Initial EP-U3R-15-002.pdf

U.S. Department of Health and Human Services

Office of the Assistant Secretary for Preparedness and Response

Office of Emergency Management

Division of National Healthcare Preparedness Programs

Funding Opportunity Announcement and Grant Application Instructions

Funding Opportunity Title:

Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities

(CFDA #93.817)

Funding Opportunity Number: EP-U3R-15-002

Application Due Date: 04/22/2015

Table of Contents

I. FUNDING OPPORTUNITY DESCRIPTION

II. AWARD INFORMATION

III. ELIGIBILITY INFORMATION

IV. APPLICATION AND SUBMISSION INFORMATION

V. APPLICATION REVIEW INFORMATION

VI. AWARD ADMINISTRATION INFORMATION

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

I. FUNDING OPPORTUNITY DESCRIPTION

Executive Summary and Background

Beginning in March of 2014, West Africa experienced the largest Ebola outbreak on record. Unlike many smaller preceding outbreaks of Ebola virus disease (Ebola), this particular outbreak spread to multiple African countries and caused (as of February 2015) more than 22,000 suspected human cases. In August 2014, the first American Ebola patient was flown to the United States (U.S.) for treatment. Additional patients have subsequently been medically-evacuated to the U.S. and two returned travelers were diagnosed and treated in

Dallas, Texas and New York City, New York. These experiences, as well as the secondary infections of two health care workers in a Dallas hospital, identified opportunities to improve preparedness for and treatment of suspected and confirmed patients with Ebola. In response, Congress appropriated emergency funding, in part to ensure that the health care system is adequately prepared to respond to future Ebola patients. In doing so, Congress directed the Department of Health and Human Services (HHS) to develop a regional approach to caring for future Ebola patients.

The funding provided through the Hospital Preparedness Program (HPP) Ebola Preparedness and Response

Activities is intended to ensure the nation’s health care system is ready to safely and successfully identify, isolate, assess, transport, and treat patients with Ebola or patients under investigation for Ebola, and that it is well prepared for a future Ebola outbreak. While the focus will be on preparedness for Ebola, it is likely that preparedness for other novel, highly pathogenic diseases will also be enhanced through these activities.

Important lessons learned in the U.S. response to Ebola include that the safety of health care workers – from clinicians and laboratorians to ancillary staff – must be foremost in health care system preparedness and response activities; that the care of Ebola patients is clinically complex and demanding; and that early case recognition is critical for preventing spread and improving outcomes. Health care worker safety is best achieved through a deep understanding and correct implementation of infection control, appropriate use of personal protective equipment (PPE), continuous training, demonstration of competencies, and participation in frequent exercises. Assuring that Ebola patients are safely and well cared for in the U.S. health care system and that frontline providers are trained to recognize and isolate a person with suspected Ebola are the cornerstones of this HPP funding opportunity announcement (FOA).

In December 2014, HHS released its Interim Guidance for U.S. Hospital Preparedness for Patients under

Investigation or with Confirmed Ebola Virus Disease: A Framework for a Tiered Approach, which outlines the different roles U.S. acute health care facilities can play in preparing to identify, isolate, and evaluate patients with possible Ebola or treat patients with confirmed Ebola. These roles include serving as Ebola treatment centers, assessment hospitals, and frontline health care facilities. Since the fall, state health officials have been designating hospitals that have been assessed by a Centers for Disease Control and Prevention

(CDC)-led Rapid Ebola Preparedness (REP) team to serve as Ebola treatment centers. HHS appreciates the ongoing efforts of the public health and health care communities across the country to prepare our nation’s health care system for Ebola.

Experience with Ebola patients in the U.S. has shown that care of such individuals is clinically complex, requiring highly skilled health care providers and technologically-advanced care. This has led Congress, experts, and stakeholder groups to suggest that, to the extent possible, care of Ebola patients should be concentrated in a small number of facilities. At the same time, however, the nation’s hospitals must be prepared to handle one or more simultaneous clusters of Ebola patients. Further, as described in the Interim

Guidance, all hospitals must be able to identify, diagnose, and treat a suspected Ebola patient until they can be transferred to a facility that can provide definitive care.

http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/assessment-hospitals.html http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/frontline-healthcare-facilities.html

To that end, building upon the state- and jurisdiction-based tiered hospital approach and meeting Congress’ regional directive, through this FOA, HHS seeks to establish a nationwide, regional treatment network for

Ebola and other infectious diseases, which balances geographic need, differences in institutional capabilities, and accounts for the potential risk of needing to care for an Ebola patient. This network will consist of:

1) Up to ten regional Ebola and other special pathogen treatment centers (one in each of the ten HHS regions, that have been already designated by their state health officials to serve as Ebola treatment centers and have been assessed by a CDC-led REP team) and that can be ready within a few hours to receive a confirmed Ebola patient from their region, across the U.S., or medically-evacuated from outside of the U.S., as necessary. These hospitals will also have enhanced capacity to care for other highly infectious diseases. Part B of this FOA more fully describes these hospitals.

