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The Hospital Preparedeness Program & Public Health Emergency Preparedness Program Cooperative Agreement is a contract between the Federal Government (ASPR & CDC) and the states. It is not an agreement between CDC and local health departments or between ASPR and healthcare coalitions.

HOLD

The purpose of 2017-2022 HPP-PHEP cooperative agreement is to strengthen and enhance the capabilities of the public health and health care systems to respond to evolving threats and other emergencies. Effective responses will enable jurisdictions to prevent or reduce morbidity and mortality from public health incidents whose scale, rapid onset, or unpredictability stresses the public health and health care systems and to ensure the earliest possible recovery and return of the public health and health care systems to pre-incident levels or improved functioning.

By the end of the project period, ASPR expects HPP awardees to strengthen and enhance the readiness of the health care system for activities that advance and document progress toward meeting the goals of the four capabilities detailed in the 2017-2022 Health Care Preparedness and Response Capabilities.

ASPR also expects awardees to document progress across five key domains in establishing or maintaining ready health care systems through strong health care coalitions.

HPP awardee strategies, activities, and related outputs indicated in the logic model will lead to achieving these response and program outcomes during the project period:

  • Timely assessment and earliest possible sharing of essential elements of information,
  • Earliest possible identification and investigation of an incident,
  • Earliest possible implementation of intervention and control measures,
  • Earliest possible communication of situational awareness and risk information,
  • Continuity of emergency operations management throughout the surge of an emergency or incident,
  • Timely and situationally appropriate coordination and support of response activities with partners, and
  • Continuous learning and improvements are systematic.

ASPR will monitor process outputs and performance measures to determine each awardees level of performance.

Important!  Remember, the cooperative agreement is a contract between ASPR and the Awardee, not between the Awardee and the healthcare coalition. HPP cooperative agreement requirements and recommendations only enforceable on the sub grantee – the healthcare coalition – if they are specifically stated in the coalition's sub grant.

But, if the term "the HCC Must" is stated within the cooperative agreement, the Awardee Must include the requirement within the coalition's sub grant.

HPP Cooperative Agreement subgrant flow

2017-2018 hpp cooperative agreement domain one strategy

strengthen community resilience

Resilient communities develop, maintain, and leverage collaborative relationships among government, community organizations, and individual households that enable them to more effectively respond to and recover from disasters and emergencies. Awardees must conduct the following activities that sustain or expand community resilience. These activities must be actionable, realistic, and support the achievement of readiness outputs and intended outcomes.

  • Partner with stakeholders by developing and maturing health care coalitions
  • Characterize the probable risks to the jurisdiction and the HCC
  • Characterize populations at risk
  • Engage communities and health care systems
  • Operationalize response plans.

 

Establish a Healthcare Coalition:

For the purposes of this FOA, ASPR defines a health care coalition (HCC) as a coordinating body that incentivizes diverse and often competitive health care organizations and other community partners with differing priorities and objectives and reach to community members to work together to prepare for, respond to, and recover from emergencies and other incidents that impact the public’s health. HCCs should coordinate with their HCC members to facilitate:

  • Strategic planning
  • Identification of gaps and mitigation strategies
  • Operational planning and response
  • Information sharing for improved situational awareness
  • Resource coordination and management.

All awardees must develop and/or mature their HCCs by the end of Budget Period 1. With funding provided, HPP expects awardees to refine and/or sustain HCCs through the end of the five-year project period. Further, awardees must work collaboratively with each HCC and its members including by defining all HCC boundaries in their jurisdictions by the end of Budget Period 1. The following are Budget Period 1 requirements.

  • When defining the HCC boundaries, awardees and HCCs must consider daily health care delivery patterns, corporate health systems, and defined catchment areas, such as regional emergency medical services (EMS) councils, trauma regions, accountable care organizations, emergency management regions, etc.
  • Awardees must ensure partnership and engagement with their local health departments within identified HCC boundaries.
  • Awardees must ensure that there are no geographic gaps in HCC coverage and that all interested health care facilities, including independent facilities, are able to join an HCC, if desired.

Following are additional factors that awardees and their HCCs should consider when defining HCC boundaries for Budget Period 1 and the entire project period.

  • HCC boundaries may span several jurisdictional or political boundaries. Please note that due to cooperative agreement restriction, funding must be limited to HCCs within awardees’ jurisdictional boundary.
  • HCC boundaries should encompass more than one of each member type, such as hospitals and EMS, to enable coordination and enhance the HCC’s ability to share the load during an emergency (see also HCC member requirements below).

Once boundaries are established, HCCs must coordinate with all ESF-8 lead agencies within those defined boundaries. HCCs serve as multiagency coordination groups that should support and integrate with ESF-8 activities.

Coordination between the HCC and the ESF-8 lead agency can occur in a number of ways. Some HCCs serve as the ESF-8 lead agency for their jurisdiction(s). Others integrate with their ESF-8 lead agency through an identified designee at the jurisdiction’s emergency operations center (EOC) who represents HCC issues and needs and provides timely, efficient, and bidirectional information flow to support situational awareness.

More Detail! More information about defining HCC boundaries can be found in Capability 1, Objective 1, Activity 1 of the Health Care Preparedness and Response Capabilities!

ASPR defines an HCC member as an entity within the HCC’s defined boundaries that actively contributes to HCC strategic planning, identification of gaps and mitigation strategies, operational planning and response, information sharing, and resource coordination and management.

HCCs must collaborate with a variety of stakeholders to ensure the community has the necessary medical equipment and supplies, real-time information, communication systems, and trained and educated health care personnel to respond to an emergency. These stakeholders include core HCC members and additional HCC members. HCCs should include a diverse membership to ensure a successful whole community response. 

HCCs must ensure the following core membership:

  • Hospitals (a minimum of two acute care hospitals)
  • EMS (including inter-facility and other non-EMS patient transport systems)
  • Emergency management organizations
  • Public health agencies.

Further, awardees are not permitted to use HPP funds to make subawards to any HCC that does not meet the core membership requirements. ASPR understands that urban and rural HCCs may have different membership compositions based on population characteristics, geography, and types of hazards, but each funded HCC must include, at least, the core members.

Awardees and HCCs should expand HCC membership to include additional types of members. In cases where there are multiple entities of an HCC member type, there may be a subcommittee structure that establishes a lead entity to communicate common interests to the HCC. The awardee must make available a listing or provide access to a listing of additional coalition members as defined in the 2017-2022 Health Care Preparedness and Response Capabilities. HCC membership does not begin or end with attending meetings (see also HCC governance requirements below). 

HCCs also should include specialty patient referral centers such as pediatric, burn, trauma, and psychiatric centers, as HCC members within its geographic boundaries. They may also serve as referral centers to other HCCs where that specialty care does not exist.

More Detail! More information about identifying HCC membership can be found in Capability 1, Objective 1, Activity 2 of the Health Care Preparedness and Response Capabilities!

Each HCC funded by the awardee must define and implement a governance structure and necessary processes to execute activities related to health care delivery system readiness and coordination by the end of Budget Period 1. HCC governance should include organizational structures, roles and responsibilities, mechanisms to provide guidance and direction, and processes to ensure integration with the ESF-8 lead agency.

The HCC must document the following information related to its governance and must be prepared to submit the documentation to an HPP field project officer (FPO) upon request:

  • HCC membership
  • An organizational structure to support HCC activities
  • Member guidelines for participation and engagement
  • Policies and procedures
  • Integration within existing state, local, and member-specific incident management structures and specifies roles.

Information about using HPP funds to establish a HCC legal entity can be found ASPR Grant Directive-02(A). “Use of Grant Funds for Setting up a HCC as a Separate Legal Entity” is available in the HPP-PHEP Supplemental Guidelines.

More Detail! More information about establishing HCC governance can be found in Capability 1, Objective 1, Activity 3 of the Health Care Preparedness and Response Capabilities!

ASPR will implement an HPP-provided tool that the HCC, in coordination with their awardee and HCC members, must use to self-assess its progress toward meeting program requirements and the 2017-2022 Health Care Preparedness and Response Capabilities. The tool will allow HCCs and their members to better plan and prioritize activities, help awardee and HCC leadership identify risks and issues earlier, and enable HPP to provide more targeted assistance.

Each HCC funded by the awardee must develop a preparedness plan and submit the plan to ASPR by the end of Budget Period 1 with the annual progress report (APR).

The HCC must develop its preparedness plan to include core HCC members and additional HCC members so that, at a minimum, hospitals, EMS, emergency management organizations, and public health agencies are represented. The HCC preparedness plan must emphasize strategies and tactics that promote communications, information sharing, resource coordination, and operational response planning with HCC members and other stakeholders.

HCC members should approve the initial preparedness plan and maintain involvement in no less than annual reviews. The final preparedness plan must be approved by all its core member organizations. The review should include identifying gaps in the preparedness plan and working with HCC members to define strategies to address the gaps. Following reviews, the HCC must update the plan as necessary after exercises and real incidents. All of the HCC’s additional member organizations must be given an opportunity to provide input into the preparedness plan, and all member organizations must receive a final copy of the plan.

