Public Health Emergency - Leading a Nation Prepared
Awarding Agency: U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of Prepared-ness and Emergency Operations (OPEO), Division of National Healthcare Prepared-ness Programs (DNHPP)
Funding Opportunity Title: Announcement of Availability of Funds for the Hospital Preparedness Program (HPP)
Announcement Type: Continuation (Cont) Cooperative Agreement (CA)
Catalog of Federal Domestic Assistance (CFDA) Number: 93.889
Application Due Date: May 21, 2010
Anticipated Award Date: July 1, 2010
Project Period: Year two of a three year period
FY10 Budget Period: 12-Months
The ASPR, OPEO, DNHPP, HPP requests continuation applications for State and jurisdictional hospital preparedness CAs, as authorized by section 319C-2 of the Public Health Service (PHS) Act, as amended by the Pandemic and All-Hazards Preparedness Act (PAHPA) (P.L. 109-417). This authorizes the Secretary of Health and Human Services (HHS) to award grants in the form of a CA to eligible entities, to enable such entities to improve surge capacity and enhance community and hospital preparedness for public health emergencies. The Consolidated Appropriations Act, 2010 (P.L. 111-117), provides funding for these awards. The funding provided through the HPP is for activities that include, but are not limited to, exercising and improving preparedness plans for all-hazards including pandemic influenza, increasing the ability of healthcare systems to provide needed beds, engaging with other responders through interoperable communication systems, tracking bed and resource availability using electronic systems, developing ESAR-VHP systems, protecting their healthcare workers with proper equipment, decontaminating patients, enabling partnerships/coalitions, educating and training their healthcare workers, enhancing fatality management and healthcare system evacuation/shelter in place plans, and coordinating regional exercises.
Purpose: The HPP goal is to ensure awardees use FY10 CA funds to maintain, refine, and to the extent achievable, enhance the capacities and capabilities of their healthcare systems, and for exercising and improving preparedness plans for all-hazards including pandemic influenza. For the purposes of the FY10 HPP CA, healthcare systems (e.g., sub-awardees) are composed of hospitals and other healthcare facilities which are defined broadly as any combination of the following: outpatient facilities and centers (e.g., behavioral health, substance abuse, urgent care), inpatient facilities and centers (e.g., trauma, State and Federal veterans, long-term, children's, tribal), and other entities (e.g., poison control, emergency medical services, CHCs, nursing, etc.).
Eligible Entities: State/Territory health departments (plus NYC, LA County, DC, and Chicago)
The Public Health Service (PHS) Act, as amended by PAHPA
Pursuant to section 319C-2(c) activities supported through funds under this FOA must help awardees to meet the following goals as outlined in section 2802(b):
Integration: Ensure the integration of public and private medical capabilities with public health and other first responder systems, including:
Medical: Increasing the preparedness, response capabilities, and surge capacities of hospitals, other healthcare facilities, and trauma care and emergency medical service systems, with respect to public health emergencies. This shall include developing plans for the following:
At-risk populations: Taking into account the public health and medical needs of at-risk individuals in the event of a public health emergency.
Coordination: Minimizing duplication of, and ensuring coordination among, Federal, State, local, and tribal planning, preparedness, response and recovery activities (including the State Emergency Management Assistance Compact). Planning shall be consistent with the National Response Framework (NRF), or any successor plan, the National Incident Management System (NIMS), and the National Preparedness Goal (NPG), as well as any State and local plans.
Continuity of Operations: Maintaining vital public health and medical services to allow for optimal Federal, State, local, and tribal operations in the event of a public health emergency.
The following four overarching requirements must be incorporated into the development and maintenance of all sub-capabilities:
In accordance with Homeland Security Presidential Directive (HSPD)-5, NIMS provides a consistent approach for Federal, State, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic inci-dents, regardless of cause, size, or complexity. As a condition of receiving HPP funds, awardees shall ensure that appropriate participating healthcare systems continue im-plementing and maintaining NIMS activities during FY10, and FY11 budget periods.
