PKG00248781-instructions.docx

U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response Hospital Preparedness Program (HPP) Funding Opportunity Announcement (FOA) and Grant Application Instructions Funding Opportunity Title:

Hospital Preparedness Program Cooperative Agreement

(CFDA # 93.8989)

Funding Opportunity Number: EP-U3R-19-001 All applications must be submitted by: May 3, 2019

Table of Contents

I. FUNDING OPPORTUNITY DESCRIPTION

A. Executive Summary and Background The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) leads the country in preparing for, responding to, and recovering from the adverse health effects of emergencies and disasters. ASPR’s programs improve the nation’s ability to withstand adversity, strengthen health and emergency response systems, and enhance national health security. ASPR’s Hospital Preparedness Program (HPP) is the only source of federal funding specifically for health care delivery system readiness. HPP aims to improve patient outcomes, minimize the need for federal and supplemental state resources during emergencies, and enable rapid recovery from catastrophic events through the development of health care coalitions (HCCs). HCCs incentivize and support diverse and often competitive health care organizations with differing priorities and objectives to work together to save lives during disasters and emergencies that exceed the day-to-day capacity and capability of individual health care and emergency response systems. ASPR recognizes that there is shared authority and accountability for the health care delivery system’s readiness that rests with private organizations, government agencies, and states’/jurisdictions’ Emergency Support Function 8 (ESF-8) – Public Health and Medical Services lead agencies. HCCs serve an important communication and coordination role within their jurisdictions, given the many public and private entities that must come together to ensure health care delivery system readiness.

To describe what health care delivery system partners, including HCCs, health care organizations, and emergency medical services (EMS), must do to effectively prepare for and respond to emergencies ASPR developed the 2017-2022 Health Care Preparedness and Response Capabilities. These capabilities illustrate the range of health care preparedness and response activities that, if conducted, represent the ideal state of readiness in the United States. Individual health care organizations, HCCs, jurisdictions, and other stakeholders that develop the capabilities outlined in the 2017-2022 Health Care Preparedness and Response Capabilities document will help patients receive the care they need at the right place, at the right time, and with the right resources during emergencies; decrease deaths, injuries, and illnesses resulting from emergencies; and promote health care delivery system resilience in the aftermath of emergencies.

The goals of the four health care preparedness and response capabilities are as follows:

Capability 1: Foundation for Health Care and Medical Readiness The community’s health care organizations and other stakeholders – coordinated through a sustainable HCC – have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.

Capability 2: Health Care and Medical Response Coordination Health care organizations, the HCC, their jurisdiction(s), and the state’s/jurisdiction’s ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.

Capability 3: Continuity of Health Care Service Delivery Health care organizations, with support from the HCC and the state’s/jurisdiction’s ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.

Capability 4: Medical Surge Health care organizations deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the state’s/jurisdiction’s ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

ASPR recognizes that the entirety of the 2017-2022 Health Care Preparedness and Response Capabilities will not be achieved solely with the funding provided to HPP recipients and sub-recipients (including HCCs and health care organizations) through the HPP cooperative agreement. This FOA describes ASPR’s expectations and priorities and lists performance measures for assessing HPP recipients’ and sub-recipients’ progress toward building the capabilities. Overall, the goal of the HPP cooperative agreement is to build acute care medical surge capacity through the maintenance and growth of strong HCCs.

B. Statutory Authorities Overarching Authorities Section 319C-2 of the Public Health Service (PHS) Act (title 42 United States Code (USC) § 247d-3b), as amended.

Section 311 of the PHS Act (title 42 USC § 243), subject to available funding and other requirements and limitations.

1. References The following are federal strategies, guidance documents, and directives that support the authorities and objectives of the readiness and response activities detailed in this FOA.