Each preparedness plan can be presented in various formats, including a subset of strategic documents, annexes, or a portion of the HCC’s concept of operations (CONOPS) plans; however, at a minimum the HCC preparedness plan must:

  • Incorporate the HCC’s and its associated members’ priorities for planning and coordination based on regional needs and gaps. Priorities will depend on multiple factors including perceived risk, emergencies occurring in the region, available funds, applicable laws and regulations, supporting personnel, HCC member facilities and organizations involved, and time constraints
  • Leverage HCC members’ existing facility preparedness plans as required by the CMS Emergency Preparedness Rule: Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
  • Be developed by HCC leadership with broad input from HCC members and other stakeholders
  • Outline strategic and operational objectives for the HCC as a whole and for each HCC member
  • Include short-term – within the year – and longer-term – three- to five-year – objectives
  • Include a recurring objective to develop and review the HCC response plan, which details the responsibilities and roles of the HCC and its members, including how they share information, coordinate activities and resources during an emergency, and plan for recovery
  • Inform training, exercise, and resource and supply management activities during the year
  • Include a checklist of each HCC member’s proposed activities, methods for members to report progress to the HCC, and processes to promote accountability and completion.
More Detail! More information about the HCC Preparedness Plan can be found in Capability 1, Objective 3 of the Health Care Preparedness and Response Capabilities!

All HPP and PHEP awardees must participate in or complete a jurisdictional risk assessment (JRA) at least once every five years.

The five-year period can extend from one project period to the next, but ASPR and CDC require awardees conduct at least one JRA in this project period. For instance, if a JRA was conducted in Budget Period 4 during the previous project period, one is not necessary until Budget Period 4 of this project period. HPP and PHEP awardees should coordinate risk assessment activities with each other and with relevant emergency management and homeland security programs in their jurisdictions. In addition, risk assessment activities must be coordinated as possible with relevant emergency management and homeland security programs to support jurisdictional Threat and Hazard Identification and Risk Assessment (THIRA) efforts.

HPP and PHEP awardees should use the JRA to identify the potential hazards, vulnerabilities, and risks facing their jurisdiction and their HCCs. Awardees should incorporate the impact from incidents that may have occurred since the last JRA. Awardees must ensure that all their funded HCCs have the opportunity to provide input into the JRA for this project period. Further, awardees must provide their HCCs with the date the JRA was completed or is projected to be completed.

ASPR and CDC recommend more frequent analyses of hazards and vulnerabilities to maintain progress toward improving community resilience. Awardees should incorporate impact from incidents that may have occurred since the last JRA for which public health or health care had a lead role in mitigating identified disaster health risks. If a JRA or equivalent was conducted less than five years before an incident, awardees should review risks and develop brief narratives describing how they have continued to engage critical partners to address vulnerable populations.

In addition, ASPR and CDC recommend awardees review current findings of the National Health Security Preparedness Index (NHSPI) and their respective State Preparedness Reports (SPR) to help gauge risks and gaps. NHSPI is intended to help guide efforts to improve state and local public health systems and achieve a higher level of health security preparedness. HPP and PHEP awardees should use NHSPI results to help them assess their jurisdictional strengths and weaknesses. The results should be analyzed, along with other data sources such as the HHS Capabilities Planning Guide, jurisdictional risk assessments, incident after-action reports and improvement plans, site visit observations, and other jurisdictional priorities and strategies, to help determine their strategic priorities, identify program gaps, and, ultimately, prioritize preparedness investments. More information on the NHSPI can be found at http://www.nhspi.org/.

Each awardee-funded HCC must complete an annual hazard vulnerability analysis (HVA) to identify and plan for risks, in collaboration with the awardee.

These assessments can determine resource needs and gaps, identify individuals who may require additional assistance before, during, and after an emergency, and highlight applicable regulatory and compliance issues. The HCC and its members should use the information about these risks and needs to inform training and exercises and prioritize strategies to close or mitigate preparedness and response gaps within their boundaries. The HCC must be prepared to submit documentation about its HVA to the HPP FPO upon request.

General principles for the HCC HVA process include, but are not limited to, the following:

  • The HVA process should be coordinated with state and local emergency management organization assessments, such as THIRA, and any public health hazard assessments, including a jurisdictional risk assessment. The intent is to ensure completion, share risk assessment results, and minimize duplication of effort.
  • The assessment components should include regional characteristics, such as risks for natural or manmade disasters, geography, and critical infrastructure.
  • The assessment components should address population characteristics, including demographics, and consider those individuals who might require additional help in an emergency including children, pregnant women, seniors, and individuals with access and functional needs, including people with disabilities and others with unique needs.
  • The HCC should regularly review and share the HVA with all members.

Each HCC funded by awardees must complete a resource assessment to identify health care resources and services at the jurisdictional and regional levels that could be coordinated and shared.

This information is vital for continuity of health care delivery during and after an emergency. Further, this information is critical to uncovering resource vulnerabilities relative to the HCC’s HVA that could impede the delivery of medical care and health care services during an emergency. To meet the community’s clinical care needs during an emergency, HPP awardees must ensure that each HCC maintains visibility into their members’ resources and resource needs, such as personnel, facilities, equipment, and supplies. HCCs must be capable of tracking this information and sharing it with all of their members by the end of Budget Period 2.

The HCC must be prepared to submit documentation about its resource assessment to the HPP FPO upon request.

Additionally, the HCC, in collaboration with its HCC members, should compare available resources and current HVA(s) to identify gaps and help prioritize HCC and HCC member activities. The HCC should focus its time and resource investments on closing those gaps that will improve the care of acutely ill and injured patients.

More Detail! More information about identifying risks and needs, assessing hazard vulnerabilities, assessing regional health care resources, and prioritizing resource gaps and mitigation strategies can be found in Capability 1, Objective 2, Activities 1, 2, and 3 of the Health Care Preparedness and Response Capabilities!

Certain individuals may require additional assistance before, during, and after an emergency. HPP and PHEP awardees must conduct inclusive risk planning for the whole community, including for children; pregnant women; senior citizens; individuals with access and functional needs, including people with disabilities; individuals with pre-existing, serious behavioral health conditions; and others with unique needs throughout the five year project period.

In conducting this risk planning, HPP and PHEP awardees must involve each HPP-funded HCC and its HCC members. In addition, HPP and PHEP awardees are encouraged to involve experts in non-infectious diseases (chronic conditions and maternal and child health experts) in risk planning.

HPP and PHEP awardees must describe the structure or processes in place to integrate the access and functional needs of at-risk individuals. Recommended strategies involve inclusion in public health, health care, and behavioral health response activities; furthermore, these strategies should be identified and addressed in operational work plans. ASPR and CDC encourage HPP and PHEP awardees, subawardees, and HCCs to identify community partners with established relationships with diverse at-risk populations, such as social services organizations and Federally Qualified Health Centers.

HPP awardees and HCCs must obtain de-identified data from the U.S. Department of Health and Human Services emPOWER map every six months to identify populations with unique health care needs, such as dialysis and those with electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs.

ASPR strongly recommends that HPP awardees also use the Agency for Toxic Substances and Disease Registry (ATSDR)’s Social Vulnerability Index, which helps identify risk factors and at-risk populations by geographic area. Other demographic tools, such as the U.S. Census/American Community Survey, may help awardees, subawardees, and HCCs to better anticipate the potential access and functional needs of at-risk community members before, during, and after an emergency.

As part of inclusive planning for populations at risk conducted by HPP awardees, HPP-funded HCCs must:

  • Support public health agencies with situational awareness and information technology (IT) tools already in use that can help identify children, seniors, pregnant women, people with disabilities, and others with unique needs
  • Support public health agencies in developing or augmenting existing response plans for these populations, including mechanisms for family reunification
  • Identify potential health care delivery system support for these populations (pre- and post-event) that can prevent stress on hospitals during an emergency
  • Assess needs and contribute to medical planning that may enable individuals to remain in their residences during certain emergencies. When that is not possible, coordinate with the ESF-8 lead agency to support the ESF-6 (Mass Care, Emergency Assistance, Housing, and Human Services) lead agency with inclusion of medical care at shelter sites
  • Coordinate with the ESF-8 lead agency to assess medical transport needs for these populations.

Resources to facilitate this work can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

More Detail! More information for HPP awardees and HCCs about assessing community planning for populations at risk can be found in Capability 1, Objective 2, Activity 4 of the Health Care Preparedness and Response Capabilities!

HPP and PHEP awardees must continue to build and sustain community partnerships to support health care preparedness and response to ensure that activities have the widest possible reach with the strongest possible ties to the community.

Awardees must describe the structure or processes in place to integrate the access and functional needs of at-risk individuals. Recommended strategies to integrate the access and functional needs of at-risk individuals involve inclusion in public health, healthcare, and behavioral health response strategies within work plans. ASPR and CDC recommend awardees, subawardees, and HCCs identify community partners with established relationships with diverse at-risk populations, such as social services organizations, and use available tools to better anticipate the potential access and functional needs of at-risk community members before, during, and after an emergency.

Helpful tools include the CDC Public Health Workbook To Define, Locate, and Reach Special, Vulnerable, and At-risk Populations in an Emergency and ATSDR’s Social Vulnerability Index (https://svi.cdc.gov/), which helps identify risk factors and at-risk populations by geographic area. Numerous additional resources to facilitate this work can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.