Application Requirement - Awardees: All awardees will assess and report annually which participating healthcare systems currently have adopted all NIMS implementation activities, and which are still in the process of implementing the 14 activities. For any participating healthcare system still working to implement NIMS activities, funds must be prioritized and made available during the FY10 and FY11 budget periods to ensure the full implementation and maintenance of all activities during the three-year project period.
Application Requirement - Healthcare Systems: All participating healthcare systems must comprehensively track all NIMS implementation activities, and report on those activities annually as part of the reporting requirements for the FY10
Application Requirement: FY10 HPP applications must clearly describe which at-risk populations with medical needs are being served, and the activities that will be undertaken with respect to the needs of these individuals. Medical needs include, but are not limited to behavioral health consisting of both mental health and substance abuse considerations. Awardees should work with community-based organizations serving these groups to ensure plans are appropriate, involve the necessary partners, and include representation from the at-risk populations.
In addition to those individuals specifically recognized as at-risk in section 2802(b)(4)(B) of the PHS Act (E.g., children, senior citizens, and pregnant women), individuals who may need additional response assistance should include those who: have disabilities; live in institutionalized settings; are from diverse cultures; have limited English proficien-cy or are non-English speaking; are transportation disadvantaged; have chronic medical disorders; and/or have pharmacological dependency. In simple terms, at-risk popula-tions are those who have, in addition to their medical needs, other needs that may inter-fere with their ability to access or receive medical care. Such needs could include addi-tional needs in one or more of the following functional areas:
Application Requirement: Awardees shall ensure that education and training opportunities/programs exist for healthcare workers who respond to terrorist incidents or other public health emergencies during the FY10 and FY11 budget periods and ensure those opportunities or programs encompass the sub-capabilities described herein.
Awardees shall undertake activities that ensure all education and training opportuni-ties/programs enhance the ability of healthcare workers (including not only healthcare system workers, but those from local health departments, community healthcare sys-tems, emergency response agencies, public safety agencies, and others) to respond in a coordinated and non-overlapping manner. In order to reduce costs and build relationships, joint training of all healthcare system workers is strongly encouraged.
*Funds may be used to offset the cost of healthcare system worker participation in train-ing centered on sub-capability development; to prepare workers with the necessary knowledge, skills and abilities to perform/enhance the sub-capability; and to participate in drills and exercises around those sub-capabilities or related systems.
*The HPP fully expects that awardees will work closely with their sub-awardees in de-termining cost-sharing arrangements that will facilitate the maximum number of workers participating in training, drills and exercises.
Application Requirement: *To meet the applicable goals described in section 2802(b) of the PHS Act, all FY10 applications must address the evaluation of State and local preparedness and response capabilities through drills and exercises.
In FY10, and throughout the three-year project period, awardees are strongly encour-aged to continue to use the DHS Senior Advisory Committees, established to coordi-nate Federal preparedness programs and encourage collaboration at the State and lo-cal level among homeland security, emergency management, public safety, public health, the health and medical community, and other responders, to develop and refine a multi-year exercise plan for conducting joint exercises to meet multiple requirements from various grant/CA programs, and minimize the burden on exercise planners and participants.
Exercise plans must demonstrate coordination with relevant entities such as local healthcare system partnerships/coalitions, Metropolitan Medical Response System (MMRS) entities, the local Medical Reserve Corps (MRC), Urban Area Working Groups (UAWG) and the Cities Readiness Initiative (CRI) jurisdictions, to the extent possible.
*Awardees are expected to work with relevant State and local officials to provide infor-mation for the National Exercise Schedule (NEXS), so that exercises can be coordi-nated across levels of government.
*At-risk populations and/or those who represent them must also be engaged in prepa-redness planning and exercise activities.
Project Activities Funded:
FY10 HPP cooperative agreement funds will be used to continue building medi-cal surge capacity and capability at the State and local level through associated planning, personnel, equipment, training and exercises.
Level One Sub-Capabilities
Application Requirement: All awardees are required to equip participating healthcare systems, to the extent achievable, with communication devices which allow them to communicate horizontally (with each other), and vertically with EMS, fire, law enforce-ment, local and State public health agencies, etc.
