PHEP Cooperative Agreement

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phep: funding

 
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By the end of the project period, PHEP awardees should build or maintain the necessary elements identified in the Public Health Preparedness Capabilities: National Standards for State and Local Planning to achieve substantial, measurable progress in each of the funded public health preparedness capabilities across the six domains.

To achieve this goal, the Strategies and Activities section of the logic model focuses on 1) areas for which improvement has been identified in drills, exercises, and incident responses across each of the public health preparedness capabilities and medical countermeasure (MCM) technical assistance action plans and 2) program requirements for the project period, both of which are described in more detail in the Strategies and Activities section.

PHEP awardee strategies, activities, and related outputs indicated in the logic model will lead to progress in the development and maintenance of established (CDC's expected level of effectiveness) state, local, and territorial public health emergency management and response programs during the project period. Ultimately, CDC expects awardees to achieve the following response and program outcomes:

  • Timely assessment and sharing of essential elements of information,
  • Earliest possible identification and investigation of an incident with public health impact,
  • Timely implementation of intervention and control measures,
  • Timely communication of situational awareness and risk information,
  • Continuity of emergency operations management throughout the surge of an emergency or incident,
  • Timely coordination and support of response activities with partners, and
  • Continuous learning and improvements are systematic.
Important!  Remember, the cooperative agreement is a contract between ASPR and the Awardee, not between the Awardee and the healthcare coalition. PHEP cooperative agreement requirements and recommendations only enforceable on the sub grantee – the local health department (LHD) – if they are specifically stated in the LHD's sub grant.

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

2016-2017 cooperative agreement

the cooperative agreement is a contract between the federal government and the states or other awardees

phep/hpp joint requirements

  • Describe their top jurisdictional strategic priorities for the remainder of the project period.
  • Identify the data sources used to inform their Budget Period 5 strategic priorities. Sources include but are not limited to jurisdictional risk assessments, capability self-assessments, and after-action reviews and improvement plans.
  • List challenges or barriers that are anticipated for Budget Period 5, including any budgetary issues that might hinder the success or completion of the project as originally proposed and approved.

Awardees are required to complete jurisdictional risk assessments (JRA) to identify potential hazards, vulnerabilities, and risks within the community, including interjurisdictional (e.g., cross-border) risks as appropriate, that specifically relate to the public health, medical, and behavioral health systems and the functional needs of at-risk individuals. Awardees must provide the date the jurisdictional risk assessment was completed or is projected to be completed. In addition, HPP and PHEP awardees must coordinate risk assessment activities with relevant emergency management and homeland security programs in their jurisdictions to account for specific factors that affect the community. Active coordination supports whole community planning, builds community resiliency, and should support the comprehensive jurisdictional Threat and Hazard Identification and Risk Assessment (THIRA) administered by the U.S. Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA).

  • Awardees must update their multiyear training and exercise plans (TEPs) to reflect planned activities. Updated TEPs must be submitted at the time of application.
    • In Budget Period 5, ASPR will no longer require submission of separate HPP exercise plans, exercise narratives, and training plans.
  • Awardees must conduct one joint statewide or regional full-scale exercise within the five-year project period to test public health and healthcare preparedness capabilities.
    • Joint exercises must include participation from healthcare coalitions (including, at a minimum, hospitals, public health departments, emergency management agencies, and emergency medical services) and public health jurisdictions.
    • In addition, joint exercises should meet multiple program requirements, including HPP, PHEP, medical countermeasures planning and Cities Readiness Initiative (CRI) requirements, to help minimize the burden on exercise planners and participants.
    • Exercises conducted with funding from other preparedness grant programs with similar exercise requirements may be used to fulfill the joint HPP-PHEP exercise requirements if the public health and healthcare preparedness capabilities are tested and evaluated. Awardees are encouraged to invite participation from representatives/planners involved with other federally mandated or private exercise activities. At a minimum, ASPR and CDC encourage HPP and PHEP awardees to share their TEP schedules with the entities included in their exercise plans.
  • Awardees must conduct an annual public health and medical preparedness exercise or drill that specifically includes at-risk individuals or populations (see www.phe.gov/Preparedness/planning/abc/Pages/atrisk.aspx) and report in the following year’s funding application on the strengths and weaknesses identified and corrective actions taken to address weaknesses. HPP awardees should consider the access and functional needs of at-risk individuals and engage these populations as they plan Budget Period 5 healthcare coalition-based exercises.
  • Awardees must complete and submit after-action reports and improvement plans (AAR/IPs) for all responses to real incidents and for exercises conducted during Budget Period 5 to demonstrate compliance with HPP and PHEP program requirements. HPP and PHEP awardees should provide an AAR/IPs for each qualifying exercise within 90 days.
  • ASPR and CDC will provide awardees with technical assistance documents that provide more information on exercise planning and implementation.
  • Awardees are strongly encouraged to nominate exercises into the National Exercise Program. (NEP). The NEP is critical to our nation’s ability to test and validate core capabilities. For additional information on the NEP, please refer to www.fema.gov/national-exercise-program.

