning riurnbers should allow ('.oastal agencies to give real numbers of what could
send to a wildfire understanding the same assets could not be provided in a Hurricane
situation.
Agencies,will have
the ability-to deploy
more or less than the F.............. ................... ..............
planning numbers
listed below.
Agency Name
Provider/ License#
Agency Mail Address
Agency
Agency
Agreement Signatory
What Position (and
above) can
Deph)yrnents
Deployment Contact ..........
#
Deployinent all
to.
EXpiration/Renewal .................m..
Date
Does each deployable,
EMS Unit have a
VHF M(,,)bile radio
(Not 111) with TX
Inter Op channels?
V11FYC") VHF No)
18
........—------ .................. ......
TX 1`MTFMOA 09/25/2012
# TX MICUS 81'ask Force
Leaders
#Type I AI,S F—
w/ I lazMat ## FIMS Group
Supervisors
# Type 11 AI,S
non-1 fazMat # Doctors
# Type III BI,S ---- # mid-Level
w/ I lazMat Practitioners F-
# Type IV BI,S # Nurses F
non-liazMat
9 Strike Team 4 Paramedics
Leader (not oil F
AMB/AMBUS)
# Command Intermediate(not
Center F On
AMR/AMBUS)
#AMBUS F 9 FMT-Basic
# Mobile — (not on
Medical Unit F AMB/AMBUS)
# Support flTech
Trailer F
8—
M Clerk
# -IST F
(Medical 4 Logistical
Incident Crewman
Support)
It Command
# AS M Staff,
(Ambulance
Staging
Manager)
19
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