Long-Term Care Toolkit Appendix K: MOU Template

Background

For emergency preparedness, a memorandum of understanding (MOU) establishes a mutual, nonbinding agreement of how and to what extent organizations will respond to and support each other during an emergency or disaster incident. These understandings should define the scope of services to be provided and reimbursement considerations in advance of an incident to help each facility establish an effective emergency plan.

Developing MOUs is an essential element of a strong and effective emergency plan. If your facility is concerned about the legal or binding nature of an MOU with a response partner, it is recommended that you consult your facility’s legal counsel.

Guidance

There are three MOU template options to choose from and apply to the needs of your facility. They are to provide:

• Temporary shelter (between facilities that are similar by level of service or license).
• Temporary shelter (with a non-long-term care facility, e.g., church, senior center, school).
• Transportation services.

The MOU templates contain standard text that may be used as written or modified as needed by your facility or facilities. The templates include guidance that should be considered while developing the MOU. This guidance text, as well as blank spaces and prompts for you to enter facility-specific information, should be removed before the MOU is finalized.

Samples of the templates are hyperlinked to Word versions of the templates with fillable fields.

The examples below are from the Wisconsin Department of Health Services.

Memorandum of Understanding for Temporary Shelter (like facility)

Memorandum of Understanding for Temporary Shelter (Community Partner/Non-LTC)

Memorandum of Understanding for Transportation Services