Awardees must work with their local public health jurisdictions to test and strengthen administrative preparedness planning including coordination with healthcare systems, law enforcement, and other relevant stakeholders. For Budget Period 5, awardees must also identify whether their jurisdictions have:

  • Tested expedited procedures as identified in their administrative preparedness plans for (1) receiving emergency funds during a real incident or exercise, (2) reducing the cycle time for contracting and/or procurement during a real emergency exercise.
  • Implemented internal controls related to subrecipient monitoring and any negative audit findings resulting from suboptimal internal controls.
  • Tested emergency authorities and mechanisms as identified in their administrative preparedness plans to reduce time for hiring and/or reassignment of staff (workforce surge). If they were tested, identify which procedures were tested and describe the average times for recruitment and/or hiring of staff in routine and emergency circumstances.

Awardees must maintain current all-hazards public health emergency preparedness and response plans and be prepared to submit plans to ASPR or CDC if requested and make plans available for review during site visits. In the Program Requirements Update, awardees must describe activities and the role of public health, healthcare, and behavioral health systems related to all-hazards preparedness and response planning, the process for obtaining public comment, and any cross-border activities (for border states only).

While the overarching focus of this continuation guidance is on healthcare preparedness (HPP) and public health preparedness (PHEP), it must be recognized that preparedness is but one element of the emergency management cycle that emphasizes preparedness “for response.” Response capabilities, whenever possible, should be included in preparedness efforts. How any given hospital, healthcare coalition, public health agency, emergency medical services entity, or region “responds” to an event is the ultimate measure of success, not simply the efficacy or cumulative acquisitions supported by the preparedness effort alone. Preparedness should be tested, mitigation strategies should be developed or adjusted based on those tests (or response to real incidents), and the results of such efforts should be incorporated into the preparedness portfolio whenever possible. Thus, continuity from preparedness to response should always be the ultimate goal.

Awardees are required to have updated plans describing activities they will conduct with respect to pandemic influenza as required by Sections 319C-1 and 319C-2 of the PHS Act. HPP awardees can satisfy the annual requirement through the submission of required program data such as the capability self-assessment and program measures that provide information on the status of state and local pandemic response readiness, barriers and challenges to preparedness and operational readiness, and efforts to address the needs of at-risk individuals. PHEP awardees must submit status reports describing corrective actions plans and improvements taken to address operational readiness gaps identified in the CDC pandemic influenza readiness assessment (PIRA) completed in 2015. Awardees must submit the status reports within 90 days of receiving their PIRA summary reports outlining operational gaps. In addition, awardees must submit any follow-up data needed to better inform the PIRA baseline data.

Awardees must describe the structure or processes in place to integrate the access and functional needs of at-risk individuals, including but not limited to children, pregnant women, older adults, people with disabilities, and people with limited English proficiency and non-English speaking populations. Strategies to integrate the access and functional needs of at-risk individuals involve inclusion in public health, healthcare, and behavioral health response strategies; furthermore, these strategies are identified and addressed in operational work plans. Awardees, subawardees, and healthcare coalitions are encouraged to identify community partners with established relationships with diverse at-risk populations, such as social services organizations, and to use demographic tools such as the Social Vulnerability Index and the U.S. Census/American Community Survey to better anticipate the potential access and functional needs of at-risk community members before, during, and after an emergency.

Awardees must describe the structure or processes in place to integrate individuals with chronic medical conditions, including individuals who rely on electricity to power life-sustaining medical and assistive equipment and health care services. Examples of such equipment includes, but is not limited to, ventilators, oxygen concentrators, enteral feeding machines, intravenous pumps, suction pumps, at-home dialysis machines, electric wheelchairs and scooters, and electric beds, as well as beneficiaries who rely on specific healthcare services including dialysis, oxygen tank services, and home health visits. Strategies to integrate the needs of individuals with chronic medical conditions involve inclusion in public health, healthcare, and behavioral health response strategies; furthermore, these strategies are identified and addressed in operational work plans. Awardees, subawardees, and healthcare organization are encouraged to use the HHS emPOWER Map at www.phe.gov/empowermap/Pages/default.aspx to better anticipate the potential access and functional needs of individuals with chronic medical conditions before, during, and after an emergency.

