oppEP-HIT-18-001-cfda93.817-cidEP-HIT-18-001-062560-instructions.docx

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:

Partnership for Disaster Health Response Cooperative Agreement

CFDA# 93.817

Funding Opportunity Number: EP-HIT-18-001 Application Due Date: August 15, 2018

U.S. Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR) Office of Emergency Management (OEM) Division of National Healthcare Preparedness Programs (NHPP)

Announcement Type: Cooperative Agreement Funding Opportunity Number: EP-HIT-18-001 Catalog of Federal Domestic Assistance (CFDA) Number: 93.817 All applications must be submitted by: August 15, 2018 at 11:59 p.m. ET

I. FUNDING OPPORTUNITY DESCRIPTION

Statutory Authority Section 319C-2 of the Public Health Service (PHS) Act (42 U.S.C. § 247d-3b), as amended

BACKGROUND:

Government Agency

The Office of the Assistant Secretary for Preparedness and Response (ASPR) is a staff division within the Office of the Secretary, U.S. Department of Health and Human Services (HHS). ASPR leads the nation’s efforts to prevent, protect against, mitigate, respond to and recover from the adverse health effects of public health incidents. ASPR focuses on preparedness planning and response; federal emergency medical operational capabilities; countermeasures research, advance development, and procurement; and grants to strengthen the capabilities of hospitals and healthcare systems to prepare for, respond to, and recover from public health emergencies and medical disasters. ASPR also provides federal support, including medical professionals through its National Disaster Medical System, to augment state and local capabilities during an incident.

Executive Summary

Since 2002, the Hospital Preparedness Program (HPP) cooperative agreement has provided funding to support healthcare preparedness for disasters including the development of additional surge capacity. In recent years, the focus of the program has centered on the development and enhancement of healthcare coalitions (HCCs) – partnerships between core member stakeholders in healthcare, emergency medical services (EMS), public health, and emergency management. These coalitions are focused on facilitating an integrated and coordinated response across the local area.[footnoteRef:1] [1: 2017-2022 Health Care Preparedness and Response Capabilities. Office of the Assistant Secretary for Preparedness and Response. November 2016. http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf. ]

State public health departments serve as the awardees for HPP and the complementary Public Health Emergency Preparedness Program (PHEP) cooperative agreement. While significant progress has been made in many healthcare preparedness and response capability areas, there is still much work to be done. In particular, the medical aspects of disaster response, especially those related to the promotion and sharing of strategic medical intelligence, clinical expertise, and complex medical management have not been as well addressed, nor have issues of patient care coordination across larger geographic areas. This includes assuring that clinical expertise is available during specialized responses (e.g. radiation response), and is integrated into decisions about response assets, crisis standards of care, and administration of medical countermeasures (e.g. large-scale administration of intravenous anthrax countermeasures).

Healthcare is almost exclusively a private sector function, but with public responsibilities during a disaster. Healthcare system capacity is stretched thin on a daily basis, and the specific challenges of planning for a large-scale event involving critical care, burn care, pediatric care, high consequence infectious diseases, or radiation exposure require rapid engagement of subject matter experts into decision-making and a robust understanding and leveraging of area resources. The current HPP does not address the need for access to specialized clinical expertise and highly coordinated patient care and patient movement in disasters, particularly when it involves multiple coalitions or states.

ASPR aims to better identify and address gaps in coordinated patient care during disasters through the establishment and maturation of a Regional Disaster Health Response System (RDHRS) (Figure). The primary objectives of the RDHRS are to:

1. Improve bidirectional communication and situational awareness of the medical needs and issues of the response between healthcare organizations and local, state, regional, and federal partners;

2. Leverage, build, or augment the highly specialized clinical capabilities critical to unusual hazards or catastrophic events; and

3. Augment the horizontal (whole of community) integration of key stakeholders that comprise healthcare coalitions with readily accessible and clinical capabilities that are largely missing from the current configuration of such coalitions.

The RDHRS structure is conceptualized as a tiered system that builds upon the existing Medical Surge Capacity and Capability (MSCC)[footnoteRef:2],[footnoteRef:3] foundation for local medical response (e.g. trauma systems and HCCs) by enhancing coordination mechanisms and incorporating discrete clinical and administrative capabilities at the state and regional levels. The RDHRS is not intended to alter or displace current local patient referral patterns, but is instead intended to define the delivery of clinical care when the existing referral patterns and health care delivery capacity and capabilities are exceeded by catastrophic events (requiring either redistribution of patients, importation of resources, or resource utilization guidelines). [2: Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf] [3: MSCC: The Healthcare Coalition in Emergency Response and Recovery. https://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx]