Awardees are encouraged to fund at least one dedicated line for a minimum of 3 healthcare systems per sub-State region as part of HPP participation in the Federal Communications Commission TSP program. The TSP requires local telecommunica-tions service providers to give restoration, or provisioning service priority to users even during disasters, where there is extensive damage to the telecommunications infrastructure and large numbers of other local customers are out of service.
Application Requirement: During the FY 10 and FY11 budget periods, awardees are required to maintain and refine an operational bed tracking, accountability/availability systems compatible with the HAvBED data standards and definitions.
Systems must be maintained, refined, and adhere to all requirements and definitions, with the ongoing ability to submit required data using one of two following mechanisms:
Awardees may choose to use the HAvBED web-portal to manually enter the required data. Data are to be reported in aggregate by the State, therefore the State must have a system that collects the data from the participating healthcare systems, OR Awardees may use existing systems to automatically transfer required data to the HAvBED server using the HAvBED EDXL Communication Schema, found at: www.havbed.hhs.gov
Application Requirement: The ASPR expects that all ESAR-VHP electronic system, operational, evaluation and reporting compliance requirements are met by August 8, 2012.
The purpose of the ESAR-VHP program is to establish a national network of State-based programs to effectively facilitate the use of volunteers in local, territorial, State, and Federal emergency responses. In order to successfully support the use of health professional volunteers at all tiers of response, State ESAR-VHP programs must work to ensure program viability and operability through the development of plans to:
Application Requirement: All awardees must work closely with participating health-care systems and other appropriate entities, to ensure that facility level fatality man-agement plans are integrated into local, jurisdictional and State plans for disposition of the deceased. These plans must clearly account for the proper identification, handling and storage of remains.
In FY10 and FY11, awardees shall continue to develop disaster and mass fatality man-agement plans and concepts of operation with participating healthcare systems, local health departments, emergency management and their State/jurisdictional Chief Medi-cal Examiner/Coroner.
Application Requirement: The ASPR understands that not all scenarios will (or should) require a full or partial facility evacuation. In some situations it may be safer and more medically responsible for healthcare systems to shelter in place versus eva-cuating patients and/or facilities.
*Awardees must continue to integrate the evacuation planning of participating health-care systems into Tiers 2, 3, and 4 of the MSCC framework.
Proactive planning and preparation will ensure successful operational plans. Awardees should continue to maintain and refine plans, based on their State, regional, and/or community-based HVAs, to identify the imminent threat to life in the area. The nature of the vulnerability and the hazards posed should help the awardees and healthcare systems plan for the event. Awardees should continue to maintain and refine their plans based on the personnel, equipment and systems, planning, and training needs to ensure the safe and respectful movement of patients, and the safety of facility healthcare workers and family members.
During the FY10 and FY11 budget periods, all awardees shall continue to ensure operational partnerships/coalitions that encompass all CRI cities in the State plus an equal number of partnerships/coalitions involving non-CRI sub-State regions.
For example, if a State possesses 2 CRI cities, then 4 partnerships/coalitions must be maintained and refined (2 in the CRI cities and 2 in other sub-State regions).
Partnerships/coalitions are strongly encouraged to continue to plan and de-velop memoranda of understanding (MOU) to share assets, personnel and information. These MOUs shall be tested through tabletop components of exercises conducted in CRI and non-CRI cities as described above in the Exercises, Evaluations and Corrective Actions section.
Partnerships/coalitions shall develop plans to unify ESF-8 management of healthcare during a public health emergency, and integrate communication with jurisdictional command in the area.
Level Two Sub-Capabilities
Level Two Sub-capability activities remain allowable under the FY10 HPP CA pro-vided all are adequately justified through the HVA/Capability-Based planning process, and all Level One Capabilities are being adequately addressed in the work plan.
During any budget period within the three-year project period, the ASPR expects awar-dees to continue developing and improving their ACS plans and concept of operations for providing supplemental surge capacity to the healthcare system. ACS plans should include issues on providing care and allocating scarce equipment, supplies, and personnel by the State at such sites.
ACS planning should be conducted by closely working with HHS Regional Emergency Coordinators (RECs), local health departments, State Public Health Agencies, State Medicaid Agencies, State Survey Agencies, provider associations, community partners, State mental health and substance abuse authorities, and neighboring and regional healthcare systems.