· 2017-2022 Health Care Preparedness and Response Capabilities

· 2019 HPP Performance Measures Implementation Guidance (to be released in Spring 2019)

· Healthy People 2020

· Preparedness objectives for Healthy People 2020

· HHS Pandemic Influenza Plan

· Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health

· Homeland Security Presidential Directive (HSPD)-5 (Management of Domestic Incidents)

· HSPD-21 (Public Health and Medical Preparedness)

· Presidential Policy Directive-8 (National Preparedness)

· National Health Security Strategy

· Centers for Medicare and Medicaid Services (CMS); Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (Rule CMS-3178-F)

· Homeland Security Exercise and Evaluation Program (HSEEP)

· International Health Regulation Monitoring and Evaluation Framework

· National Incident Management System (NIMS)

· National Preparedness Goal C. Purpose The purpose of this FOA is to strengthen and enhance the acute care medical surge capacity through the maintenance and growth of strong HCCs within each HPP-funded state, territory, freely associated state, and locality. This FOA provides funds to build acute care medical surge capacity by ensuring that HPP recipients focus on objectives and activities that advance progress toward meeting the goals of the four capabilities detailed in the 2017-2022 Health Care Preparedness and Response Capabilities and document progress in establishing or maintaining response-ready health care systems through strong HCCs.

D. Implementation Health Care Preparedness and Response Capabilities Throughout the project period, ASPR expects recipients and sub-recipients to develop and strengthen the four health care preparedness and response capabilities through the implementation of select objectives and activities. ASPR has prioritized these select objectives and activities, recognizing that not all of the objectives and activities listed in the 2017-2022 Health Care Preparedness and Response Capabilities can be implemented with the funding available through HPP.

ASPR encourages HCCs, health care organizations, and other stakeholders supporting the provision of care during emergencies to use ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE) to receive assistance and resources for developing the capabilities.

Readiness and Operations Cycle HPP’s readiness and operations cycle furthers the concepts outlined in the National Preparedness Goal by organizing the objectives and activities of the 2017-2022 Health Care Preparedness and Response Capabilities into phases. The phases of the annual readiness and operations cycle strengthen HPP’s focus on readying our health care systems for response to medical surge emergencies.

HPP FOA Structure Recipients and HCCs will structure their work plans by the 2017-2022 Health Care Preparedness and Response Capabilities. Within each capability, work plan activities will progress each year through the readiness and operations cycle (See HPP FOA Structure in Figure 1).

Figure 1. HPP FOA Structure Ideally, work plan activities under each phase will correspond to quarters in each fiscal year (FY). In quarter one, activities would focus on planning and preparing. In quarter two, activities would focus on training and equipping. In quarter three, activities would focus on exercising, and in quarter four, activities would focus on evaluating and sharing lessons learned. While responses are the optimal tests of plans and training activities, these naturally occur at any point in the cycle—when disasters strike—and should be followed by the evaluation, planning, and training phases based on lessons learned from each response.

Utilization of the readiness and operations cycle will support recipients and sub-recipients in making continuous improvements each year.

Please refer to Appendix A for explicit guidance on objectives and activities required for this project period. This appendix includes all HPP-specific requirements and joint activities with the Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness (PHEP) program, as well as other requirements associated with statute and HHS grant guidance.

Option for Flexibility for Remote and Isolated Frontier Communities For the FY 2019-2023 project period, HPP recognizes the unique challenges and needs of hospitals located in remote and isolated frontier communities. To improve the effectiveness of HPP funding and to reduce the burden on recipients and sub-recipients, ASPR worked with the Health Resources and Services Administration (HRSA) Office of Rural Health Policy to categorize these hospitals and offer modified objectives, activities, and funding requirements. To be eligible for classification as an “isolated frontier hospital”, hospitals must meet the following criteria:

· Be located in a geographic region within the U.S. that is classified by the U.S. Department of Agriculture Economic Research Service as both Frontier and Remote Area (FAR) level 4 (see Appendix B), and

· Be greater than 60 miles from the next nearest hospital. It is the responsibility of the recipient to determine if a hospital located in a FAR level 4 locale is greater than 60 miles from the next nearest hospital.