At all levels of RDHRS, activities aim to optimize clinical surge capacity, provide clinical expertise to support healthcare surge planning, and ensure that appropriate clinical expertise is involved and empowered as a partner in emergency planning and response. At the state level, RDHRS specifically aims to establish more robust situational awareness of healthcare system capability and capacity, coordination and prioritization mechanisms for patient transfers, process and policy for resource management, and access to clinical specialists in areas such as pediatrics, trauma and burn care, and infectious disease. The maturation of these capabilities will better enable states to respond to healthcare crises within their geographic boundaries and increase their ability to support resource requests from other states. At the regional (e.g. multi-state) level, the RDHRS will cultivate and establish mechanisms for sharing the clinical expertise necessary to respond to low-probability, high-risk threats (e.g. chemical, biological, radiological, and nuclear (CBRN) threats) and provide a mechanism to coordinate patient care and movement across jurisdictional boundaries. RDHRS will also integrate with and leverage the expertise and resources of existing response systems for biologic (e.g. National Ebola Training and Education Center) radiologic (e.g. Radiation Injury Treatment Network), and trauma- (trauma systems) based disasters.

Figure. Diagram of the Regional Disaster Health Response System

This funding opportunity announcement (FOA) does not aim to establish the RDHRS in its entirety, but instead funds a limited number of demonstration projects that will help identify issues, develop best practices, and demonstrate the potential effectiveness and viability of this concept. The awards will focus primarily on building and maturing the partnerships that are required to effectively prepare for and respond to the management of patients in disasters, including those that facilitate rapid expansion of medical surge capacity of the existing healthcare system, coordination of patient and resource movement to support the response, and the swift involvement of specific clinical specialists. The intent of this effort is to enhance response capabilities for both small- and large-scale emergencies and disasters. Whereas the healthcare coalition effort has successfully promoted “horizontal integration” of key stakeholders in the emergency response system, including healthcare entities and organizations, this effort will bolster such efforts by simultaneously promoting “vertical integration” of key expert resources such as trauma centers, pediatric centers, and poison control centers.

To that end, ASPR will fund two (2) “Partnerships” that will serve as demonstration sites for implementation of the RDHRS concept. Each Partnership will bring together required members as described in the Eligibility Criteria section and as required by section 319C-2(b)(1)(A) of the Public Health Service Act (42U.S.C. § 247d-3b(b)(1)(A)), as amended. Successful applicants will propose a governance structure that is capable of coordinating healthcare assets across the awardee’s state and is also poised to share information and medical assets with other states in their HHS region.

The capabilities included in this FOA are designed to be complementary to the HPP capabilities but emphasize the clinical coordination aspects of disaster response. These are discussed in detail below but include:

· Building a Partnership for Disaster Health Response;

· Aligning Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters;

· Increasing Statewide and Regional Medical Surge Capacity;

· Improving Statewide and Regional Situational Awareness; and

· Developing Readiness Metrics and Conduct an Exercise to Test Capabilities.

Purpose

To fund two demonstration projects that will help identify issues, develop best practices, and demonstrate the potential effectiveness and viability of the RDHRS concept.

Project Outcomes

· The awardee will establish a statewide Partnership of healthcare and governmental partners relevant to the coordinated delivery of patient care in disasters, as described in the “Capability 1: Build a Partnership for Disaster Health Response” section below.

· The Partnership will operationalize the capabilities necessary for effective and coordinated emergency response to identify best practices, lessons-learned, and barriers to state- and region-wide implementation and coordination of the RDHRS concept, as described in the sections titled “Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters,” “Capability 3: Increase Statewide and Regional Medical Surge Capacity,” and “Capability 4: Improve Statewide and Regional Situational Awareness.”

· The Partnership will develop readiness metrics related to the operational capabilities described in “Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters,” “Capability 3: Increase Statewide and Regional Medical Surge Capacity,” and “Capability 4: Improve Statewide and Regional Situational Awareness.”

· The Partnership will conduct a state- or region-wide exercise to test the operationalization of these capabilities as described in detail in the section titled “Capability 5: Develop Readiness Metrics and Conduct an Exercise to Test Capabilities.”

Implementation

Strategy: The Partnership will demonstrate the following capabilities in support of a coordinated, statewide and regional emergency response. Awardees must address all components included in the “objectives” and “activities” listed below in their application.

Capability 1: Build a Partnership for Disaster Health Response

Objective 1: Establish and Operationalize a Partnership for Disaster Health Response

Activity 1: Identify Partnership members and build the necessary relationships to facilitate statewide coordination of health and medical assets in disaster planning and response.