2) State or jurisdiction Ebola treatment centers that can safely care for patients with Ebola in the event of a cluster of Ebola patients that overwhelms the regional Ebola and other special pathogen treatment center (Clinical judgment, available logistical resources, and patient preference may indicate the patient should receive treatment at a state/jurisdiction Ebola Treatment Center rather than be transferred to a Regional Ebola and other special pathogen treatment center).

3) Assessment hospitals.

4) Frontline health care facilities.

Support for facilities in categories 2 through 4 above is described in Part A of this FOA.

This network will be supported by regular exercises and plans that describe how suspected Ebola patients are identified, diagnosed, and if necessary, safely transferred to the appropriate facility.

The Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities will provide awardees with funds to support this regional, tiered approach. At the state or jurisdiction level, awardees may support health care facilities that are capable of serving as Ebola treatment centers and assessment hospitals for their states or jurisdictions, as well as support health care coalitions to prepare frontline hospitals and overall health care system Ebola preparedness activities. Hospitals that have been designated as Ebola treatment centers as of February 14, 2015 should receive no less than $500,000 through Part A (refer to Appendix 3 for a complete list of such facilities). Awardees will have the discretion to provide additional funding to the Ebola treatment centers listed in Appendix 3 as their allocation allows. If an awardee funds an Ebola treatment center not listed in Appendix 3, it must have already been assessed by a CDC-led REP team as of the posting of this FOA. Awardees also have the discretion to fund assessment hospitals, as their allocation allows.

Awardees may support both future preparedness efforts and compensate facilities and coalitions for preparedness activities undertaken since July 2014.

ASPR is awarding a total of $194,500,000 in funding for Ebola health care system preparedness and response and the development of a regional Ebola treatment strategy.

Part A: $162,000,000 to support state- or jurisdiction-designated Ebola treatment centers, assessment hospitals, and health care coalitions for overall health care system preparedness.

Part B: $32,500,000 for the development of a regional network for Ebola patient care, including the establishment of approximately ten regional Ebola and other special pathogen treatment centers with significantly enhanced Ebola and other infectious disease capabilities that will accept a confirmed

Ebola patient from their region, across the U.S., or medically-evacuated from West Africa, as necessary.

This announcement is only for non-research activities supported by ASPR’s Division of National

Healthcare Preparedness Programs (NHPP). If research is proposed, the application will not be reviewed.

Statutory Authority

Title VI of Division G of the Consolidated and Continuing Appropriations Act, 2015 and section 311 of the

Public Health Service Act, as amended.

Purpose

The purpose of this FOA is (1) to improve health care system preparedness for Ebola and (2) to develop a regional hospital network for Ebola patient care.

Part A: Health Care System Preparedness for Ebola

Through Part A, HHS will provide funding to all 62 HPP awardees for the purpose of supporting health care system preparedness for Ebola. The awardees will have discretion about how to adequately fund their health care systems, so they achieve the preparedness capabilities needed for Ebola. While the focus will be on preparedness for Ebola, it is likely that preparedness for other novel, highly pathogenic diseases will also be enhanced through these activities. Through Part A, jurisdictions may use a portion of the funding to:

compensate health care facilities for Ebola preparedness activities undertaken since July 2014, build additional capabilities to ensure the nation’s health care system and health care workers are ready to safely and successfully identify, isolate, assess, transport, and treat patients under investigation with Ebola or confirmed to have Ebola, and be well prepared for a future Ebola-like event.

Project Outcomes

Awardees will develop and implement a health care system concept of operations (CONOPS) for care of Ebola patients. This CONOPS must link state activities related to active and direct active monitoring of returning travelers to designated assessment hospitals and treatment hospitals, and ensure that patients can be safely transported to a regional Ebola and other special pathogen treatment center and/or a state or jurisdiction Ebola treatment center in the event that they are not the same or the regional facility cannot accept patients. Awardees must ensure their Part A funding strategy for state/jurisdiction Ebola treatment centers, assessment hospitals, and health care coalitions (including frontline health care facilities, EMS and other partners) matches their CONOPS. Each awardee’s health care system CONOPS for Ebola will be maintained and exercised annually throughout the project period.

Awardee CONOPS will outline health care system and facility gaps to improve operational readiness, bearing in mind that the requirements of state/jurisdiction Ebola treatment centers should be more extensive than those for assessment and frontline facilities, and that interfacility transport of patients may be needed.

The 18 states/jurisdictions at higher risk for Ebola1 will have assessment hospitals located within 75 miles of at least 85 percent of their returning traveler populations. All other states/jurisdictions will have at least one assessment hospital.

All awardees will have a plan and written agreement in place for the transfer of a patient with Ebola from an assessment hospital to a regional Ebola and other special pathogen treatment center

(established through Part B of this FOA).

Any state/jurisdiction-based Ebola treatment center receiving funding through Part A will care for an

Ebola patient if the regional facility cannot accept additional patients (in the event of a national emergency). Any funded Ebola treatment center may be expected to provide Ebola patient care regardless of the patient’s home jurisdiction.