Local Health Department Participation in HCCs

HPP and PHEP awardees must ensure that local health departments participate in HCCs in their jurisdictions. PHEP awardees should also ensure partnership and engagement with fusion centers, poison control centers, and other community-based organizations. Additional guidance on recommendations can be found in the 2017-2022 HPP-PHEP Supplemental Guidelines.

 

Sustainability and HCC Value

Sustainability planning is a critical component in HCC development. Strong governance mechanisms, constant regional stakeholder engagement, and sound financial planning help form the foundation to continue HCC activities well into the future.

There are a variety of ways to promote greater community effectiveness and organizational and financial sustainability. Full investment in readiness includes in-kind donation of time, resources, support, and continued engagement with HCC members and the community. Financial strategies, including cost-sharing techniques and other funding options, enhance stability and sustainment. The HCC should:

  • Offer HCC members technical assistance or consultative services in meeting the CMS Emergency Preparedness Rule: Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
  • Develop materials that identify and articulate the benefits of HCC activities to its members and additional stakeholders and promote HCC preparedness efforts to health care executives, clinicians, community leaders, and other key audiences
  • Explore ways to meet individual member’s requirements for tax exemption through community benefit
  • Analyze critical functions to preserve and identify financial opportunities beyond federal funding, such as foundations and private funding, dues, and training fees to support or expand HCC functions
  • Develop a financing structure, and document the funding models that support HCC activities
  • Determine ways to cost share, such as coordinating required exercises with public health agencies, emergency management organizations, and other organizations with similar requirements
  • Incorporate leadership succession planning into the HCC governance and structure
  • Leverage group buying power to obtain consistent equipment across a region and allow for sharing or emergency allocation of equipment

Executive, Clinician, and Community Leader Engagement

Health care executives can promote coordination and buy-in across all health care facility and organization types, clinical departments, and nonclinical support services. To that end, the HCC should communicate the direct and indirect benefits of HCC membership to health care executives to advance their engagement in preparedness and response and to contribute to their understanding of other day-to-day benefits HCC membership offers.

Health care executives should provide input, acknowledgement, and approval regarding HCC strategic and operational planning. The HCC should regularly inform health care executives of HCC activities and initiatives through reports and regular invitations to participate in meetings, trainings, and exercises. At a minimum, the HCC must engage its members’ health care executives in debriefs (“hot washes”) related to exercises, planned events, and real incidents (See HPP 2017-2022 Performance Measures Implementation Guide).

More Detail! More information about engaging health care executives and clinicians can be found in Capability 1, Objective 5, Activities 2 and 3 of the Health Care Preparedness and Response Capabilities!

Further, ASPR encourages HCCs to engage health care delivery system clinical leaders to provide input, acknowledgement, and approval regarding strategic and operational planning. Clinicians from a wide range of specialties should be included in HCC activities on a regular basis to validate medical surge plans and to provide subject matter expertise to ensure realistic training and exercises. Clinicians with relevant expertise should lead health care provider training for assessing and treating various types of illnesses and injuries. Clinicians should be engaged in strategic and operational planning, contribute to committees and advisory boards, and participate in training and education sessions. Additional engagement can include active participation in planning, exercise, and response activities.

More Detail! More information about engaging community leaders can be found in Capability 1, Objective 5, Activity 4 of the Health Care Preparedness and Response Capabilities!

Consistent with a whole community approach to preparedness, the HCC should actively work with and engage community leaders outside of its members. The HCC should identify and engage community members, businesses, charitable organizations, and the media in health care preparedness planning and exercises to promote the resilience of the entire community. Community engagement creates greater awareness of the HCC’s role and emergency preparedness activities.

More Detail! More information about sustainability planning and promoting the value of health care coalitions can be found in Capability 1, Objective 5, Activities 1 and 5 of the Health Care Preparedness and Response Capabilities!

HPP and PHEP awardees and each HCC, as part of a coordinated statewide effort, must conduct a joint statewide exercise (functional or full-scale exercise) once during the project period to test progress toward achieving the capabilities outlined in the 2017-2022 Health Care Preparedness and Response Capabilities and the Public Health Preparedness Capabilities: National Standards for State and Local Planning, and in collaboration with cross-border metropolitan statistical area (MSA)/Cities Readiness Initiative (CRI) regions. Exercise requirement details are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.

2017-2018 hpp cooperative agreement domain two strategy

strengthen incident management

HPP and PHEP awardees must conduct the following activities to strengthen emergency operations management throughout all phases of an incident.

  • Coordinate emergency operations
  • Standardize the incident command structure (ICS) for public health
  • Establish incident command structures for health care organizations and HCCs
  • Ensure HCC integration and collaboration with ESF-8
  • Expedite fiscal and administrative preparedness procedures

All-hazards Emergency Preparedness and Response Plan

HPP and PHEP awardees must maintain a current all-hazards public health and medical emergency preparedness and response plan.

Awardees must submit their plans to ASPR and CDC when requested and make it available for review during site visits. Awardees must provide an opportunity for each HCC in their jurisdictions to review and provide updates to their preparedness and response plans. In addition, awardees must obtain public comment and input on public health and medical emergency preparedness and response plans and their implementation using existing advisory committees or a similar mechanism to ensure continuous input from other state, local, and tribal stakeholders, the health care delivery system, and the general public, including members of at-risk populations and those with an expertise integrating the access and functional needs of at-risk individuals.


Emergency Management Assistance Compact (EMAC)

Awardees must describe in their all-hazards public health and medical emergency preparedness and response plans how they will use EMAC or other mutual aid agreements for medical and public health mutual aid to support coordinated activities and to share resources, facilities, services, and other potential support required when responding to emergencies that impact the public’s health. Awardees should work with state emergency management organizations and other related agencies to incorporate EMAC into training and exercises as a way to gain familiarity with processes for requesting and deploying resources through the EMAC system.

Information regarding the ongoing development of public health mission ready packages (MRPs) can be found in the 2017-2012 HPP-PHEP Supplemental Guidelines.

HCCs serve a communication and coordination role within their respective jurisdictions. This coordination ensures the integration of health care delivery into the broader community’s incident planning objectives and strategy development.

It also ensures that resource needs that cannot be managed within the HCC itself are rapidly passed along to the ESF-8 lead agency. HCC coordination may occur at its own coordination center, the local EOC, or by virtual means – all of which are intended to interface with the ESF-8 lead agency.

Coordination between the HCC and the ESF-8 lead agency can occur in a number of ways. Some HCCs serve as the ESF-8 lead agency for their jurisdictions. Others integrate with their ESF-8 lead agency through an identified designee at the jurisdiction’s EOC who represents HCC issues and needs and provides timely, efficient, and bidirectional information flow to support situational awareness. Regardless, HCCs connect the medical response elements and provide the coordination mechanism among health care organizations, including hospitals and EMS, emergency management organizations, and public health agencies.

HPP awardees must ensure by the end of Budget Period 2 that their HCCs are engaged when an emergency with the potential to impact the public’s health occurs within their boundaries. The HCC and its members must, at a minimum, define and share essential elements of information (EEIs) to include elements of electronic health record and resource needs and availability. In particular, awardees must ensure the HCC is engaged when one or more health care organizations have lost capacity or ability to provide patient care or when a disruption to a health care organization requires evacuation.

See also HPP requirements under Strategy 2, Activity 4: Ensure HCC Integration and Collaboration with ESF-8.

National Incident Management System Implementation

HPP awardees must ensure that HCCs assist their members with NIMS implementation throughout the project period. HCCs must:

    Promote NIMS implementation among HCC members, including training and exercises, to facilitate operational coordination with public safety and emergency management organizations during anemergency using an incident command structure (ICS)
  • Assist HCC members with incorporating NIMS components into their emergency operations plans
  • For those HCC members not bound by NIMS implementation, the HCC should consider training on response planning techniques, organizational structure, and other incident management practices that will prepare members for their roles during a response.

    More Detail! More information about NIMS implementation can be found in Capability 1, Objective 4, Activity 1 of the 2017-2022 Health Care Preparedness and Response Capabilities!

Each HCC funded by the awardee must develop a response plan that is informed by its members’ individual emergency operations plans and submit the plan to ASPR by the end of Budget Period 2 with annual progress reports.

Each HCC’s response plan must describe the HCC’s operations that support strategic planning, information sharing, and resource management. The plan must also describe the integration of these functions with the ESF-8 lead agency to ensure information is provided to local officials and to effectively communicate and address resource and other needs requiring ESF-8 assistance. In cases where the HCC serves as the ESF-8 lead agency, the HCC response plan may be the same as the ESF-8 response plan.

The interests of all members and stakeholders should be considered in the response plan; however, each HCC must coordinate the development of its response plan by involving core members and other HCC members so that, at a minimum, hospitals, EMS, emergency management organizations, and public health agencies are represented in the plan. Each HCC must review and update its response plan regularly, and after exercises and real incidents.