· Partnerships must include the following required members:

· One or more hospitals, at least one of which shall be a designated trauma center;[footnoteRef:4],[footnoteRef:5] [4: For States that do not have Trauma centers, partnerships may include Trauma centers in neighboring States that are willing to become partners. The application must clearly demonstrate how funds will be shared with the Trauma center despite the fact it is in different State from the partnership. The American College of Surgeons sets the standards for Trauma Center Designation. These standards/processes are found at http://www.facs.org/trauma/ntdbacst.html. Simply put, a Trauma Center (TC) is designated in one of 2 ways: (1) TC directly contacts the American College of Surgeons (ACS) Verification Program or (2) The State has passed laws for its own designation process and the designations are done at the State level. In this latter case, States must use the same standards as required by the ACS's Verification Program.] [5: ASPR strongly encourages partnerships to include a ACS/COT designated Level 1 trauma center.]

· One or more other local health care facilities, including clinics, health centers, community health centers, primary care facilities, mental health centers, mobile medical assets, or nursing homes; and

· One or more political subdivisions, one or more States, or one or more States and one or more political subdivisions.

· A signed MOU must be submitted by each required member of the Partnership as an appendix in the application package.

· Partnerships must also acquire and submit letters of support from, at minimum, the following supporting organizations:

· State Office of Public Health/Health

· Healthcare coalition leaders (or points of contact) in the state

· State Trauma Advisory Council (or equivalent)

· State Office of Emergency Medical Services

· Describe any existing relationships with the additional partners listed in the Special Requirements section, and, where possible, submit letters of support from these entities.

· Identify operational barriers to accomplishing the project outcomes and how these barriers will be overcome.

Activity 2: Propose a governance structure for the partnership that enables performance of the requisite capabilities, objectives, and activities.

· Propose an overall governance structure for the Partnership, including the roles and responsibilities of all participating entities and organizations.

· Designate an Executive Director and a Medical Director to act as leaders of clinical preparedness and response and neutral brokers among the partnership members and supporting organizations.[footnoteRef:6] [6: Grant funds may be used to pay a salary for each of these positions.]

· Describe integration of the Partnership with existing state and community incident management structures and specify roles within the Partnership that augment and complement existing systems and processes.

· Describe plans to convene Partnership members in person at least quarterly.

· Identify and document governance best practices.

Activity 3: Identify mechanisms that enable the Partnership to coordinate with equivalent entities in other states in their HHS region.

· Describe any established or potential relationships, processes, and mechanisms that would allow for information, material, personnel, and expertise to be shared across states in an emergency.

· Identify mechanisms to engage in regional planning, share protocols and best practices, and participate in exercises with other states.

· Identify and document challenges related to working with other state partners.

Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters

Objective 1: Identify Critical Clinical Capabilities and Gaps in Existing Disaster Plans

Activity 1: Assess statewide risk and vulnerabilities related to the clinical management of patients.

· Demonstrate Partnership involvement in state and local disaster planning efforts to ensure clinical accuracy and relevance while drafting and updating disaster plans.

· Include trauma systems in state disaster planning processes.

· Determine the clinical impact of likely disaster response scenarios with particular attention to demands on the healthcare system that would overwhelm existing local and regional capability and capacity.

· Identify and document regional and statewide healthcare resources and services that are vital to continuity of healthcare delivery during a disaster (e.g. clinical services, infrastructure, supply chain, caches, healthcare workforce, etc.).

Activity 2: Identify and document planning gaps related to clinical surge capacity.

· Identify and document potential gaps in state and regional surge capacity planning for conventional, contingency, and crisis surge.[footnoteRef:7] [7: Hick JL, Barbera JA, Kelen GD. Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(2 Suppl):S59–S67.]

· Identify and document surge capacity assets in the state and region required for a clinical response to high consequence infectious disease, burn, pediatric, and mass casualty scenarios, as well as any scenario identified in Activity 1 that is significantly likely to overwhelm existing capability and capacity.

· Conduct a statewide needs assessment of the implementation of an alternate care system (e.g. alternate care site locations, personnel, supplies, equipment)[footnoteRef:8],[footnoteRef:9] and the means by which such systems would complement the conventional delivery of healthcare services (e.g. telemedicine, electronic prescribing, triage lines). [8: Institute of Medicine. (2012). Crisis Standards of Care. A Systems Framework for Catastrophic Disaster Response. Volume 5: Alternate Care Systems. ] [9: Alternate Care Systems: Stratification of Care. Hanfling D. (2009). https://www.ncbi.nlm.nih.gov/books/NBK32849/]

· Define the indicators and triggers needed to initiate crisis standards of care.[footnoteRef:10] [10: Hanfling D , Hick JL , Stroud C , eds; Committee on Crisis Standards of Care . Crisis Standards of Care: A Toolkit for Indicators and Triggers. Washington, DC: The National Academies Press ; 2013 .]

· Identify barriers and gaps related to the use of conventional, contingency, and crisis care strategies.[footnoteRef:11] [11: Hick JL, Barbera JA, Kelen GD. Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(2 Suppl):S59–S67.]