Each of the 18 high risk states/jurisdictions will designate at least one state/jurisdiction Ebola treatment center to provide surge capacity for the regional Ebola and other special pathogen treatment centers established through Part B of this FOA. If a high-risk state/jurisdiction does not currently have an

Ebola treatment center, they will establish a written agreement with a neighboring state or jurisdiction to use that state or jurisdiction’s Ebola treatment center.

Note: For the 18 high-risk states/jurisdictions, if one of these awardees does not have a regional Ebola and other special pathogen treatment center (established through Part B of this FOA) within their jurisdiction’s political boundaries, they must have a state/jurisdiction Ebola treatment center.

Alternatively, if a high-risk state/jurisdiction does not currently have an Ebola treatment center, it must establish written agreement with a neighboring state or jurisdiction to use that state or jurisdiction’s

Ebola treatment center for surge capacity. Upon reviewing each of the 18 high-risk state or jurisdiction’s health care system CONOPS for Ebola, and other components of their funding applications as detailed in the FOA, HHS will reduce allocations for those high-risk states or jurisdictions that do not have an Ebola treatment center within their jurisdiction and provide additional funding to those states/jurisdictions with which they have a written agreement.

Within 72 hours of the region’s Ebola treatment center (see Part B of this FOA) accepting a confirmed

Ebola patient, all state/jurisdiction Ebola treatment centers located within that region will begin their just-in-time trainings and final preparations, so they are able to accept a patient (in the event of a small cluster of cases).

All awardees will complete Ebola patient care and transport arrangements within four hours of a diagnosis; planning for Ebola patient care and transport will begin at the time the decision is made to conduct laboratory testing for Ebola. This includes transport to either a regional Ebola and other special pathogen treatment centers or a state- or jurisdiction-designated Ebola treatment center (see

Appendix 2: Ebola Patient Decision Algorithm).

Health care coalitions will:

o Ensure the EMS system is capable of safely transporting Ebola patients.

High-risk jurisdictions include: California, Chicago, Connecticut, District of Columbia, Georgia, Maryland, Massachusetts, Minnesota, New Jersey, New York, New York City, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Virginia, and

Washington. Risk is based on the percentage of returning travelers from impacted countries, and reflects West African diaspora population centers, and jurisdictions with enhanced airport entrance screenings.

o Ensure the competency of health care workers, clinical laboratories, and EMS personnel in the coalition through supporting annual training and exercises.

o Purchase PPE or support facility or agency purchase and stockpile, preferably using vendor-managed inventories, at the coalition/community/or regional level. At a minimum, coalitions will coordinate with partners to obtain visibility of the PPE supplies available at health care facilities and EMS agencies in their communities.

Implementation

Awardees must address all activities and strategies listed below in their Part A application.

Activity A: Develop a Concept of Operations

Strategy: Outline the jurisdiction’s tiered approach for health care system response, including the assessment, transport, and treatment of persons suspected or confirmed to have Ebola.

o Develop and implement a health care system CONOPS for Ebola and ensure their Part A funding strategy for state/jurisdiction Ebola treatment centers, assessment hospitals, and health care coalitions (including frontline health care facilities, EMS, and other partners) matches their CONOPS. Each awardee’s health care system CONOPS for Ebola will be maintained and exercised annually throughout the project period.

o Develop a plan and signed written agreement for the transfer of a patient with Ebola from an assessment hospital to a regional Ebola and other special pathogen treatment center, established through Part B of this FOA. Transfer to a regional facility will be part of a state’s

CONOPS and annual exercise.

o Assure the health care system CONOPS includes a plan for coordinating with airport authorities and other states within the region to identify airports that can accept air transport of

Ebola patients.

o Assure the CONOPS includes the plan for active and direct active monitoring (AM/DAM) and a communications strategy for notifying health care partners (i.e., EMS and assessment hospitals) prior to transporting a patient in AM/DAM.

o Outline a plan to address health care system and facility gaps to improve operational readiness, bearing in mind that the requirements of Ebola treatment centers should be more extensive than those for assessment and frontline facilities.

o Outline a safe ground transport plan that allows for intra- and inter-state transport of potential or confirmed Ebola patients, as necessary. See Appendix 2, the Ebola Patient

Decision Algorithm, for more information.

Activity B: Assure Readiness of Ebola Treatment Centers and Assessment Hospitals

Strategy 1: Improve and maintain health care worker readiness for Ebola and Ebola-like diseases o Provide hospital-level training of staff, specifically focusing on health care worker safety when caring for an Ebola patient (e.g., PPE donning/doffing, rapid identification and isolation of a patient, safe treatment protocols, and the integration of behavioral health support) and early recognition, isolation, and activation of the facility’s Ebola plan.

o Conduct annual exercises (including after action reviews and corrective action plans), which should include unannounced first encounter drills for Ebola (and other infectious diseases, such as MERS-CoV and measles), patient transport exercises, and patient care simulations.

http://www.cdc.gov/vhf/ebola/hcp/us-hospital-preparedness.html o Purchase PPE in accordance with CDC guidelines, and share, in real time, situational awareness regarding their PPE models/types and supply levels with their health care coalitions

(HCCs).

o Conduct just-in-time training and final preparations to assure state/jurisdiction Ebola treatment centers can provide surge capacity to the region’s Ebola and other special pathogen treatment center (see Part B of this FOA) and are able to accept a patient (in the event of a small cluster of cases) within 72 hours of the region’s Ebola and other special pathogen treatment center accepting a confirmed patient.

o Receive and participate in training, peer review, and an assessment of their readiness from the

National Training and Education Center (to be established) to ensure adequate preparedness and trained clinical staff knowledgeable in treating patients with Ebola in the U.S.