The HCC response plan can be presented in various formats, including the placement of information described below in a supporting annex. Regardless of the format, each HCC’s response plan must clearly outline:

  • Individual HCC member organization and HCC contact information;
  • Locations that may be used for multiagency coordination;
  • Process for multiagency coordination if location is virtual;
  • A brief summary of each individual member’s resources and responsibilities;
  • Integration with appropriate ESF-8 lead agencies;
  • Emergency activation thresholds and processes;
  • Alert and notification procedures;
  • EEIs agreed to be shared, including information format, such as bed reporting, resource requests and allocation, and patient distribution and tracking procedures;
  • Communication and IT platforms and redundancies for information sharing;
  • Support and mutual aid agreements;
  • Evacuation and relocation processes;
  • Additional HCC roles and responsibilities as determined by state or local plans and agreements such as staff sharing, alternate care sites, and shelter support; and
  • Activation and notification processes for initiating and implementing medical surge response coordination among HCC members and other topics related to medical surge, including:
  • Strategies to implement if the emergency overwhelms regional capacity or specialty care including trauma, burn, and pediatric capability;
  • Strategies for patient tracking;
  • Strategies for initial patient distribution (or redistribution) across the region and among local hospitals in the event a facility becomes overwhelmed; and
  • Processes for joint decision making and engagement among the HCC, HCC members, state, and local public health agencies, and emergency management organizations to avoid crisis conditions based on proactive decisions about resource utilization.

Each HCC should also monitor their members’ progress toward closing gaps in their own plans and offer assistance to help close the gaps as appropriate.

More Detail! More information about the HCC Response Plan can be found in Capability 2, Objective 1, Activity 2 of the 2017-2022 Health Care Preparedness and Response Capabilities!

Each awardee must develop a health care system recovery plan and submit the plan to ASPR by the end of Budget Period 2 with annual progress reports.

Recovery processes can be integrated into awardees’ existing plans, such as an annex to the emergency operations plan, or developed as a separate, standalone plan. The awardee must ensure the HCCs and their members participate in the development of the state and local pre-emergency recovery planning activities as described in the National Disaster Recovery Framework to leverage recovery resources, programs, projects, and activities.

The health care system recovery plan must outline, at a minimum:

  • Goals and strategic priorities for the continued delivery of essential health care services, including behavioral health, and opportunities for improvement after an emergency;
  • Flexible operational objectives and tactics to accommodate different recovery approaches;
  • Integration with pre-incident plans including community health improvement plans or organizational capital improvement plans;
  • Critical infrastructure dependencies regarding public utilities, IT, transportation, etc.; and
  • Workforce retention issues essential to operations, including access to child or adult dependent care.
More Detail! More information about planning, assessing and facilitating recovery for the health care system can be found in Capability 3, Objective 7, Activities 1, 2, and 3 of the Health Care Preparedness and Response Capabilities!

HCC Continuity of Operations Plan

Each HCC funded by the awardee must develop an HCC continuity of operations (COOP) plan that is informed by its members’ COOP plans and submit the plan to ASPR by the end of Budget Period 3 with annual progress reports. HCC COOP plans may be an annex to the HCC’s response plan or may take another form.

Each HCC’s COOP plan should include, at a minimum:

  • Activation and response functions;
  • Multiple points of contact for each HCC member;
  • Orders of succession and delegations of authority for leadership continuity;
  • Immediate actions and assessments to be performed in case of disruptions;
  • Safety assessment and resource inventory to determine whether or not the HCC can continue to operate;
  • Redundant, replacement, or supplemental resources, including communication systems; and
  • Strategies and priorities for addressing disruptions to mission critical systems that include but not limited to electricity, water, and medical gases.

Each HCC, in coordination with the awardee, should ensure that communication and coordination systems that are used for incident management are adequately secured, backed up, and have redundant power and server protections.

2017-2018 hpp cooperative agreement domain three strategy

strengthen information management

HPP and PHEP awardees must conduct the following activities to strengthen information sharing among public health and medical preparedness and response partners and enhance emergency public information and warning.

  • Share situational awareness across the health care and public health systems
  • Share emergency information and warnings across disciplines, jurisdictions, and HCCs and their members
  • Conduct external communication with the public.

HPP and PHEP awardees must work together to establish a common operating picture, or situational awareness tool, that facilitates coordinated information sharing among all public health, health care, HCCs, and relevant stakeholders.

This includes state, local and territorial public health agencies and their respective preparedness programs, public health laboratories, communicable disease programs, and programs addressing healthcare-acquired infections. Information sharing is the ability to share real-time information related to the emergency, such as capacity, capability, and stress on health care facilities and situational awareness across the various response organizations and levels of government. Accomplishing these activities will enable the health care delivery systems, public health, and other organizations that contribute to responses to coordinate efforts before, during, and after emergencies; maintain situational awareness; and effectively communicate with the public.

Given the need to establish a common operating picture for effective response, HPP and PHEP awardees and HCCs must provide situational awareness data, including data on bed availability, to ASPR and CDC during emergency response operations and at other times, as requested.

Additionally, HPP and PHEP awardees, the HCCs, and their members must agree to participate in current and future federal health care situational awareness initiatives for the duration of the five-year project period.

Health Care Situational Awareness and Sharing

The development of information sharing procedures and the use of interoperable and redundant platforms is critical to a successful response.

In particular, information sharing allows for the tracking of resource availability and needs and also allows HCC members, other stakeholders, and the ESF-8 lead agency to provide coordinated, accurate, and timely information to health care providers and the public. Information sharing requirements exist for both HPP awardees and HCCs to help ensure proper resource coordination and situational awareness.

HCCs also play an important role in sharing information with their HCC members, the ESF-8 lead agency, and additional stakeholders. HPP awardees must ensure that each HCC is able to access and collect timely, relevant, and actionable information about their members during emergencies.

HPP requires all funded HCCs to share pertinent emergency information with their HCC members, the ESF-8 lead agency, and other stakeholders. Information sharing procedures must be documented in each HCC’s response plan by the end of Budget Period 2. When documenting information sharing procedures in response plans, HCCs should:

  • Define communication methods, frequency of information sharing, and the communication systems and platforms available to share information during an emergency response and steady state
  • Identify triggers that activate alert and notification processes
  • Define the EEIs that HCC members should report to the HCC, and coordinate with other HCC members and with federal, state, local, and tribal response partners during an emergency to shareinformation, such as the number of patients, severity and types of illnesses or injuries, operating status, resource needs and requests, and bed availability
  • Identify the platform and format for sharing each EEI to include elements of the EHR
  • Describe a process to validate health care organization status and requests during an emergency; this includes situations where reports are received outside of HCC communication systems and platform, such as media reports, no report when expected, rumors of distress, etc.

Coordinate Emergency Information Sharing between Public Health and Health Care

ASPR and CDC recognize and value the distinct roles and responsibilities of HPP and PHEP awardees, HCCs, and their members, as well as emergency management and other response partners.

HPP and PHEP awardees must identify reliable, resilient, interoperable, and redundant information and communication systems and platforms, including those for bed availability, EMS data, and patient tracking, and provide access to HCC members and other stakeholders.

The following are factors that HCCs, in coordination with HPP and PHEP awardees and other public health agency members, should consider when developing processes and procedures to rapidly acquire and share clinical knowledge:

  • Processes and procedures should address a variety of emergencies such as chemical, biological, radiological, nuclear, or explosive (CBRNE), trauma, burn, pediatrics, or highly infectious disease outbreaks
  • Approaches to improve patient management, particularly at facilities that may not care for certain types of patients regularly

Sharing accurate and timely information is critical during an emergency. Accordingly, by the end of the five-year project period each HCC must assist its members with developing the ability to rapidly alert and notify their employees, patients, and visitors. Alerts and notifications should update stakeholders on the emergency situation, protect stakeholders’ health and safety, and facilitate provider-to-provider communication.

By the end of the five-year project period, the HCC, in coordination with its public health agency members and HPP and PHEP awardees, must also develop processes and procedures to rapidly acquire and share clinical knowledge between health care providers and between health care organizations during responses.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objectives 2 and 3 of the Health Care Preparedness and Response Capabilities!
 

Healthcare Coalitions Redundant Communications Systems and Platforms

HCCs can use communication systems and platforms to assist in the collection and dissemination of timely, relevant, and actionable information. Accordingly, HPP awardees must ensure that each HCC has primary and redundant communications systems and platforms capable of sending EEIs by the end of Budget Period 1.

Additionally, by the end of Budget Period 1, each HCC must be able to demonstrate its ability to use these systems to effectively coordinate information during emergencies, planned events, and on a regular basis. As part of this requirement and to ensure the continuity of information flow and coordination activities, multiple employees from each HCC member organization must understand and have access to the HCC’s information sharing platforms.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objectives 2 and 3 of the Health Care Preparedness and Response Capabilities!

Coordinate Public Messaging (Joint Requirements)

Accurate and timely communication with the public is important during a response to a public health emergency. Accordingly, by the end of Budget Period 2, each HCC and its members, in collaboration with HPP and PHEP awardees, should agree upon and plan for the type of information that will be disseminated by either the HCC or its individual members to the public during an emergency.

Additionally, by the end of the five year project period, the HCC, in collaboration with HPP and PHEP awardees, should provide public information officer (PIO) training to those who are designated to act in that capacity during an emergency for HCC members and are in need of such training. This training should include health risk communication training.

Health care organizations, as well as HCCs and public health departments, should work with their community’s Joint Information Center (JIC) to ensure information is accurate, consistent, linguistically and culturally appropriate, and disseminated to the community using one voice during an emergency.