Awardees can use HPP and PHEP funding to support coordination activities, such as local health departments planning with health care coalitions, and must track accomplishments. Awardees should coordinate activities with state emergency management agencies, emergency medical services providers (including the State Office of Emergency Medical Services), mental health agencies (including the State Mental Health Authority and the Disaster Behavioral Health Coordinator), healthcare coalitions, and educational agencies and state child care lead agencies. When possible, efforts to coordinate with other stakeholders in the healthcare delivery system (skilled nursing facilities, dialysis centers, ambulatory clinics, community health centers, and other outpatient care delivery partners) should also be supported. HHS strongly encourages awardees to work collaboratively with other federal health and preparedness programs in their jurisdictions, including the Emergency Medical Services for Children Program, to maximize resources and prevent duplicative efforts.

The daily delivery of public health and health care, including accountable care organizations, health information exchanges, and integrated behavioral healthcare, impacts both public health and health care preparedness and response. Awardees should consider linkages with programs and activities that would improve their ability to execute the public health or health care preparedness capabilities. As awardees develop and refine health care coalitions, they should plan coalition activities that are built around day-to-day health care systems and referral patterns. In addition, awardees must work to establish new partnerships with infection control or prevention programs in their jurisdictions that can advance the development of stronger healthcare system infection control and prevention programs.

Awardees must establish and maintain advisory committees or similar mechanisms of senior officials from governmental and nongovernmental organizations involved in homeland security, health care, public health, and behavioral health to help integrate preparedness efforts across jurisdictions and to maximize funding streams. This will enable HPP and PHEP programs to better coordinate with relevant public health, health care, and preparedness programs.

Awardees must obtain public comment and input on public health 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 and the general public, including those with an understanding of at-risk populations and their needs.

Awardees and subawardees that use federal preparedness grant funds to support emergency communications activities must comply with current SAFECOM guidance for emergency communications grants. SAFECOM guidance is available at www.safecomprogram.gov.

The ESAR-VHP compliance requirements identify capabilities and procedures that state ESAR-VHP programs must have in place to ensure effective management and interjurisdictional movement of volunteer health personnel in emergencies. Awardees must coordinate with volunteer health professional entities and are encouraged to collaborate with the Medical Reserve Corps (MRC) to facilitate the integration of MRC units with the local, state, and regional infrastructure to help ensure an efficient response to a public health emergency. More information about the MRC program can be found at www.medicalreservecorps.gov.

HPP and PHEP awardees must engage the State Unit on Aging, Area Agency on Aging, or an equivalent office in addressing the public health emergency preparedness, response, and recovery needs of older adults. Awardees must provide evidence that this state office is engaged in the jurisdictional planning process.

Awardees must describe in their all-hazards public health 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 public health emergencies.

Awardees in jurisdictions located on the United States-Mexico border or the United States-Canada border must conduct activities that enhance border health, particularly regarding disease detection, identification, investigation, and preparedness and response activities related to emerging diseases and infectious disease outbreaks whether naturally occurring or due to bioterrorism. This focus on crossborder preparedness reinforces the U.S. public health and health system preparedness whole-of-community approach which is essential for local-to-global threat risk management and response to actual events regardless of source or origin.

Awardees must conduct activities to meet preparedness goals with respect to chemical, biological, radiological, or nuclear threats, whether naturally occurring, unintentional, or deliberate. Awardees should also consider active shooter and bombing threats. Emphasis on the response should include the ability to create medical surge capacity and capability. Plans should highlight the importance of using a “systems” approach to manage scarce resources, including limited medical countermeasures, staff, and medical resources.

Public health preparedness programs should prioritize and emphasize strengthening and sustaining cross-discipline coordination and communication between preparedness programs and HCC members, communicable disease programs, and state HAI programs/advisory groups (or other infection control groups) to advance infectious disease preparedness planning across the public health and healthcare systems. ASPR and CDC have developed guidelines to assist with further developing and refining healthcare and public health preparedness capability-based work plans to include, but not limited to, healthcare system and community preparedness, emergency public information and warning, information sharing, medical surge, non- pharmaceutical interventions, and responder safety and health. These guidelines are available in the PERFORMS Resource Library.

Awardees must ensure emergency preparedness and response coordination with designated educational agencies and lead child care agencies in their jurisdictions.