Strategy 2: Enhance the hospital’s physical infrastructure to ensure infection control for Ebola preparedness and response, as necessary.

o Reconfigure patient flow in the emergency department to provide isolation capacity for patients under investigation (PUI) for Ebola and other potentially infectious patients.

o Retrofit inpatient care areas for enhanced infection control (e.g., donning/doffing rooms).

o Ensure PUIs receive appropriate care until an Ebola diagnosis is confirmed or ruled out.

o Consider establishing dedicated space and procuring separate equipment and supplies for clinical laboratories for Ebola.

o Ensure capability to handle Ebola-contaminated or other highly-contaminated infectious waste

(e.g., through purchase or contract to use on-site a high-volume autoclave capable of sterilizing all hospital waste used in the care of a patient with Ebola, or by having a waste management facility within the state or jurisdiction willing and able to incinerate and dispose of Ebola waste, or by having a written agreement with another state willing and able to do so).

o Consider adjusting Electronic Health Records (EHRs) to ensure prompt staff screening for patients’ travel histories and newly emerging diseases.

o Identify opportunities to use and coordinate facility-specific pathways for state/jurisdiction

Ebola treatment centers and assessment hospitals to ensure better infection control through resources linked to either CDC’s Public Health Emergency Preparedness (PHEP) program and/or CDC’s Epidemiology and Laboratory Capacity (ELC) for Infectious Diseases program.

Activity C: Develop Capabilities of Health Care Coalitions to enable their members to care for Ebola patients

Strategy 1: Ensure all coalition partners have access to PPE, trainings, and exercises according to their respective role in the health care system.

o Purchase PPE or support facility purchase and stockpile, preferably using vendor-managed inventories and mutual aid agreements at the coalition, community, or regional level. Rapidly distribute or re-distribute PPE to a facility within their coalition as needed. At a minimum, coalitions will coordinate with partners to obtain visibility of the PPE supplies available at health care facilities in their communities and ensure it can be moved rapidly as needed.

o Ensure the competency of health care workers to identify, assess, and treat suspected or confirmed patients with Ebola through annual training.

o Conduct annual coalition level exercises with, at a minimum, frontline facilities and EMS.

Exercises in the first year should be specific to Ebola and will not necessarily satisfy the annual HPP-PHEP exercise requirements. If in subsequent years, there are no global outbreaks of Ebola, exercises may address other infectious diseases, such as MERS-CoV and http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html measles, and may satisfy the annual HPP-PHEP exercise requirements upon approval of your

Field Project Officer.

o Conduct just-in-time training and assist coalition partners in final preparations to assure state/jurisdiction Ebola treatment centers and assessment hospitals are able to accept a patient

(in the event of a small cluster of cases) within 72 hours of the region’s Ebola and other special pathogen treatment center (see Part B of this FOA) accepting a confirmed patient. This includes coordination with EMS and interfacility transport agencies.

Strategy 2: Ensure that EMS and interfacility transport systems and 9-1-1/Public Safety Answering

Points are included in Ebola coalition planning.

o Provide funding, as necessary, to EMS agencies for Ebola preparedness activities, such as

PPE, training, and exercises.

o Ensure that medical waste generated through the care of Ebola patients for EMS is safely managed through their own plans, a hospital’s plan, or a separate coalition plan.

Strategy 3: Integrate health care system preparedness and infection control through health care coalition engagement with State Healthcare-Associated Infection (HAI)/Infection Control advisory groups, established with funding and guidance from CDC’s Epidemiology and Laboratory Capacity for Infection Control (ELC) program and to consider how a regional emergency preparedness structure could support improved infection control for coalition members.

Evaluation and Performance Measurement

Measures have not been finalized and are subject to change. ASPR will work with applicants over the first six weeks post-award to develop the evaluation and performance measurement strategy. This information and guidance containing ASPR-required performance measures will be issued by NHPP following the posting of the funding announcement.

Potential performance measures for the project period:

1. The proportion of clinical, lab, and ancillary staff at Ebola Treatment Centers rostered to support care for an Ebola patient with updated annual training certification on PPE donning/doffing (Goal:

100 percent).

2. Report the time, in minutes, it takes an assessment hospital to identify and isolate a patient with

Ebola or other highly contagious disease (e.g., MERS-CoV, measles, etc.) following emergency department triage, as evidenced by a real-world case or no-notice exercise (Goal: 5 minutes).