Additionally, ASPR and CDC recommend that HPP and PHEP awardees coordinate public messaging and information sharing regarding monitoring and tracking of cases of persons under investigation during infectious disease outbreaks with PIOs for various response partners to ensure maximum coordination and consistency of messaging.

More Detail! More information about sharing emergency information procedures and platforms can be found in Capability 2, Objective 3 of the Health Care Preparedness and Response Capabilities!

2017-2018 hpp cooperative agreement domain four strategy

strengthen countermeasures and mitigation

HPP and PHEP awardees should conduct the following activities that strengthen access to and administration of medical and other countermeasures for pharmaceutical and non-pharmaceutical interventions and strengthen mitigation strategies.

  • Manage access to and administration of pharmaceutical and non-pharmaceutical interventions
  • Ensure safety and health of responders
  • Operationalize response plans.

Following an emergency, effective care cannot be delivered without available staff and appropriate countermeasures. Accordingly, managing access to and administration of countermeasures and ensuring the safety and health of clinical and other personnel are important priorities for preparedness and continuity of operations.

While PHEP funding plays an important role in medical countermeasure (MCM) planning and procuring and dispensing MCMs for the community, including at-risk populations, HPP funding assists in planning for closed points of dispensing (POD) and ensuring that health careworkers and their families are protected during emergencies.


MCM Distribution and Dispensing Plans

A number of federally funded programs exist to enhance preparedness for and response to a public health emergency, including CDC’s Strategic National Stockpile (SNS), CHEMPACK program, and Cities Readiness Initiative (CRI). HPP and PHEP awardees, including HCCs and their members, must understand their jurisdictional MCM distribution plans by the end of Budget Period 1, either through participation in jurisdictional MCM operational readiness reviews or briefings provided by the jurisdiction’s MCM coordinator.

Additionally, in jurisdictions participating in the CHEMPACK program, CRI, or other local and state plans for maintaining treatment or prophylaxis caches, HPP and PHEP awardees and each HCC must be engaged in the development, training, and exercising of these MCM distribution and dispensing plans by the end of Budget Period 1. Additionally by the end of Budget Period 1, each HCC should collaborate with local public health departments and PHEP awardees to assist its members with closed points of dispensing (POD) plans. Local public health departments supported by PHEP funding are responsible for general population POD planning with assistance from the state.

 

Assess Supply Chain Integrity

Conducting an assessment of the supply chain’s integrity is one strategy to help HPP awardees and HCCs identify equipment and supply needs that will be in demand during an emergency and develop strategies to address potential shortfalls.

To ensure the ongoing delivery of patient care services following an emergency, critical equipment and supplies must be made available for all populations. For example, pharmaceuticals and medical materiel are needed for both emergency treatment and to maintain the health of patients, providers, and first responders.

By the end of the five-year project period, HPP awardees and HCCs must conduct a supply chain integrity assessment to evaluate equipment and supply needs that will be in demand during emergencies and develop strategies to address potential shortfalls. Upon request, HPP awardees must provide documentation of the assessment and corresponding mitigation strategies to an HPP FPO. As part of this supply chain integrity assessment, each HCC and its members should:

  • Collaborate with manufacturers and distributors to collect information on access to critical supplies, availability in regional systems, and potential alternate delivery options in the case that access or infrastructure is compromised
  • Collaborate with the ESF-8 lead agency when using this information to effectively coordinate equipment and supply needs within the region.

Completing a supply chain integrity assessment will likely highlight vulnerabilities in access to or availability of critical supplies. Accordingly, HPP awardees, HCCs, and HCC members may purchase pharmaceuticals and other medical materiel likely to be required during a patient surge. All HPP awardees, HCCs, or HCC members purchasing pharmaceuticals and other medical materiel with HPP funds must consider strategies for the acquisition, storage, rotation with day-to-day supplies to diminish waste due to expiring supplies, use including policies relating to the activation and deployment of their stockpile, and disposal. HPP awardees and HCCs must document such strategies and provide documentation to the FPO upon request.

More Detail! More information about resources to consider during a supply chain integrity assessment, mitigation strategies, and acquisition of pharmaceuticals and medical materiel can be found in Capability 3, Objective 3 of the Health Care Preparedness and Response Capabilities!

HPP and PHEP awardees, HCCs, and their members must equip, train, and provide resources necessary to protect responders, employees, and their families from hazards during response and recovery operations.

Personal protective equipment (PPE), MCMs, workplace violence training, psychological first aid training, and other interventions specific to an emergency are all necessary to protect responders and health care workers from illness or injury and should be readily available to the health care workforce.


Personal Protective Equipment

Awardees and HCCs should manage PPE resources, including stockpiling considerations, vendor-managed inventory, and the potential reuse of equipment; this includes consistent policies regarding the type of PPE necessary for various infectious pathogens, and sharing information about PPE supplies across HCCs, EMS, public health agencies, and other members.

 

Protecting the Health Care Workforce

The health care workforce needs readily available PPE, such as respirators, protective clothing, gloves, and face shields, for protection from a wide range of threats including infectious diseases, radiation, chemical exposure, and various physical hazards.

Any HPP awardee, HCC, or HCC member purchasing PPE with HPP funds must consider and document acquisition, storage, rotation, activation, use, and disposal decisions and provide this documentation to the FPO upon request.

ASPR encourages, when possible, regional procurement of PPE. This procurement approach may offer significant advantages in pricing and consistency for staff, especially when PPE is shared across health care organizations in an emergency. Additionally, in circumstances where HCC members are part of a larger corporate health system, a balance between corporate procurement and regional procurement should be considered.

2017-2018 hpp cooperative agreement domain five strategy

strengthen surge management

Following a public health incident, HPP and PHEP awardees should coordinate to assess the public health and medical needs of the affected community, with PHEP awardees focusing on public health surge needs and HPP awardees and their HCCs focusing on medical surge needs.

While the two programs may focus on different sectors within the community, HPP and PHEP awardees must coordinate these activities jointly.

The following four activities are used to manage public health surge:

  • Address mass care needs, such as shelter monitoring
  • Address surge needs, including family reunification
  • Coordinate volunteers
  • Prevent or mitigate injuries and fatalities.

Management of Public Health Surge | Joint Requirements

 

Address Health Needs in Congregate Locations

PHEP awardees must coordinate with health care coalitions and their members to address the public health, medical, and mental health needs of those impacted by an incident at congregate locations.

HPP awardees should serve as subject matter experts to PHEP awardees on the health care needs of those impacted by an incident. For example, HPP awardees, HCCs, and HCC members should serve as a planning resource to PHEP awardees and public health agencies as they develop mass shelters. In particular, HPP awardees and HCCs should provide their expertise on the inclusion of medical care at shelter sites.

 

During a public health incident or crisis, families are at risk for becoming disconnected. HPP awardees and HCCs must serve as planning resources and subject matter experts to PHEP awardees and public health agencies as they develop or augment existing response plans for affected populations, including mechanisms for family reunification.

These plans should give consideration to:

  • Information needed to facilitate reunification of families
  • Reunification considerations for children
  • Family notification and initiation of reunification processes.
 

During an infectious disease outbreak, HPP and PHEP awardees, HCCs, and HCC members all have roles in planning for and responding to outbreaks that stress either the capacity or the capability of the public health or health care delivery systems.

ASPR and CDC require that awardees and HCCs coordinate the following activities to ensure the ability to surge to meet the demands during a highly infectious disease response.

  • Establish a common operating picture that facilitates coordinated infectious disease information sharing among all HCC members and relevant stakeholders, including state, local, and territorial public health agencies and their respective preparedness programs, state public health laboratories, communicable disease programs, and health care-associated infections (HAI) programs.
  • PHEP awardees should ensure infectious disease response planning includes state and local emergency management, partners responsible for airports and international points of entry into the United States, including CDC quarantine stations of jurisdiction, public safety, and other relevant agencies and community partners. Planning should include identification and management of potentially infected interstate and international travelers and acquisition and deployment of immunizations and prophylactic medication as appropriate.
  • Develop or update plans to describe how jurisdictional public health departments will:
  • Monitor known cases or exposed persons including how surveillance will be shared,
  • Conduct short- and long-term follow-up of known or suspected households, and
  • Ensure the security of storage and retrieval of sensitive information.
  • Establish key indicators, critical information requirements, and EEI that will assist with timing of notifications, alerting, and coordinating responses to emerging or re-emerging infectious disease outbreaks of significant public health and health care importance, including novel or high-consequence pathogens.
  • Provide real-time information through coordinated information sharing systems (see Capability 2, Objective 3, Activity 4 of the 2017-2022 Health Care Preparedness and Response Capabilities and Capability 6: Public Health Preparedness Capabilities: National Standards for State and Local Planning) and ensure that information is directed to the public and to the many disciplines that comprise the responder community.
  • Coordinate public messaging and information sharing, including information related to monitoring and tracking of persons under investigation (PUIs), among PIOs for jurisdictional public health agencies, as well as PIOs at HCCs and health care organizations.
  • Ensure infectious disease response planning includes state and local emergency management, transportation, public safety, and other relevant agencies and community partners.
  • Continue planning with health care organizations and other stakeholders such as mortuary, autopsy personnel, and medical examiners, to coordinate the management of the deceased when bodies are considered infectious, including addressing the provision of body bags and other supplies, defining assistance, and developing relationships with crematoriums, funeral directors, and other partners to effectively plan for managing the deceased when bodies are considered infectious.
  • Identify, leverage, and share leading practices to optimize infectious disease preparedness and response activities.