*Many awardees have been developing ACS plans as an option for providing disaster and mass casualty medical care in the event that healthcare systems are overrun or rendered unusable by a disaster. Awardees may use HPP CA funds to continue build-ing robust plans for the use of such facilities.
During any budget period within the three-year project period, awardees may need the ability to provide care outside of their healthcare systems. Use of mobile medical as-sets (tents, trailers or medical facilities that can be easily transported from one place to another) may be an option for some jurisdictions until patients in large population cen-ters can be evacuated to less affected outlying areas with intact healthcare delivery systems. Awardees may continue to develop or begin to establish plans for a mobile medical capability, working with State and local stakeholders to ensure integration of plans and sharing of resources. Mobile medical plans must address staffing, supply and re-supply, and training of associated personnel, who may function interchangeably as surge augmentation or evacuation facilitators.
During any budget period within the three-year project period, each awardee may de-velop an operational plan that assures storage, rotation and timely distribution of critical antibiotic medications through the supply chain during an emergency, for healthcare workers and their families. Although many awardees should already have caches in place due to the multiple years of HPP funding for this activity, awardees may continue to establish, maintain or enhance event accessible caches of specific categories of pharmaceuticals, and ensure availability in facilities/on-site, cached within regions, or at the State level.
*Awardees may undertake analysis of and propose funding for the purchase of antiviral caches to care for patients in healthcare systems, if this has not already occurred. HPP funding may be used to purchase, replace and rotate pharmaceuticals only if the purchases are linked to State, regional, and/or community-based HVAs, and gaps iden-tified that show where and why sufficient quantities do not currently exist.
During any budget period within the three-year project period, awardees should ensure adequate types and amounts of personal protective equipment (PPE) to protect current and additional trained healthcare workers expected in support of the events of highest risk, and identified through State, regional, and/or community-based HVAs or assessments. The amount should be tied directly to the number of healthcare workers needed to support bed surge capacity during an MCI that requires PPE.
The level of PPE should be established based on the HVA, and the level of decontami-nation that is planned in each region. For example, those healthcare systems that have identified probable high-risk scenarios (E.g., the facility functions near an organophosphate production plant with a history of employee contamination incidents) should have higher levels of PPE, and more stringent decontamination processes.
During any budget period within the three-year project period, each awardee should ensure that adequate portable or fixed decontamination system capability exists Statewide for managing adult and pediatric patients, as well as healthcare workers, who have been exposed during all-hazards health and medical disaster events.
The level of capability should be in accordance with the number of required surge ca-pacity beds expected to support the events of highest risk identified through State, re-gional, and/or community-based HVAs or assessments. All decontamination assets shall be based on how many patients/providers can be decontaminated on an hourly basis.
The Medical Reserve Corps (MRC) program is administered by the HHS Office of the Surgeon General. MRC units are organized locally to meet the health and safety needs of their communities. MRC members are identified, credentialed, trained and organized in advance of an emergency, and may be also be utilized throughout the year to improve the public health system.
FY10 HPP CA funds may be used to:
Protecting and ensuring the resiliency of the critical infrastructure and key resources (CI/KR) of the United States is essential to the Nation’s security, economic vitality and public health. In The National Infrastructure Protection Plan (NIPP) Base Plan, the De-partment of Homeland Security sets forth the national model to protect critical assets, systems, networks, and functions for each of the 17 national CI/KR sectors identified in Homeland Security Presidential Directive (HSPD)-7, Critical Infrastructure Identification, Prioritization and Protection.
During any budget period within the three-year project period, awardees may propose projects that relate directly to resilience and protection of critical healthcare systems and services. Suggestions should be based on a need identified in State, regional, and/or community-based HVAs, or other assessments.
Some examples may include: upgrading of security systems; movement of switching rooms and generators; ensuring adequate back up generators or other power sources for key facilities in the region; expanding the functions/services that have back-up power (HVAC, elevators, security systems, etc.); or implementing strategies for managing ha-zardous medical waste.
HHS recognizes that healthcare system level needs will likely be high for these kinds of activities but still urges awardees to consider activities and purchases that support REGIONAL approaches to planning and response due to limited funding and competing demands.
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