· Where state crisis standards of care plans have been developed, ensure there is an implementation plan for crisis care in the clinical setting.

Objective 2: Align Existing Coalition and State Response Plans to Facilitate Coordinated Medical Surge

Activity 1: Build a framework for the coordination of planning activities related to the management of patients in disasters across all RDHRS tiers (i.e. coalition-, state-, and regional-levels).

· Develop consistency of protocols, policies and procedures across coalitions (to the degree possible).

· Identify and resolve potential conflicts related to coordination of healthcare assets (e.g. patient movement, patient tracking, expertise and resource sharing, and policy support) across multiple coalitions.

Objective 3: Facilitate Legal and Policy Coordination and Alignment Activity 1: Identify laws, regulations, and policies that impact the establishment of statewide and regional (i.e. multistate) coordination of healthcare in disaster planning and response.

· Document the state processes for declaration of emergencies, specific state-level waivers that may be implemented, existing liability protections for healthcare providers in disasters, and laws and regulations related to allocation of personnel, resources, and equipment.

· Document the state-level legalities surrounding alternate care systems (e.g. alternate care sites, crisis standards of care, quarantine and isolation).

· Document existing laws, regulations, and policies that impact interstate (i.e. regional) coordination of healthcare assets, including the sharing of highly specialized clinical expertise, in large-scale disasters.

Activity 2: Establish a mechanism for real-time legal, regulatory, and policy discussion related to the coordination of patient care in disasters.

· Demonstrate a process for joint clinical policy development during a disaster (e.g. establishment of common clinical guidelines, crisis standards of care, fatalities management, etc.).

Capability 3: Increase Statewide and Regional Medical Surge Capacity

Objective 1: Train and Prepare the Healthcare and Medical Workforce

Activity 1: Educate and train the healthcare and medical workforce on identified preparedness and response gaps related to the clinical management of patients.

· Identify basic elements to be included in a standardized training program for medical response personnel (e.g. state-sponsored medical teams), healthcare providers, and medical volunteers. This might include disaster ethics, triage principles, assessment and care of injuries or illness resulting from known CBRN threats, and other topics.

· Conduct a gap analysis of required and available training at the state and local levels for clinical response personnel who would detect or respond to a CBRN emergency. Consider, in particular, training related to healthcare worker protection, responder safety and security, individual resilience, HAZMAT, and infection control, especially as related to pathogens of high consequence.

· Demonstrate how just in time (JIT) training may be provided to increase healthcare worker resilience as required for response to different hazards and by professionals of different clinical specialty expertise.

Activity 2: Identify and develop the clinical expertise needed to support medical surge in large-scale and highly specialized disaster scenarios.

· Provide specialized surge management, expertise, education, and patient care coordination (to include EMS capabilities) during emergencies that result in a surge of (1) chemical, (2) radiation, (3) burn, (4) trauma, (5) high consequence infectious disease, and/or (6) pediatric patients.

· Assess needs and provide behavioral health support during a response.

· Identify methods to disseminate existing response expertise (e.g. NETEC, RITN, trauma, etc.) in the state and deploy it through means such as telemedicine and mobile teams to support medical surge in large-scale and highly specialized disaster scenarios.

· Conduct a statewide analysis of medical countermeasures acquisition and distribution strategies that will be undertaken in healthcare settings (e.g. retail pharmacies, clinics, hospitals, etc.) or that are likely to require clinical staffing (e.g. home delivery, points of distribution, etc.) and identify challenges in administration, provider training, and facility capacity.

Objective 2: Identify and Utilize Healthcare Surge Professionals

Activity 1: Draft a plan for the use of healthcare surge professionals internal and external to the state.

· Develop a model and plan for the establishment, deployment, and sustainment of specialized medical teams to large-scale disasters that occur within and outside of the state.

· Ensure that highly specialized clinical capabilities in infectious disease, pediatrics, and trauma and burn care are readily available anywhere in the state during large-scale disasters.

· Plan for the use of healthcare volunteers to support statewide medical response efforts.

· Implement mechanisms to use appropriately licensed health professionals from states within and outside of the HHS region during disasters (e.g. Uniform Emergency Volunteer Health Practitioners Act, central credentialing process, centralized request for hospital staff).

· Develop a model and plan for the deployment of Medical Reserve Corps (MRC) and Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) volunteers and define how these assets may be used to support medical surge planning and response within and outside of the state.

· Plan for the use of unaffiliated healthcare providers (e.g. licensing and credentialing agreements) to support statewide medical response efforts.

· Demonstrate knowledge of available interstate medical resources and personnel (e.g. EMAC, etc.) so that they may be rapidly shared across state lines.

Objective 3: Increase Readiness for Medical Surge

Activity 1: Improve inpatient, hospital, and EMS surge response.