ASPR and CDC also recommend the following joint activities:

  • HCCs and state HAI multidisciplinary advisory groups or similar infection control groups within the state should partner to develop a statewide plan for improving infection control within health care organizations.
  • Jurisdictional public health infection control and prevention programs including HAI programs and HCC members should jointly develop infectious disease response plans for managing individual cases and larger emerging infectious disease outbreaks.
  • HPP and PHEP awardees, HCCs, and their members should collaborate on informatics initiatives to include but are not limited to electronic laboratory reporting, electronic test ordering, electronic case reporting, electronic death reporting, and syndromic surveillance.
  • HPP and PHEP awardees and HCCs should engage with the community to improve understanding of issues related to infection prevention measures, such as:
  • Changes in hospital visitation policies,
  • Social distancing, and
  • Infection control practices in hospitals, such as: PPE use, hand hygiene, source control, and isolation of patients.
  • HPP and PHEP awardees, HCCs, and their members should promote coordinated training and maintenance of competencies among public health first responders, health care providers, EMS, and others as appropriate, on the use of PPE, environmental decontamination, and management of infectious waste. Training should follow OSHA and state regulations.
  • HPP and PHEP awardees, HCCs and their members should collaborate to develop and implement strategies to ensure availability of effective supplies of PPE, including:
  • Working with suppliers and coalitions to develop plans for caching or redistribution and sharing and
  • Informing each other and integrating plans for purchasing, caching, and distributing PPE.
  • HPP and PHEP awardees, HCCs, and their members should sustain planning for the management of PUIs to:
  • Monitor health care personnel who may have had a risk exposure to a PUI by directly treating or caring for a PUI in a health care setting and
  • Clarify roles and responsibilities for key response activities related to the monitoring of PUIs,to include:
  • Assisting or assessing readiness of health care organizations in the event of a PUI and
  • Conducting AARs and testing plans for PUI management to identify opportunities to improve local, state, and national response activities.
More Detail! More information about addressing specialty medical surge for infectious diseases can be found in Capability 4, Objective 9 of the Health Care Preparedness and Response Capabilities!

HPP and PHEP awardees must coordinate the identification, recruitment, registration, training, and engagement of volunteers to support the jurisdiction’s response to incidents. To develop competency in implementing plans involving volunteers, awardees should ensure volunteers are included in training, drills, and exercises throughout the five-year project period.

HPP awardees, including HCCs and their members, should work to manage volunteers in the hospital or other health care setting. This includes:

  • Identifying situations that would require volunteers in hospitals. Leverage existing hospital volunteer services and staffing resource mechanisms;
  • Identifying processes to assist with volunteer coordination, including protocols to handle walk-up volunteers and others who cannot participate due to state regulations;
  • Estimating the anticipated number of volunteers and health professional roles based on identified situations and resource needs of the facility;
  • Identifying and addressing volunteer liability, licensure, workers compensation, scope of practice, and third-party reimbursement issues that may deter volunteer use;
  • Leveraging existing government and nongovernmental volunteer registration programs, such as Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and Medical Reserve Corps (MRC); and
  • Developing rapid credential verification processes to facilitate emergency response.

The following four activities are used to manage medical surge:

  • Conduct health care facility evacuation planning and execute evacuations
  • Address emergency department and inpatient surge
  • Develop alternate care systems
  • Address specialty surge, including pediatrics, chemical, radiation, burn, trauma, behavioral health, and highly infectious diseases.

Management of Medical Surge

 

By the end of Budget Period 1, HPP awardees, HCCs, and HCC members must ensure all health care organizations, public health agencies, and emergency management organizations are included in evacuation, transportation, and relocation planning and execution during exercises and real incidents.

Further, HPP awardees, HCCs, and HCC members must sustain or further develop their evacuation planning and response activities throughout the remainder of the five-year project period.


Coalition Surge Test

To test the ability of the HCC to perform components of the 2017-2022 Health Care Preparedness and Response Capabilities, each HCC must conduct an exercise using the Coalition Surge Test once each budget period. Additional information on HPP exercise requirements and the Coalition Surge Test are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.

 

HCCs and their members that coordinate during a medical surge response are more likely to effectively manage the emergency without state or federal assets or employing crisis care strategies. However, it is not possible to plan for all worst-case scenarios, and there may be times when the health care delivery system is stressed beyond its maximum surge capacity.

During those scenarios, crisis care strategies may be employed and planned for well in advance. Planning for medical surge should follow the medical surge capacity and capability (MSCC) tiered approach, where successive levels of assistance are activated as the emergency evolves.

Accomplishing these activities will enable the health care delivery system and other organizations that contribute to responses to coordinate efforts before, during, and after emergencies; continue operations; and appropriately surge as necessary.

 

Immediate bed availability (IBA) is defined as the ability of a hospital to provide at least 20 percent bed availability of staffed beds within four hours of a disaster.

IBA is built on three pillars: continuous monitoring across the health system; off-loading of patients who are at low risk for untoward events through reverse triage; and on-loading of patients from the disaster. While the goal of IBA is to create capacity within hospitals, other health care partners including home care providers, skilled nursing facilities, long-term care facilities, clinics, and community and tribal health centers, can meet the needs of patients who are discharged early as part of the surge response.

HCCs and their members must plan and respond together to address emergency department and inpatient surge with the goal of ensuring IBA throughout the five-year project period. In particular, HCCs and their members should focus their hospital medical surge capability and IBA activities in these areas:

  • Emergency department beds
  • General medical, general surgical, and monitored beds
  • Critical care beds
  • Surgical intervention units
  • Clinical laboratory and radiology services
  • Health care volunteer management
  • Equipment and supplies
  • Staffing
  • Coordination of ambulance transport with EMS System
 

By the conclusion of the five-year project period, HPP awardees must document their processes to oversee jurisdictional crisis standards of care (CSC) planning and to coordinate all local or regional planning efforts.

HPP awardees must be prepared to submit documentation to their FPOs and ASPR’s Technical Resource, Assistance Center, and Information Exchange (TRACIE) detailing these processes upon request.

Further, HPP awardees must ensure the documentation includes:

  • Efforts undertaken to promote a uniform approach to establishing the ethical and legal frameworks necessary for CSC planning and implementation, for example, liability protections and specific rules and laws that might need modification or suspension to support CSC implementation, such as to broaden scope of practice or relax interstate licensure requirements
  • Efforts undertaken to promote community engagement and discussion related to CSC planning
  • Evidence of jurisdictional support of crisis surge response, including specific methodologies to allow for the expansion of health care service delivery, including establishment of alternate care facilities, adjustment of prescribing practices, and amendment of EMS protocols
  • Efforts undertaken to socialize and describe CSC planning in a whole-of-government context,including discussions with elected officials and other government leaders
  • The process used to ensure provision of consistent and uniform clinical guidance for scarce resource conditions

HCCs also play a role in CSC planning. By the end of the five-year project period, each HPP-funded HCC must document its plan for implementing CSC, integrating EMS, hospital, public health, and emergency management policies related to situations in which the usual delivery of health care services is not possible due to disaster conditions. HCCs must be prepared to submit the documentation regarding this plan to an HPP FPO upon request.

HCCs must include in the documentation:

  • The key stakeholders involved in the planning, including a description of how these stakeholders integrate with each other to ensure a coordinated response to crisis conditions
  • Efforts undertaken to promote provider engagement in CSC planning
  • Activities to support the implementation of crisis care decision-making by EMS agencies, including dispatch, transport, and treatment decisions
  • Activities to support the implementation of crisis care decision-making by hospitals and other health care entities, especially as they relate to managing limited resources and the integration of crisis strategies into surge capacity planning and incident management
More Detail! More information about addressing emergency department and inpatient medical surge can be found in Capability 4, Objective 2, Activity 1 of the Health Care Preparedness and Response Capabilities!
An alternate care system, defined as the use of nontraditional settings and modalities for health care delivery, may be required when demand overwhelms a region or the nation’s health care delivery system for a prolonged period, or an emergency has significantly damaged infrastructure and limited access to health care.

HCCs should plan to provide support, including personnel and supplies, to public health agencies and emergency management organizations that have leadership roles in selecting, establishing, and operating alternative care sites.

Accordingly, HPP awardees and HCCs should plan for the development of alternate care systems, in collaboration with state and local public health agencies and emergency management organizations, prior to the conclusion of the five-year project period. However, the development of an alternate care system does not begin and end with identification of alternate care sites.

HPP awardees and HCCs are encouraged to consider additional factors in their alternate care system activities prior to the conclusion of the five-year project period:

  • Establishment of telemedicine or virtual medicine capabilities
  • Establishment of assessment and screening centers for early treatment
  • Provision of medical care at shelters
  • Assisting with the selection and operation of alternate care sites
More Detail! More information about the development of alternate care systems can be found in Capability 4, Objective 2, Activity 3 of the Health Care Preparedness and Response Capabilities!
 

Each HCC should promote its members’ planning for pediatric medical emergencies and foster relationships and initiatives with emergency departments that are able to stabilize and manage pediatric medical emergencies.