  • Maintain a current all-hazards public health emergency preparedness and response plan and submit to ASPR or CDC when requested and make available for review during site visits.
  • Submit required progress reports and program and financial data, including progress in achieving evidence-based benchmarks and objective standards; performance measures data including data from local health departments; outcomes of annual preparedness exercises including strengths, weaknesses and associated corrective actions; and accomplishments highlighting the impact and value of the HPP and PHEP programs in their jurisdictions.
  • Inform and educate hospitals and healthcare coalitions within the jurisdiction on their role in public health emergency preparedness and response.
  • Submit an independent audit report every two years to the Federal Audit Clearinghouse within 30 days of receipt of the report.
  • Provide situational awareness data during emergency response operations and other times as requested.
  • Document maintenance of funding and matching funds.
  • Have in place fiscal and programmatic systems to document accountability and improvement. The following are accountability processes designed to generate programmatic improvements:
    • Plan and participate in joint site visits at least once every 12-24 months. In addition to site visits, awardees are encouraged to invite HPP and PHEP project officers and senior ASPR and CDC staff to attend or observe events such as scheduled exercises, regional meetings, jurisdictional conferences, senior advisory committee meetings, and coalition meetings supported by HPP and PHEP funding to gain insight on strengths and challenges in preparedness planning.
    • Participate in mandatory meetings and training. The following meetings are considered mandatory, and awardees should budget travel funds accordingly:
      • Annual preparedness summit sponsored by the National Association of County and City Health Officials (NACCHO)
      • Directors of public health preparedness annual meeting sponsored by the Association of State and Territorial Health Officials
      • Healthcare coalition preparedness conference as specified by ASPR.
      • Other mandatory training sessions that may be conducted via webinar or other remote meeting venues.
    • Engage in technical assistance planning. Awardees must actively work with their HPP and PHEP project officers to properly identify, manage, and update technical assistance plans at least quarterly during Budget Period 5.
    • Maintain all program documentation for purposes of data verification and validation. ASPR and CDC strongly encourage awardees to develop internal electronic systems that allow jurisdictions to share documentation with HPP and PHEP project officers, including evidence of progress completing corrective actions for weaknesses identified during exercises and drills. In Budget Period 5, ASPR and CDC will strengthen the emphasis on verification and validation of requirements to identify strengths and potential gaps, better review and evaluate progress, and engage in technical assistance.

2016-2017 phep specific requirements

2017-2018 funding restrictions

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

phep/hpp overarching funding restrictions and conditions

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.

phep specific funding restrictions and conditions

  • use funds to lease vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gas-driven motorized carts.( with prior approval)
  • use funds to purchase material-handling equipment (MHE) such as industrial or warehouse-use trucks to be used to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads (with prior approval).
  • use funds to purchase caches of antibiotics for use by first responders and their families to ensure the health and safety of the public health workforce (with prior approval).
  • use funds to support appropriate accreditation activities that meet the Public Health Accreditation Board’s preparedness-related standards (with prior approval).

phep cooperative agreement appropriations

the phep cooperative agreement is a contract between the the cdc and the states

phep base funding by year

2016: $546,940,949 (accounts for PHEP restoration under Zika Act)
2015: $546,940,949
2014: $548,182,450
2013: $519,471,972
2012: $554,803,057
2011: $523,215,590
2010: $611,341,225
2009: $618,830,835
2008: $629,146,071
2007: $791,779,743
2006: $699,013,268
2005: $809,956,000
2004: $809,956,000

cdc zika funding shift and restoration

CDC Zika PHEP funding restoration graphic

On September 29, 2016, the President signed the Zika Response and Preparedness Act, which includes restoration of $44,250,000 to the Public Health Emergency Preparedness (PHEP) Program that has been redirected to fight Zika

The funding will be available to the states as soon as authorized, stated a source at the CDC.

The funding was redirected from the PHEP program in March after Congress failed to provide emergency supplemental funding for Zika research and response, as requested by the White House. The shift required states to submit amended budgets to the CDC, which led to cuts in sub grants to local health departments across the country.

Because of the Congressionally mandated PHEP formula, the cuts were not equally distributed, ranging from 0.8% in Palau to 9.4% in California. Also, in many states, because of bleed-over in state office operational cost, such as dual funded (HPP & PHEP) personnel and shared technology solutions, HPP sub grants were also reduced.

The Zika Response and Preparedness Act provides full funding restoration for the states, but it may not necessarily translate to the same for local health departments. The onus here is not on the CDC, as each state's laws, regulations, and policies will determine how or if current PHEP sub grants with locals can be amended before the funding obligation date of June 30, 2017.