3. For state/jurisdiction Ebola treatment centers, report the time it takes for the initial on-call team to report to the unit upon notification of an incoming Ebola patient, as evidenced by a real-world event or no-notice exercise (Goal: 8 hours).

4. The proportion of hospitals, EMS, and ambulatory care providers within a coalition that share visibility, at least bi-monthly, of their PPE supply with coalition partners (Goal: 80 percent).

5. Report the time, in minutes, it takes from an assessment hospital’s notification to the health department of the need for interfacility transfer of a patient with confirmed Ebola to the arrival of a staffed and equipped EMS/interfacility transport unit, as evidenced by a no-notice exercise

(Goal: 4 hours).

6. Report the proportion of state/jurisdiction Ebola treatment center and assessment hospital staff necessary to implement the facility’s Ebola plan that have been rostered and trained (Goal: 100 percent).

7. For state/jurisdiction Ebola treatment centers, report the time it takes to recall all rostered and trained staff designated to provide surge care for an Ebola patient upon notification of an Ebola patient at a regional Ebola and other special pathogen treatment center, as evidenced by a no-notice exercise (Goal: 72 hours).

Funding Strategy

ASPR will provide funding to all 62 HPP awardees (the 50 states, the District of Columbia, three directly-funded cities, and the U.S. territories and freely associated states) for the purpose of supporting health care system preparedness for Ebola using a base + population + Ebola risk formula. The risk portion is based on the percentage of returning travelers from impacted countries, and reflects West African diaspora population centers and jurisdictions with enhanced airport screenings.

The formula sets the base at $200,000 for islands/territories, $700,000 for low-risk awardees, and $1,700,000 for high-risk awardees. On top of the base, additional funding is distributed to all awardees based on population (30 percent) and risk (70 percent). Additional funding ($500,000) is provided to the nine awardees with a stand-alone pediatric Ebola treatment center (see Appendix 3 for complete list of Ebola treatment centers).

Funding awarded for Part A will be based on a 60 months (5 years) budget and project period. Further, HPP requires that all entities (Ebola treatment centers, assessment hospitals, and health care coalitions) receiving funding through Part A have a plan to maintain their readiness to care for an Ebola patient for the duration of the project period through annual staff trainings and exercises and sustainment of Ebola PPE.

Within their allocation for Part A, the awardees will have discretion as to how to adequately fund their health care systems, so they achieve the preparedness capabilities needed for Ebola:

ASPR requires that awardees limit funding to the Ebola treatment centers listed in Appendix 3, and to assessment hospitals that have been designated by their state health officials as of the posting of this

FOA.

Hospitals that have been designated as Ebola treatment centers as of February 14, 2015, including stand-alone pediatric facilities, should receive no less than $500,000 through Part A (refer to Appendix

3 for a complete list of such facilities). Awardees will have the discretion to provide additional funding to the Ebola treatment centers listed in Appendix 3 as their allocation allows. If an awardee funds an

Ebola treatment center not listed in Appendix 3, it must have already been assessed by a CDC-led REP team as of the posting of this FOA. Awardees also have the discretion to fund assessment hospitals, as their allocation allows.

Awardees may use a portion of the funding to retroactively compensate health care coalitions and health care facilities, including Ebola treatment centers and assessment hospitals, for Ebola preparedness activities undertaken since July 2014 that are consistent with the activities described in

Part A of this FOA. Awardees must request retroactive compensation at the time of the application.

The request should contain the following information:

o Time period;

o Line item budget for the period; and, o Narrative description of the Ebola preparedness activities.

Awardees must limit their direct costs (excluding subawards to HCCs and health care facilities) to no more than 10 percent of the Part A allocation. ASPR will consider requests for exemptions on a case-by-case basis. Of the funds for subawards:

o At least 30 percent must be allocated to health care coalitions in the jurisdiction.

o No more than 70 percent may be used to provide funding directly to Ebola treatment centers and/or assessment hospitals.

Funding to any individual facility in Part A (whether an Ebola treatment center or assessment hospital) must be generally limited to no more than $1 million; however, funding for an Ebola treatment center should be greater than for an assessment hospital.

In awarding funds, states and jurisdictions should consider the investments made by the facilities to become Ebola treatment centers or assessment hospitals. In addition, while awardees may not utilize

HPP resources to reimburse hospitals for the costs associated with caring for PUIs, states/jurisdictions may wish to prioritize assessment hospitals that received multiple PUIs when allocating funding for preparedness activities.

None of the funds made available in Part A of this FOA may be used to reimburse hospitals or entities for the costs associated with caring for persons under investigation for Ebola or for the costs of treating a confirmed Ebola patient.

Awardees may also apply for additional funding through Part B of this FOA, which will be based on a five-year budget and project period. Awardees may submit budget modifications for Part A upon learning of Part

B funding decisions.