· Draft policies and procedures that enable statewide visualization of emergency department and inpatient medical surge capacity using the mechanism described in Capability 4, Objective 1. Ideally these metrics should be reported through electronic health records systems and not manually.

· Promote implementation of surge capacity planning efforts in the management of seasonal ED overcrowding issues.

· Document challenges to increasing medical surge capacity in inpatient settings and for EMS.

Activity 2: Improve out-of-hospital medical surge response.

· Assure local coordination with outpatient settings and other out-of-hospital services and include these facilities in alternate care system planning to decrease the stress on inpatient facilities.

· Establish coordinated policies and procedures that integrate EMS response and patient destination choices with outpatient healthcare facilities.

· Document challenges to increasing medical surge capacity in outpatient settings.

Activity 3: Develop a clinical virtual support system and alternate care telephonic support system.

· Describe how telephone/telemedicine/virtual support will be used to effectively share subspecialty expertise during disasters throughout the state and/or region.

· Demonstrate how critical care medical direction and oversight (adult and pediatric) may be provided during a medical surge response by using telemedicine.

Objective 4: Plan for and Coordinate Healthcare Evacuation and Relocation Activity 1: Identify shortcomings in patient evacuation and relocation plans.

· Identify and address any shortcomings in existing patient evacuation and relocation plans across the geographic area (e.g. heavy reliance on a single vendor and other redundancies).

· Establish MOUs among healthcare and EMS entities across the state (and, where possible and necessary, with neighboring states) to facilitate secondary distribution of patients and resources via ground and air transfer to balance healthcare demand.

Activity 2: Describe the process for patient tracking and transport.

· Describe the process for patient tracking and transport across coalitions and/or jurisdictional boundaries and outside of regular referral patterns during a catastrophic event, including transport of high consequence infectious patients and others who may require specialized care during evacuation and relocation.

· Describe the process for family notification and family reunification when patients are evacuated or discharged out of healthcare settings during a catastrophic event.

Objective 5: Maintain Access to Supplies and Equipment during an Emergency Activity 1: Assess supply chain integrity.

· Assess the degree to which facility and coalition supply chain integrity could be impacted by a large-scale event that impacts a large proportion of the state (e.g. heavy reliance on a single vendor and other redundancies) and develop a joint understanding of strategies to address the vulnerabilities.

Activity 2: Assess and address equipment, supply, and pharmaceutical requirements.

· Establish communications and, where possible, written agreements with vendors, MOUs between coalitions, and EMAC between states for durable medical equipment (DME), disposable supplies, blood, and pharmaceuticals.

Capability 4: Improve Statewide and Regional Situational Awareness

Objective 1: Utilize Information Sharing Procedures and Platforms

Activity 1: Coordinate statewide healthcare situational awareness.

· Coordinate statewide/regional healthcare situational awareness through a centralized medical operations center that can integrate key information sharing functions (establishment of situational awareness, sharing of clinical expertise, etc.) with the state emergency operations center (EOC) or equivalent during a response.

· Identify the roles of the partners who should report to the medical operations center.

· Define the essential elements of information (EEI) to be shared in an emergency to facilitate medical surge response (e.g., number of patients, severity and types of illnesses or injuries, operating status, resource needs and requests, bed availability).

· Define the EEIs necessary for patient movement and patient tracking.

· Define the EEIs necessary for regional (i.e. interstate) healthcare situational awareness and decision-making (e.g. laboratory data, statewide surge capacity, etc.).

· Develop a roadmap to create an interoperable IT system that allows for the collection and sharing of EEIs and other real-time situational awareness of the operating status of the healthcare system.

Activity 2: Identify information access and data protection procedures.

· Establish necessary data use agreements, policies, and data protection procedures to protect healthcare information systems and networks.

Activity 3: Utilize communication systems and platforms.

· Demonstrate integration and coordination across communications systems to establish a common operating picture and shared situational awareness across the state and/or region; describe the design and any challenges to its establishment.

· Develop processes and procedures to rapidly acquire and share clinical knowledge among healthcare providers and healthcare organizations during responses to a variety of emergencies (e.g. CBRN, trauma, burn, pediatrics, or highly infectious disease); this could include conference calls, newsletters, trainings, telehealth/telemedicine, and other means.

Capability 5: Develop Readiness Metrics and Conduct an Exercise to Test Capabilities Objective 1: Develop Readiness Metrics Activity 1: In collaboration with ASPR, develop and implement readiness metrics for peer review assessments, monitoring, recognition reporting, and a “Response Ready” designation program for coalitions.

· Develop measurable readiness metrics that are directly linked to the objectives and activities described in “Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters,” “Capability 3: Increase Statewide and Regional Medical Surge Capacity,” and “Capability 4: Improve Statewide and Regional Situational Awareness.”