HPP awardees must collaborate with the Emergency Medical Services for Children (EMSC) program within its jurisdiction to better meet the needs of children receiving emergency medical care. The Health Resources and Services Administration (HRSA) administers the EMSC program at the federal level, and HRSA awardees may be state agencies or accredited schools of medicine. This program works to ensure that critically ill and injured children receive optimal pediatric emergency care.

Following are specific areas of collaboration:

  • HPP awardees and the EMSC program awardees within their jurisdictions must provide a joint letter of support indicating that EMSC and HPP are linked at the awardee level. HPP awardees must provide the initial letter of support with their funding applications at the beginning of each budget period throughout the five-year project period.
  • HPP awardees must work with HCCs and EMSC to ensure that all hospitals are prepared to receive, stabilize, and manage pediatric patients. At the end of each budget period, HRSA will provide HPP with data regarding each hospital’s capability to manage pediatric medical emergencies to assist with this work.

EMSC awardee contact information is available in the PERFORMS Resource Library or via HPP FPOs.

 

The health care system must be prepared to manage exposed or potentially exposed patients during a chemical or radiation emergency.

To ensure successful surge management during chemical or radiation emergency events, HCCs and their members should complete the following activities prior to the conclusion of the five-year project period.

  • Coordinate training for their members on the provision of wet and dry decontamination and screening to differentiate exposed from unexposed patients (especially in radiation emergency events)
  • Ensure involvement and coordination with regional HAZMAT resources (where available) including EMS, fire service, health care organizations, and public health agencies (for public messaging)
  • Assist members with distribution of available, including mobilization of CHEMPACKs when necessary
  • Consider participating in a joint community reception center exercise with public health partners
 

HPP awardees, their HCCs, and HCC members must plan to coordinate a response to large burn and trauma emergencies in collaboration with all burn and trauma systems within their jurisdictions, boundaries, or that may partner with them.

This must be noted in the HCC response plan by the end of Budget Period 2. HPP awardees must also be prepared to submit this documentation to an FPO upon request.

Given the limited number of burn specialty hospitals and trauma centers, an emergency affecting large numbers of burn or trauma patients will require HCC and awardee involvement to ensure those patients that can benefit the most from burn and trauma services receive priority for transfer. Additionally, HCCs can assist with patient distribution to coordinate the availability of critical trauma and burn response resources, such as operating rooms, surgeons, anesthesiologists, operating room nurses, and surgical equipment and supplies.

 

Emergencies may cause severe emotional impacts on survivors, their families, and responders and may additionally cause substantial destabilization of patients with existing behavioral health issues.

Consequently, by the conclusion of the five-year project period, ASPR encourages HPP awardees to:

  • Develop and use behavioral health support and strike teams to support affected populations
  • Plan for widespread information dissemination to help providers, patients, families, and the community understand the symptoms and signs of acute stress responses and collaborate with HCCs to communicate when and where individuals should seek treatment
  • Provide ongoing support to their inpatient and outpatient behavioral health members
  • Assist with the provision of psychological first aid to those impacted, including health care workers
 

HPP awardees, HCCs, and their members have roles in planning for and responding to infectious disease outbreaks that stress either the capacity or the capability of the health care delivery system.

Prior to the end of the five year project period:

  • Awardees, HCCs, and their members must expand existing Ebola concept of operations plans (CONOPs) to enhance preparedness and response for all infectious disease emergencies that stress the health care delivery system
  • HCCs must include HAI coordinators and quality improvement professionals at the health care facility and jurisdictional levels in their activities, including planning, training, and exercises/drills; also include HCC leaders in state HAI coordination work groups
  • HCCs should develop a uniform process of continuous screening for newly presenting, hospitalized, and other patients and integrate information with electronic health records (EHRs) where possible, throughout HCC member facilities and organizations
  • HCCs should coordinate visitor policies for infectious disease emergencies at member facilities to ensure uniformity
  • HCCs should develop and exercise plans to coordinate patient distribution for highly pathogenic respiratory viruses and other highly transmissible infections, including complicated and critically ill infectious disease patients, when tertiary care facilities or designated facilities are not available
 
More Detail! More information about addressing specialty surge can be found in Capability 4, Objectives 4 through 9 of the Health Care Preparedness and Response Capabilities!

2017-2018 funding restrictions

what awardees must not do, or may do only under specified conditions

phep/hpp overarching funding restrictions and conditions

Awardees May Not:

  • use funds for research.
  • use funds for clinical care except as allowed by law.  For the purposes of this FOA, clinical care is defined as "directly managing the medical care and treatment of patients.”
  • use funds to purchase furniture or equipment. Any such proposed spending must be clearly identified in the budget. 
  • be reimbursed for pre-award costs, unless the CDC provides written approval to the awardee.
  • use funds for construction or major renovations.
  • use funds for payment or reimbursement of backfilling costs for staff.
  • use fund to pay the salary of an individual at a rate in excess of Executive Level II or $187,000 per year.
  • use funds to purchase clothing such as jeans, cargo pants, polo shirts, jumpsuits, sweatshirts, or T-shirts.
  • use funds to purchase or support (feed) animals for labs, including mice. Any requests for such must receive prior approval of protocols from the Animal Control Office within CDC and subsequent approval from the CDC OGS.
  • use funds to purchase a house or other living quarters for those under quarantine.
  • use funds for:
  • publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body
  • the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before any legislative body
  • use funds to support standalone, single-facility exercises (HPP).

Awardees May Not:

  • use funds only for reasonable program purposes, including personnel, travel, supplies, and services.
  • supplement but not supplant existing state or federal funds for activities described in the budget.
  • use funds only for reasonable program purposes, including travel, supplies, and services.
  • purchase basic (non-motorized) trailers with prior approval from the CDC OGS.
  • use funds for overtime for individuals directly associated (listed in personnel costs) with the award (with prior approval).

NOTE: The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible.

hpp specific funding restrictions and conditions

HPP Vehicle Purchase

Non-public road vehicles:

HPP grant funds can (with prior approval) be used to purchase health care coalition material-handling equipment (MHE) such as industrial or warehouse-use trucks to be used to move health care coalition materials, supplies and equipment (such as forklifts, lift trucks, turret trucks, etc.). Vehicles must be of a type not licensed to travel on public roads.

HPP Leasing and Hauling Agreements

Passenger road vehicles:

  • HPP grant funds cannot be used to purchase over-the road passenger vehicles.
  • HPP grant funds can (with prior approval) be used to procure leased or rental vehicles as means of transportation for carrying people (e.g., passenger cars or trucks) during times of need. Examples include transporting health care coalition leadership to planning meetings, to an exercise, or during a response.
  • Transportation of medical material:

    • HPP grant funds can (with prior approval) be used to procure leased or rental vehicles for movement of materials, supplies and equipment by HCC members.
    • Additionally, HPP grant funds can (with prior approval) be used for health care coalitions to make transportation agreements with commercial carriers for movement of health care coalition materials, supplies and equipment. There should be a written process for initiating transportation agreements (e.g., contracts, memoranda of understanding, formal written agreements, and/or other letters of agreement). Transportation agreements should include, at a minimum, the following elements:
    • Type of vendor
    • Number and type of vehicles, including vehicle load capacity and configuration
    • Number and type of drivers, including certification of drivers
    • Number and type of support personnel
    • Vendor’s response time
    • Vendor’s ability to maintain cold chain, if necessary to the incident
    • This relationship may be demonstrated by a signed transportation agreement or documentation of transportation planning meeting with the designated vendor. All documentation should be available to the FPO for review if requested.

Consistent with section 319C-2 of the PHS Act, HPP funds may only be used to support activities that prepare States for public health emergencies and to improve surge capacity . There are two situations when States (see definition) may use HPP funds during a State or locally declared emergency, disaster, or public health emergency (hereafter referred to as an “emergency”). These situations and related criteria are described below.

Situation 1: HPP Staff Conducting Activities Consistent with Approved Project Goals 

Awardees may use HPP funds to support positions performing preparedness-related activities consistent with the awardee’s project goals and may utilize those positions within any phase of the disaster cycle, provided that the staff members in those positions continue to do work within statutory limitations, the notice of award, and the approved spending plan. For example, an employee’s salary may be permissible for response activities if that employee is carrying out the same responsibilities he or she would carry out as part of his or her preparedness responsibilities.  

Situation 2: Using a Declared Emergency as a Training Exercise 

Under certain conditions, HPP funds may, on a limited, case-by-case basis, be reallocated to support response activities to the extent they are used for purposes provided for in Section 319C-2 of the PHS Act (the program’s authorizing statute), applicable cost principles, the funding opportunity announcement, and the awardee’s application (including the jurisdiction’s all-hazards plan). Awardees should contact their assigned HPP project officer and grants management specialists for guidance on the process to make such a change. ASPR encourages awardees to develop criteria such as costs versus benefits for determining when to request a “scope-of-work” change to use a real incident as a required exercise. 

The request to use an actual response as a required exercise and to pay salaries with HPP funds for up to seven days will be considered for approval under these conditions:

  • A state or local declaration of an emergency, disaster, or public health emergency is in effect.
  • No other funds are available for the cost.
  • The awardee agrees to submit within 60 days (of the conclusion of the disaster or public health emergency) an after-action report, a corrective action plan, and other documentation that supports the actual dollar amount spent.