The amount being awarded to each state is below.


zika act funding restoration by state

State Total Current $ %
Alabama $8,896,210 $8,282,477 $613,733 6.9%
Alaska $4,203,797 $4,008,961 $194,836 4.6%
American Samoa $363,274 $356,674 $6,600 1.8%
Arizona $11,827,592 $10,911,739 $915,853 7.7%
Arkansas $6,627,030 $6,249,569 $377,461 5.7%
California $42,550,665 $38,570,815 $3,979,850 9.4%
Chicago $9,793,363 $9,262,437 $530,926 5.4%
Colorado $9,800,461 $9,094,118 $706,343 7.2%
Connecticut  $7,724,101 $7,233,738 $490,363 6.3%
Delaware $4,386,406 $4,243,150 $143,256 3.3%
Florida $29,486,535 $26,833,350 $2,653,185 9.0%
Georgia $16,013,312 $14,662,128 $1,351,184 8.4%
Guam $485,453 $466,108 $19,345 4.0%
Hawaii $4,890,373 $4,694,308 $196,065 4.0%
Idaho $5,035,239 $4,823,671 $211,568 4.2%
Illinois $16,717,286 $15,294,823 $1,422,463 8.5%
Indiana $11,399,133 $10,526,446 $872,687 7.7%
Iowa $6,778,623 $6,385,337 $393,286 5.8%
Kansas $6,744,676 $6,355,765 $388,911 5.8%
Kentucky $8,465,354 $7,896,874 $568,480 6.7%
Los Angeles County $19,738,684 $18,163,514 $1,575,170 8.0%
Louisiana $8,899,256 $8,286,241 $613,015 $6.9%
Maine $4,706,041 $4,528,810 $177,231 3.8%
Marshall Islands $380,652 $372,239 $8,413 2.2%
Maryland $11,267,444 $10,411,078 $856,366 7.6%
Massachusetts $13,119,101 $12,181,742 $937,359 7.1%
Michigan $16,671,987 $15,361,777 $1,310,210 7.9%
Micronesia $422,693 $409,895 $12,798 3.0%
Minnesotta $11,262,604 $10,518,587 $744,017 6.6%
Mississippi $6,696,959 $6,312,338 $384,621 5.7%
Missouri $10,885,932 $10,067,187 $818,745 7.5%
Montana $4,343,135 $4,203,760 $139,375 3.2%
N. Mariana Islands $359,170 $352,998 $6,172 1.7%
Nebraska $5,365,165 $5,119,326 $245,839 4.6%
Nevada $6,763,000 $6,372,777 $390,223 5.8%
New Hampshire $4,812,829 $4,624,949 $187,880 3.9%
New Jersey $15,592,851 $14,289,117 $1,303,734 8.4%
New Mexico $6,751,311 $6,475,408 $275,903 4.1%
New York $19,804,717 $18,239,925 $1,564,792 7.9%
New York City $18,477,826 $17,319,006 $1,158,820 6.3%
North Carolina $14,918,015 $13,677,089 $1,240,926 8.3%
North Dakota $4,203,797 $4,008,961 $194,836 4.6%
Ohio $17,904,402 $16,356,243 $1,548,159 8.6%
Oklahoma $7,801,393 $7,302,035 $499,358 6.4%
Oregon $8,033,968 $7,510,978 $522,990 6.5%
Palau $324,408 $321,862 $2,546 0.8%
Pennsylvania $19,524,277 $17,808,098 $1,716,179 8.8%
Puerto Rico $7,158,040 $6,724,300 $433,740 6.1%
Rhode Island $4,502,689 $4,347,166 $155,523 3.5%
South Carolina $9,831,748 $9,225,872 $605,876 $6.2%
South Dakota $4,147,303 $4,028,356 $118,947 2.9%
Tennessee $11,253,427 $10,395,677 $857,750 7.6%
Texas $37,664,097 $34,065,482 $3,598,615 9.6%
Utah $6,656,363 $6,276,248 $380,115 5.7%
Vermont $4,203,797 $4,008,961 $194,836 4.6%
Virgin Islands $421,112 $408,479 $12,633 3.0%
Virginia $15,049,835 $13,899,895 $1,149,940 7.6%
Washington $12,132,694 $11,184,642 $948,052 7.8%
Washington, DC $6,389,265 $6,247,100 $142,165 2.2%
West Virginia $5,327,651 $5,085,641 $242,010 4.5%
Wisconsin $11,587,682 $10,844,792 $742,890 6.4%
Wyoming $4,203,797 $4,008,961 $194,836 4.6%

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