· Develop a capacity and capability analysis template that is based on the readiness standards and can be used as the basis for an annual readiness assessment of coalitions.

Objective 2: Conduct an Exercise to Test Medical Surge and Situational Awareness Capabilities Activity 1: Conduct at least one readiness exercise during the project period that measures the readiness of the coalitions’ surge capacity and demonstrates the ability to coordinate healthcare service delivery at the statewide and/or regional (i.e. interstate) level.

· The readiness exercise must test and evaluate a majority of capabilities listed in “Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters,” “Capability 3: Increase Statewide and Regional Medical Surge Capacity,” and “Capability 4: Improve Statewide and Regional Situational Awareness.”

· The exercise should also include initial event recognition and activation of the medical operations center to facilitate patient and bed tracking, and integration of clinical expertise into decision-making.

· The exercise should include a test of the implementation of alternate care systems in addition to the delivery of conventional care.

· The readiness exercise should use the newly developed readiness standards and capacity and capability analysis developed under Activity 1 of Capability 5.

· Awardee will conduct and submit one annual After Action Report and Corrective Action Plan (sample format provided in Attachments F and G, respectively).

Additional Requirements

Project Meetings

· Every Two Week Teleconferences. A conference call between ASPR and the grantee, to include at minimum the Executive Director and the Medical Director, shall occur every two weeks or as directed by the ASPR project officer. During this call, the Partnership will discuss the activities during the reporting period, any problems that have arisen, and the activities planned for the ensuing reporting period. The Executive Director may choose to include other key personnel on the conference call to give detailed updates on specific projects, or the ASPR project officer may make this request. The Partnership will maintain a table of expected activities, an actions log, and an identified risk log as a means of managing and conducting these teleconferences.

· Kick Off and Quarterly Meetings (with Government). The grantee and the Government shall participate in project meetings to coordinate the performance of the cooperative agreement. These meetings may include face-to-face meetings at the Partnership site or ASPR/HHS facilities. Such meetings may include, but are not limited to, meetings of the Partnership to discuss technical approach and operational capabilities, site visits to Partnership facilities, and meetings to discuss the technical, regulatory, and ethical aspects of the program. These meetings will also serve to formulate and agree upon the activities for the subsequent three months. In order to facilitate review of agreement activities, it is expected that the Partnership will provide data, reports, and presentations to ASPR, HHS, and/or other U.S. Government personnel as requested by the project officer. Dates for these meetings will be determined post-award.

· Quarterly Meetings of the Partnership. As described Capability 1/Activity 2, the Partnership members must meet at least quarterly. All required Partnership members should participate, as should the Executive Director and Medical Director. To the extent possible, representatives from the supporting organizations and additional partners may also participate. The purpose of these meetings is to identify and understand roles and responsibilities, formulate and agree on the activities for the subsequent three months, perform a progress check on the activities in the work plan, undergo a budget review, troubleshoot any barriers or challenges related to completing the deliverables of this cooperative agreement, and prepare for kick-off and quarterly meetings with ASPR, HHS, and/or other U.S. Government personnel. These meetings may be conducted virtually (e.g. phone- or web-conference) or in-person.

· Training Opportunities. Participation in ASPR-sponsored training, workshops, and meetings is essential to the effective implementation of the cooperative agreement. The ASPR project officer will work with awardees to help obtain supporting documentation to ensure participation at mandatory conferences and training workshops. Annual budgets should include travel for appropriate Partnership staff to attend the annual Preparedness Summit sponsored by NACCHO and the National Healthcare Coalition Conference hosted by MESH.

Reporting Requirements

· The awardee will be required to submit quarterly progress reports, including an end of year report using the template provided in Attachment E.

· The awardee will be required to submit an annual After Action Report and Corrective Action Plan as a result of the exercise conducted as part of Capability 5 using the templates in Attachments F and G, respectively.

II. AWARD INFORMATION

Estimated Total Project Cost: $6 million dollars

Estimated Funding Amount: up to $3 million dollars per award subject to availability of funds

Award Ceiling: $6 million

Anticipated Number of Awards: 2

Project Period Length: 12 months (one year)

Anticipated Start Date: September 30, 2018

Expected Duration of Support: 12 months (one year)

Type of Assistance Instrument: Cooperative Agreement

The Federal Grant and Cooperative Agreement Act of 1977, 31 U.S.C. 6305, defines the cooperative agreement as similar to a grant in that a thing of value is transferred to a recipient to carry out a public purpose. However, a cooperative agreement is used whenever substantial federal involvement with the recipient during performance is anticipated. The difference between grants and cooperative agreements is the degree of federal programmatic involvement rather than the type of administrative requirements imposed. This award is subject to the awardee(s) and collaborative requirements and responsibilities set forth in the Cooperative Agreement outlined in the program announcement under this funding opportunity and are hereby incorporated by reference as terms and conditions of this award.