Note: A change in the scope of work is required to use an actual event as an exercise whether or not funds are needed to support salaries. Also, regardless of the amount of money used in response to an event, the State is still required to meet all the requirements of the original award. 

HPP General Funding Guidance

HPP funding must primarily support strengthening health care system preparedness through the collaborative development of HCCs that prepare and respond as an entire regional health system, rather than individual health care organizations. HPP recognizes that, at the conclusion of the previous project period (2012-2017), some awardees only funded HCCs, some funded individual health care entities (with a requirement that they participate in regional preparedness efforts), and others funded a mixture of HCCs and individual health care entities.

During this project period (2017-2022), beginning in Budget Period 1, all awardees must allocate funding to HCCs. For Budget Period 1, ASPR still permits providing direct funding from the awardee to individual health care entities for regional preparedness efforts; however, ASPR expects that as the project period progresses, the awardee’s funding strategy will include allocating funding to HCCs in a graduated manner – such HCC funding should increase incrementally over the five-year project period.

As awardees allocate more funding to HCCs each year, individual health care entities can continue to receive HPP funding, through the HCC, to ensure regional coordination and collaboration. HCCs will determine the amount of funding for health care entities upon review of coalition projects, as well as health care entity projects, based on the funding priorities for each budget period. This process will ensure that HCC activities contribute to the overarching readiness, preparedness, and resilience of health care systems.

Awardees may retain direct costs for the management and monitoring of the HPP cooperative agreement during the 2017-2022 project period. Awardee-level direct costs are defined as personnel, fringe benefits, and travel. Because the goal is to support HCCs and their health care system partners, awardees must limit these direct costs to no more than 18 percent of the HPP cooperative agreement award.

By the end of Budget Period 5, awardees must limit these direct costs to no more than 15 percent of the HPP cooperative agreement award.

ASPR will consider requests for exemptions on a case-by-case basis. Requests for exemption must be submitted with the Budget Period 1 application. Requests for exemption will be strengthened by letters of support from the HCCs and the jurisdiction’s hospital association indicating these entities understand and agree with the amount the awardee is retaining for awardee-level direct costs. Please note that concurrence is not required, only recommended if an awardee is requesting an exemption.

Within the first 60 days of each budget period, all awardees must provide a detailed spend plan, including all budget line items, to all HCCs within their jurisdiction and any interested health care entity. This spend plan must also be sent to FPOs.

Awardees are not required to submit position descriptions for HPP funded-staff with the application. However, awardees may be required to submit this information to HPP if the roles and responsibilities of the employee(s), and how they support health care preparedness are not clear in the budget narrative section of the application.

Funding for Individual Healthcare Facilities

HPP awardees and their subrecipients may provide funding to individual hospitals or other health care entities, as long as the funding is used for activities to advance regional, HCC, or health care system wide priorities, and are in line with ASPR’s four health care preparedness and response capabilities.

Funding to individual health care entities is not permitted to be used to meet Centers for Medicare and Medicaid Services (CMS) conditions of participation, including CMS-3178-F Medicare and Medicaid Programs: Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. CMS-3178-F requires providers and suppliers to the following conditions of participation.

  • Development of an emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier. HPP funding may not be provided to individual health care entities to meet this requirement; however, ASPR encourages HCCs to provide technical assistance to their individual members to assist them with the development of their emergency plans. HCCs are permitted to use HPP funding to develop the staffing capacity and technical expertise to assist their members with this requirement.
  • Develop policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment. HPP funding may not be provided to individual health care entities to meet this requirement; however, ASPR encourages HCCs to provide technical assistance to their individual members to assist them with the development of policies and procedures. HCCs are permitted to use HPP funding to develop the staffing capacity and technical expertise to assist their members with this requirement.
  • Develop and maintain a communication plan: Develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems. HPP funding may not be provided to individual health care entities to meet this requirement; however, ASPR encourages HCCs to provide technical assistance to their individual members to assist them with the development a communication plan that integrates with the HCC’s communications policies and procedures. HCCs are permitted to use HPP funding for costs associated with adding new providers and suppliers to their HCC who are seeking to join coalitions to coordinate patient care across providers, public health departments, and emergency systems (e.g., hiring additional staff to coordinate with the new members, providing communications equipment and platforms to new members, conducting communications exercises, securing meeting spaces, etc.)
  • Develop and maintain a training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan. HPP funding may not be provided to individual health care entities for individual health care organizations’ trainings and exercises. HPP funding may be used to plan and conduct trainings and exercises at the regional or HCC level.
Important!  Remember, the cooperative agreement is a contract between ASPR and the Awardee, not between the Awardee and the healthcare coalition. These funding restrictions and conditions only apply to the sub grantee – the healthcare coalition – if they are specifically stated in the coalition's sub grant.

bParati Hospital Preparedness Program National Map Image

State FY 2017 (CR) FY 2018 (Request) +/-$
Alabama $3,316,320 $4,478,616 +$1,162,296
Alaska $951,914 $1,219,930 +$268,016
American Samoa $278,422 $0 -$278,422
Arizona $3,930,938 $0 -$3,930,938
Arkansas $2,002,932 $2,585,053 +$582,121
California $23,397,482 $20,175,928 -$3,221,554
Chicago $2,736,056 $2,048,099 -$687,957
Colorado $3,119,392 $0 -$3,119,392
Connecticut  $2,330,641 $0 -$2,330,641
Delaware $1,049,193 $0 -$1,049,193
Florida $11,882,752 $12,767,567 +$944,815
Georgia $5,973,258 $6,732,448 +$759,190
Guam $374,754 $0 -$374,754
Hawaii $1,261,124 $0 -$1,261,124
Idaho $1,247,694 $0 -$1,247,694
Illinois $8,772,659 $7,990,729 -$781,930
Indiana $3,934,926 $4,735,094 +$800,168
Iowa $2,130,401 $2,616,125 +$485,724
Kansas $2,117,146 $2,342,757 +$231,611
Kentucky $2,759,985 $3,970,833 +$1,210,848
Los Angeles County $9,263,958 $6,729,769 $-2,534,189
Louisiana $2,895,985 $4,412,533 +$1,516,548
Maine $1,065,567 $1,512,008 +$446,441
Marshall Islands $268,005 $0 -$268,005
Maryland $4,864,700 $4,240,380 -$624,320
Massachusetts $4,315,709 $3,684,602 -$631,107
Michigan $6,157,587 $4,221,454 -$1,936,133
Micronesia $276,806 $0 -$276,806
Minnesotta $3,518,356 $2,217,950 -$801,406
Mississippi $2,176,032 $2,861,356 +$2,685,324
Missouri $3,676,990 $5,186,585 +$1,509,595
Montana $920,601 $0 -$920,601
N. Mariana Islands $270,356 $0 -$270,356
Nebraska $1,373,309 $0 -$1,373,309
Nevada $1,911,347 $0 -$1,911,347
New Hampshire $1,089,878 $0 -$1,089,878
New Jersey $5,633,732 $5,186,585 -$535,388
New Mexico $1,527,031 $0 -$1,527,031
New York $9,639,512 $16,693,113 +$7,053,601
New York City $8,033,288 $13,455,551 +$5,514,224
North Carolina $5,908,241 $7,562,187 +$1,449,686
North Dakota $879,429 $0 -$879,429
Ohio $7,450,278 $6,202,189 +$248,089
Oklahoma $2,602,493 $2,758,110 +$155,617
Oregon $2,577,424 $0 -$2,577,424
Palau $255,373 $0 -$255,373
Pennsylvania $8,093,898 $7,851,839 -$242,059
Puerto Rico $2,576,010 $2,854,070 +$278,060
Rhode Island $940,547 $0 -$940,547
South Carolina $3,117,650 $3,929,521 +$811,871
South Dakota $848,108 $1,128,320 +$280,212
Tennessee $4,040,788 $3,659,664 -$381,124
Texas $16,176,634 $15,435,244 -$741,390
Utah $2,271,467 $0 -$2,271,467
Vermont $780,333 $0 -$780,333
Virgin Islands $305,611 $0 -$305,611
Virginia $6,075,317 $6,743,291 +$667,974
Washington $4,279,234 $0 -$4,279,234
Washington, DC $944,353 $1,814,895 +$870,542
West Virginia $1,405,606 $1,578,846 +$173,240
Wisconsin $3,634,631 $0 -$3,634,631
Wyoming $837,538 $0 -$837,538
Total $228,500,000 $204,500,000 -$24,000,000

hpp funding 2004–2018


2018-2019, BP 2 (Requested), $204,500,000
 
2017-2018, BP 1, $228,500,000
 
2016-2017, BP 5, $228,500,000
 
2015-2016, BP 4, $228,500,000
 
2014-2015, BP 3, $228,500,000
 
2013-2014, BP 2 $331,759,862
 
2012-2013, BP 1, $351,644,731
 
2011-2012, $352,605,175
 
2010-2011: $390,500,000
 
2009-2010: $362,017,984
 
2008-2009, $398,095,000
 
2007-2008: $415,032,000
 
2006-2007: $450,396,032
 
2005-2006, $491,000,000
 
2004-2005: $498,000,000
 

hpp cooperative agreement v the hcpr capabilities Image