Total availability of funds: $162,000,000

Approximate number of awards given: 62

Approximate average range of awards: $202,989 - $15,229,780

Part B: Development of a Regional Network for Ebola Patient Care

HHS will award funding through Part B of the FOA to up to 10 HPP awardees to develop a regional network for Ebola patient care, which includes a requirement to establish one regional Ebola and other special pathogen treatment center to serve each HHS region. The facility sub-recipients funded through Part B of the FOA must agree to serve as regional assets and agree to accept patients from outside of their jurisdiction. These facilities will have enhanced preparedness capabilities to ensure they are the leading providers of care and treatment for

Ebola patients in the U.S. and have the capabilities needed to manage other high containment, Ebola-like infectious diseases in the future.

All HPP jurisdictions are eligible to apply for Part B funding. However, HPP envisions Part B as a cooperative process. Ideally, only one applicant will apply from each region because all the jurisdictions in the region will agree on, and support, one applicant. HPP will award a maximum of 10 awards through Part B

(two sole source awards for [1] the Georgia Department of Public Health to support the Emory University

Hospital, Atlanta, Georgia to serve as the Region 4 regional Ebola and other special pathogen treatment center and [2] the Nebraska State Department of Health and Human Services to support the Nebraska Medicine -

Nebraska Medical Center, Omaha, Nebraska to serve as the Region 7 regional Ebola and other special pathogen treatment center) and up to eight additional competitive awards for the remaining HHS regions.

Project Outcomes

Part B awardees will develop a plan that must include signed written agreements among all states/jurisdictions in the region, and the regional Ebola and other special pathogen treatment center.

This plan will include EMS and interfacility plans to accommodate patient movement from any point in the region to the designated hospital(s). Note: Awardees are not responsible for maintaining air transport contracts or capabilities.

Any facility identified to serve as a regional Ebola and other special pathogen treatment center will:

o Accept patients from within their HHS region within eight hours of notification.

o Have the capacity (beds and staff) to treat at least two Ebola patients at one time.

o Have respiratory isolation infectious disease capacity or negative pressure rooms for at least 10 patients, preferably, within the same unit.

o Serve as the primary hospital in their HHS region for treatment of confirmed Ebola patients.

o If necessary, accept patients that are medically evacuated from Ebola-affected countries or other HHS regions.

o Maintain a heightened state of readiness for at least the five-year project period by conducting quarterly staff trainings and exercises.

o Receive and participate in training, peer review, and an assessment of their readiness from the

National Training and Education Center (to be established) to ensure adequate preparedness and trained clinical staff knowledgeable in treating patients with Ebola in the U.S.

o Either have the capability to treat pediatric Ebola patients or partner with another facility within their region to do so.

o Care for Ebola patients without disrupting overall hospital and emergency department operations.

o Participate in clinical research, clinical trials, and experimental protocols, if appropriate.

o Work with their human resources departments, as well as relevant employee unions, to develop policies and procedures to ensure health care worker readiness and safety associated with caring for an Ebola patient.

o Have the capability to handle Ebola-contaminated or other highly-contaminated infectious waste (e.g., through purchase of a high-volume autoclave capable of sterilizing all hospital waste used in the care of a patient with Ebola; by having a waste management facility within the state or jurisdiction willing and able to incinerate and dispose of Ebola waste; or by having a written agreement with another state in the region willing and able to do so).

o Integrate behavioral health considerations for patients and staff, as well as the provision of culturally and linguistically appropriate services, into medical and safety procedures.

Implementation

Applicants must address all activities and strategies listed below in their Part B application.

Activity A: Supporting regional planning for the development of a regional network for Ebola patient care.

Strategy 1: Develop written agreements between states within the region to develop a regional network for Ebola patient care, which are signed by state or jurisdiction elected officials and state or jurisdiction health officials from each state in the region.

Strategy 2: Ensure that interfacility and interstate transport plans are developed for Ebola patients that consider ground transport times between facilities and from designated airports to the

Regional Ebola and other special pathogen treatment center.

o Coordinate with public health and emergency management leaders and elected officials, such as state governors, to ensure permissible movement of patients between states. There should be a clear, written understanding of how patients from all parts of the region will be transported to the Regional Ebola and other special pathogen treatment center and what will happen if the center is at capacity (See Appendix 2, the Ebola Patient Decision

Algorithm, for more information).

o Coordinate with all states in the region; EMS agencies; state EMS officials;

state/jurisdiction assessment and treatment hospitals; and regional Ebola and other special pathogen treatment centers to determine the indications for ground transport and air transport of Ebola patients.

o Review laws and regulations within each state and jurisdiction in the region to identify and address barriers to patient transport.