Substantial federal involvement by the HHS may include but is not limited to the following functions and activities:

1. In accordance with applicable laws, regulations and policies the authority to take corrective actions if detailed performance specifications (e.g. activities in this funding guidance; approved work plan activities; budgets; performance measures and reports) are not met.

2. Review and approval of work plans and budgets before work can begin on a project during the period covered by this assistance or when a change in scope of work is proposed.

3. Review of proposed contracts.

4. Involvement in the evaluation of key recipient personnel supported through this assistance.

5. HHS and recipient collaboration or joint participation in the performance of the activities supported through this assistance.

6. Monitoring to permit specified kinds of direction or redirection of the work because of interrelationships with other projects.

7. Substantial and/or direct operational involvement or participation during the performance of the assisted activity prior to award of the cooperative agreement to ensure compliance with such generally applicable statutory requirements as civil rights, environmental protection, and provision for the handicapped.

The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party or provider who is ineligible. The measured success and impact of the Partnership demonstration projects will be used to inform future decisions regarding funding and expectations of partnerships. Additional demonstration projects may be supported in the future. Applicants who are successful in obtaining awards under this solicitation will be eligible to compete for additional demonstration project awards, should funding be available. As with all federal grants future offerings are dependent on the availability of appropriated funds in subsequent fiscal years and a decision that funding is in the best interest of the Federal government.

ASPR may award all or part of the funds, up to $6 million dollars subject to availability of funds.

III. ELIGIBILITY INFORMATION

Eligible Applicants

To be eligible for an award through this announcement an entity shall be a Partnership consisting of the following required members:

· one or more hospitals, at least one of which shall be a designated trauma center,[footnoteRef:12],[footnoteRef:13] [12: For States that do not have Trauma centers, partnerships may include Trauma centers in neighboring States that are willing to become partners. The application must clearly demonstrate how funds will be shared with the Trauma center despite the fact it is in different State from the partnership. The American College of Surgeons sets the standards for Trauma Center Designation. These standards/processes are found at http://www.facs.org/trauma/ntdbacst.html. Simply put, a Trauma Center (TC) is designated in one of 2 ways: (1) TC directly contacts the American College of Surgeons (ACS) Verification Program or (2) The State has passed laws for its own designation process and the designations are done at the State level. In this latter case, States must use the same standards as required by the ACS's Verification Program.] [13: ASPR strongly encourages partnerships to include a ACS/COT designated Level 1 trauma center.]

· one or more other local health care facilities, including clinics, health centers, community health centers, primary care facilities, mental health centers, mobile medical assets, or nursing homes; and

· one or more political subdivisions; one or more States; or one or more States and one or more political subdivisions.

Special Requirements Required Letters of Support

In addition, the awardee should:

· Have demonstrated past performance of coordinating with healthcare organizations and healthcare coalitions across the state.

· Submit with the application package letters of support from:

· State Offices Public Health/Health

· Healthcare coalitions leaders (or points of contact) in the state

· State Trauma Advisory Council (or equivalent)

· State Office of Emergency Medical Services Desired Letters of Support

· Awardees should also collaborate with the following individuals and entities within the state, at minimum, throughout the course of the project period. While letters of support from these entities are not required as part of the application package, applicants will receive additional credit in the application scoring criteria for additional letters of support:

· VA/DOD facilities

· NDMS hospitals

· State DMAT teams

· State Office of Emergency Management

· State Children’s Hospital Network (or equivalent)

· Radiation Injury Treatment Network centers

· Acute Care Hospitals/Medical Centers Table of Required Partners

The following table must be filled out reflecting the names and affiliations of all required members in the partnership (see page and attached as an Appendix to the application.

Information for any additional (desired, not required) partners that have provided letters of support may also be included, but it is not required to do so.

Table of Required Partners

Executive Director and Medical Director Qualifications

· With the application package, awardees must submit Curriculum Vitae of Key Personnel, including that of the Executive Director and Medical Director, as well as of any technical consultants that are essential to the execution of this cooperative agreement should be included in the application package.

· The Executive Director must meet or exceed the following qualifications:

· Broad knowledge of modern health care administration, systems, practices and principles

· Five or more years senior management experience

· Solid, hands-on, budget management skills, including budget preparation, analysis, decision-making and reporting (can remove or keep)

· Strong organizational abilities including planning, delegating, program development and task facilitation

· Ability to convey a vision of the RDHRS and Partnership strategic future to staff, partners, and volunteers through strong written and oral skills

· The Medical Director must meet or exceed the following qualifications:

· Physician with a current in-state license and demonstrated clinical experience.

· Board Certified in an American Board of Medical Specialties recognized specialty and clinically active.

· Familiarity with EMS, Emergency Management and Public Health laws and regulations.

· Education and/or experience with mass casualty, bioterrorism, Nuclear, Biological Chemical, Weapons of Mass Destruction (WMD) and/or disaster preparedness.[footnoteRef:14] [14: While the position’s job responsibilities and salary are designed to encompass work of a .25 FTE, the expectation of the employer is not limited to a set number of work hours, but rather the completion of all necessary tasks to meet the objectives of the grant that would naturally be attributed to the chief clinician.]

Additional Statutory Requirements

· The Secretary may not award a cooperative agreement to an eligible entity unless the application submitted by the entity is coordinated and consistent with an applicable State All-Hazards Public Health Emergency Preparedness and Response plan and relevant local plans.

· Awardees shall, to the extent practicable, ensure that activities carried out under this award are coordinated with activities of relevant local Metropolitan Medical Response Systems (MMRS), local Medical Reserve Corps (MRC), the Cities Readiness Initiative (CRI).

Other Important Notes about this Funding Opportunity Announcement

Guidance to Partnerships A political subdivision shall not participate in more than one partnership described in this announcement. It is expected that only one partnership will apply from each state because all of the required collaborating partners will agree on and support one applicant.

IV. COST SHARING AND MATCHING

Cost Sharing and Match Requirements

There is no cost sharing or match requirement for this project. This project does include maintenance of effort requirement as specified in section 319C-2(h).

· In general, an entity that receives an award under this section shall maintain expenditures for health care preparedness at a level that is not less than the average level of such expenditures maintained by the entity for the preceding 2 year period.

· Rule of construction: Nothing in this section shall be construed to prohibit the use of awards under this section to pay salary and related expenses of public health and other professionals employed by State, local, or tribal agencies who are carrying out activities supported by such awards (regardless of whether the primary assignment of such personnel is to carry out such activities).

V. APPLICATION AND SUBMISSION INFORMATION

Address to Request Application Package

Application materials can be obtained from http://www.grants.gov.

Contact person regarding this Funding Opportunity Announcement is: Virginia Simmons

Required Registrations

Applicants must register with the System for Award Management (SAM) and Grants.gov (see below for all registration requirements).

1. GET REGISTERED

You are required to complete three (3) registration processes:

1. Dun & Bradstreet Data Universal Numbering System (to obtain a DUNS number);

2. System for Award Management (SAM);and

3. Grants.gov If this is your first time submitting an application, you must complete all three registration processes. If you have already completed registrations for DUNS and SAM, you need to ensure that your accounts are still active, and then register in Grants.gov. If your organization is not registered by the deadline, the application will not be accepted.

The organization must maintain an active and up-to-date SAM and DUNS registrations in order for ASPR to make an award.

1.1 Dun & Bradstreet Data Universal Numbering System (DUNS) Registration Applicants are required to obtain a valid DUNS Number, also known as the Unique Entity Identifier, and provide that number in the application. Obtaining a DUNS number is easy and there is no charge.

To obtain a DUNS number, access the Dun and Bradstreet website at: http://www.dnb.com or call 1-866-705-5711. To expedite the process, let Dun and Bradstreet know that you are a public/private nonprofit organization getting ready to submit a federal grant application. The DUNS number you use on your application must be registered and active in the System for Award Management (SAM).

1.2 System for Award Management (SAM) Registration

You must also register with the System for Award Management (SAM) and continue to maintain active SAM registration with current information during the period of time your organization has an active federal award or an application under consideration by an agency. To create a SAM user account, Register/Update your account, and/or Search Records, go to https://www.sam.gov.

It is also highly recommended that you renew your account prior to the expiration date. SAM information must be active and up-to-date, and should be updated at least every 12 months to remain active (for both recipients and sub-recipients). Once you update your record in SAM, it will take 48 to 72 hours to complete the validation processes. Grants.gov rejects electronic submissions from applicants with expired registrations.

1.3 Grants.gov Registration

Grants.gov is an online portal for submitting federal grant applications. It requires a one-time registration in order to submit applications. While Grants.gov registration is a one-time only registration process, it consists of multiple sub-registration processes (i.e., DUNS number and SAM registrations) before you can submit your application.

You can register to obtain a Grants.gov username and password at http://www.grants.gov/web/grants/register.html.

If this is your first time submitting an application through Grants.gov, registration information can be found at the Grants.gov “Applicants” tab.

The person submitting your application must be properly registered with Grants.gov as the Authorized Organization Representative (AOR) for the specific DUNS number cited on the SF-424 (first page). See the Organization Registration User Guide for details at the following Grants.gov link: http://www.grants.gov/web/grants/applicants/organization-registration.html.

Application…