Activity B: Developing, supporting, and maintaining regional Ebola and other special pathogen treatment centers

Strategy 1: Ensure regional Ebola and other special pathogen treatment centers are ready to accept an

Ebola patient within eight hours of notification by developing and maintaining strong health care worker competencies and safety procedures and surge capacity for Ebola and Ebola-like diseases.

o Ensure regional Ebola and other special pathogen treatment centers are willing to accept training, peer review, and assessment by the National Training and Education Center to evaluate readiness and develop an improvement plan to address gaps.

o Develop, maintain, and exercise policies and procedures to ensure health care worker readiness and safety, including behavioral health considerations, associated with caring for an

Ebola patient for the five-year project period of this FOA.

o Train staff at least quarterly, specifically focusing on health care worker safety when caring for an Ebola patient (e.g., PPE donning/doffing, rapid identification and isolation of a patient, safe treatment protocols and behavioral health considerations) and early recognition, isolation, and activation of the facility’s Ebola plan.

o Conduct quarterly exercises, including after action reviews and corrective action plans, which should include unannounced first patient encounter drills for Ebola (and other infectious diseases, such as MERS-CoV and measles), patient transport exercises, and patient care simulations.

o Purchase PPE in accordance with facility Ebola treatment plans.

o Ensure behavioral health considerations for patients and staff, as well as the provision of culturally and linguistically appropriate services, are fully integrated into medical and safety procedures.

Strategy 2: Ensure the regional Ebola and other special pathogen treatment center’s infrastructure is ready and policies are established to accept an Ebola patient within eight hours of notification;

collaborate with partners, as necessary, to achieve this.

o Ensure regional Ebola and other special pathogen treatment center capacity (beds and staff) to treat at least two Ebola patients at one time.

o Ensure respiratory isolation infectious disease capacity or negative pressure rooms (for at least

10 patients, preferably, within the same unit).

o Ensure collaboration with a health care partner to provide pediatric Ebola care capabilities (if the regional Ebola and other special pathogen treatment center does not already possess these capabilities). For example, this may be accomplished by bringing specialized equipment and staff (pre-trained and credentialed) to treat a pediatric patient within the regional Ebola and other special pathogen treatment center from a partner health facility.

o Ensure the ability to provide care to the normal flow of patients and assure normal patient care is not is not interrupted during the time in which an Ebola patient or patients are being cared for in the Ebola treatment unit.

o During periods without an Ebola patient, Ebola treatment units may have alternate day–to-day uses, such as for other patient care or for research and training purposes.

o Consider the potential for offering labor and delivery services for Ebola patients, and conducting other procedures.

o Participate in clinical research, clinical trials and experimental protocols, as needed.

o Reconfigure patient flow in the emergency department to provide isolation capacity for PUIs and other potentially infectious patients.

o Retrofit inpatient care areas for enhanced infection control (e.g. donning/doffing rooms).

o Consider establishing dedicated space and procuring separate equipment and supplies for clinical laboratories for Ebola.

o Ensure capability to handle Ebola-contaminated or other highly-contaminated infectious waste

(e.g., through purchase or contract to use on-site a high-volume autoclave capable of sterilizing all hospital waste used in the care of a patient with Ebola, by having a waste management facility within the state or jurisdiction willing and able to incinerate and dispose of Ebola waste, or by having a written agreement with another state willing and able to do so).

o Consider adjusting Electronic Health Records (EHRs) to ensure prompt staff screening for patients’ travel histories and newly emerging diseases.

Evaluation and Performance Measurement

Measures have not been finalized and are subject to change. ASPR will work with applicants over the first six weeks post-award to develop the evaluation and performance measurement strategy. This information and guidance containing ASPR-required performance measures will be issued by NHPP following the posting of the funding announcement. In addition, facilities will receive peer assessment using metrics developed by the National Training and Education Center (NTEC), to be established by a separate FOA.

1. The proportion of clinical, lab, and ancillary staff at regional Ebola and other special pathogen treatment centers rostered to support care for an Ebola patient with updated quarterly training certification on PPE donning/doffing (Goal: 100 percent).

2. The time it takes until a regional Ebola and other special pathogen treatment center is ready to accept Ebola patients (both an adult and pediatric patient), as evidenced by an exercise or actual patient transfer (Goal: within 8 hours of notification).

3. The proportion of states and jurisdictions in the HHS region for which a current written and signed agreement is in place to transfer patients from assessment hospitals to the regional Ebola and other special pathogen treatment center (Goal: 100 percent).

4. Report the proportion of regional Ebola and other special pathogen treatment center staff necessary to implement the facility’s Ebola plan that have been rostered and trained (Goal: 100 percent).

5. For regional Ebola and other special pathogen treatment centers, report the time it takes for the initial on-call team to report to the unit upon notification of an incoming Ebola patient, as evidenced by a real-world event or no-notice exercise (Goal: 4 hours).

6. For regional Ebola and other special pathogen treatment centers, report the time it takes to recall all rostered and trained staff designated to care for an Ebola patient upon notification of an incoming Ebola patient, as evidenced by a real-world event or no-notice exercise or “secret shopper” (Goal: 8 hours).

7. The proportion of states and jurisdictions in the HHS region that have demonstrated the ability to move a patient across jurisdictions to a regional Ebola and other special pathogen treatment center, as evidenced by a real-world event or participation in a multi-jurisdiction exercise (Goal:

100 percent).

Eligibility and Funding Strategy

HHS will award funding through Part B of the FOA to up to 10 HPP awardees to develop a regional network for Ebola patient care, which includes a requirement to establish one regional Ebola and other special pathogen treatment center to serve each HHS region. The facility sub-recipients funded through Part B of the FOA must agree to serve as regional assets and agree to accept patients from outside of their jurisdiction. These facilities will have enhanced preparedness capabilities to ensure they are the leading providers of care and treatment for

Ebola patients in the U.S. and have the capabilities needed to manage other high containment, Ebola-like infectious diseases in the future. Regional facilities must have had a REP team visit as of the date of posting of this FOA.

All HPP jurisdictions are eligible to apply for Part B funding (See Section V for detailed selection/review criteria).

HPP will award a maximum of 10 awards through Part B:

o Two sole source awards for [1] the Georgia Department of Public Health to support the Emory

University Hospital, Atlanta, Georgia to serve as the Region 4 regional Ebola and other special pathogen treatment center and [2] the Nebraska State Department of Health and Human

Services to support the Nebraska Medicine - Nebraska Medical Center, Omaha, Nebraska to serve as the Region 7 regional Ebola and other special pathogen treatment center; and, o Up to eight additional competitive awards for the remaining HHS regions.

The states/jurisdictions that receive funding through Part B must agree to provide no less than 90 percent of the Part B funding to at least one health care facility to serve as a regional Ebola and other special pathogen treatment center. ASPR will consider requests for exemptions on a case-by-case basis.

Of the total for the regional Ebola and other special pathogen treatment center, HPP will provide at least $2,250,000 during the first year and $250,000 in the four subsequent years to maintain and sustain the capabilities of these regional centers.

None of the funds made available in Part B of this FOA may be used to reimburse hospitals or entities for the costs associated with caring for persons under investigation for Ebola or for the costs of treating a confirmed Ebola patient.

Applications will be reviewed by a review panel.

Total availability of funds: $32,500,000

Approximate number of awards given: Up to 10

Approximate award: $3,250,000 - $4,600,000

ASPR Activities

In a cooperative agreement, ASPR staff is substantially involved in the program activities, above and beyond routine grant monitoring. ASPR’s NHPP and other ASPR subject matter experts will use application submission information to identify strengths and weaknesses to update work plans and to establish priorities for site visits and technical assistance. To assist recipients in achieving the purpose of this cooperative agreement, ASPR will conduct the following activities:

Establish a National Training and Education Center (NTEC) comprised of staff from hospitals that have successfully treated Ebola to assist with peer review and assessment of regional Ebola and other special pathogen treatment centers, state/jurisdiction Ebola treatment centers, and, if desired, assessment hospitals.

Provide ongoing guidance, programmatic support, and training as it relates to the activities outlined in this Ebola and other funding announcement guidance documents.

Convene conference calls, site visits, and other communications as applicable with awardees.

Facilitate communication among awardees to advance the sharing of expertise on health care preparedness and response activities for Ebola.

Coordinate planning and implementation activities with federal partners, including the PHEP cooperative agreement administered by CDC, to optimize preparedness investments and eliminate duplication where possible.

Additionally, for Part B of this cooperative agreement, the HPP Field Project Officers and the Division of

Regional and International Coordination Regional Emergency Coordinators will work with states/jurisdictions in their region (and at least one health care facility identified by the states/jurisdictions in each HHS region) to help establish at least one Regional Ebola and other special pathogen treatment center.

Collaborations:

With ASPR-funded programs:

ASPR will collaborate with other programs and initiatives, as relevant (e.g., the Emergency Care Coordination

Center and the Biomedical Advanced Research and Development Authority) to assure that efforts are being maximized while reducing duplication of effort.

With organizations external to ASPR:

States have limited resources to improve health care system preparedness and develop Regional Ebola and other special pathogen treatment centers. Therefore, it is imperative that awardees partner with other federal

(e.g., CDC’s PHEP program) and state and local organizations (e.g., local public health departments) working to effectively prepare for Ebola and the possibility of having an Ebola patient or patient under investigation for

Ebola.

Awardees must also collaborate to integrate preparedness and infection control efforts by participating in State

Healthcare-Associated Infection (HAI)/Infection Control advisory groups, established with funding and guidance from CDC’s Epidemiology and Laboratory Capacity for Infection Control (ELC) program and to consider how a regional emergency preparedness structure could support improved infection control throughout the community

Other Important Notes about this Funding Opportunity Announcement:

This FOA covers two separate, but related projects: Part A – Health Care System Preparedness for

Ebola and Part B – Development of a Regional Network for Ebola Patient Care.

Applicants should include narratives and budgets spanning the entire length of the projects applied for, which may not exceed 60 months (five years) for Parts A and B.

ASPR will work with applicants over the first six weeks post-award to develop the evaluation and performance measurement strategy. This information and guidance containing ASPR-required performance measures will be issued by NHPP following the posting of the funding announcement.

Applicants should coordinate the HPP activities with supplemental activities under the ELC

Cooperative Agreement (CK-14-1401PPHFSUPP15) and the PHEP Cooperative Agreement (CDC-

RFA-TP12-12010302SUPP15), as well as the activities under the annual…