ASPR will consider requests for facility classification as an “isolated frontier hospital” on a case-by-case basis. Each recipient must submit requests for classification during the application process ((in Grants.gov , reference Section IV.C.Additional information for upload instructions) in the format of a letter to the HPP Director (please see contact information at the end of this announcement). HPP will not accept post-award classification requests. The letter should contain the full legal name of the identified hospital, its current physical address, the name and distance (in miles) to the next nearest hospital, and a justification explaining how this classification will improve the readiness of both the facility and HCC. Each recipient should include an accompanying letter of support from the current HCC, which must indicate the HCC understands the impact of this classification and supports the request to modify the existing activities and funding strategies for the identified hospital(s). Additional letters of support from the jurisdiction’s hospital association will further strengthen requests for classification.

The HPP-specific requirements and HPP-PHEP joint activities found in Appendix A apply to all recipients including territories, freely associated states, and isolated frontier hospitals (as defined above). However, additional guidance and technical assistance (TA) that describe modified requirements for ASPR-approved “isolated frontier hospitals” as well as American Samoa (AS), the Commonwealth of the Northern Mariana Islands (CNMI), Guam, the U.S. Virgin Islands (USVI), the freely associated states including the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau (PW) can be found in Appendix C.

Federal Requirements For the FY 2019-2023 project period, recipients must address and comply with other federal requirements that include HPP-specific requirements and HPP-PHEP joint activities and assurances. In completing the program requirements segment of the funding application, recipients must provide updates on the following programmatic requirements and assurances:

Coordinate exercise planning and implementation.

· Recipients must conduct an annual public health and medical preparedness exercise that specifically addresses the needs of people with disabilities and other at-risk individuals or populations and report in the following year’s funding application on the strengths and weaknesses identified and corrective actions taken to address weaknesses. HPP recipients should consider the access and functional needs of at-risk individuals and engage these populations as they plan the budget period’s HCC-based exercises.

· Recipients must complete and submit after action reports and improvement plans (AAR/IPs) for all responses to real incidents and planned events and for exercises conducted to demonstrate compliance with HPP program requirements. HPP recipients should provide AAR/IPs to ASPR in accordance with HSEEP guidelines for each qualifying exercise within 120 days.

Submit pandemic influenza preparedness plans.

· HPP’s authorization (sections 319C-1 and 319C-2 of the PHS Act) requires recipients to have updated plans describing activities they will conduct with respect to pandemic influenza.

· HPP recipients can satisfy the annual requirement through the submission of required program data such as the capability self-assessment and program measures that provide information on the status of state and local pandemic response readiness, barriers and challenges to preparedness and operational readiness, and efforts to address the needs of at-risk individuals.

Describe progress on capability development.

· Recipients must describe the top jurisdictional strategic priorities for the project period.

· Recipients must identify the data sources used to inform the strategic priorities. Sources include but are not limited to jurisdictional risk assessments, capability self-assessments, National Health Security Preparedness Index (NHSPI), and AAR/IPs.

· Recipients must list challenges or barriers that are anticipated for the project period, including any budgetary issues that might hinder the success or completion of the project as originally proposed and approved.

Establish and maintain senior advisory committees.

· Recipients must establish and maintain advisory committees or similar mechanisms of senior officials from governmental and non-governmental organizations involved in homeland security, health care, public health, EMS, and behavioral health to help integrate preparedness efforts across jurisdictions and to maximize funding streams.

Coordinate emergency public health and health care preparedness and response plans with educational agencies and state child care agencies.

· Recipients must ensure emergency preparedness and response coordination with educational agencies and child care agencies in their jurisdictions.

Engage State Unit on Aging or the equivalent office.

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

Meet Emergency System for Advance Registration of Volunteer Health Professionals (ESAR- VHP) compliance requirements.

· The ESAR-VHP compliance requirements identify capabilities and procedures that state ESAR-VHP programs must have in place to ensure effective management and inter-jurisdictional movement of volunteer health personnel in emergencies. Recipients must coordinate with volunteer health professional entities. ASPR also encourages recipients to collaborate with the Medical Reserve Corps (MRC) to facilitate the integration of MRC units with the local, state, and regional infrastructure to help ensure an efficient response to a public health emergency. More information about the MRC program can be found on the MRC webpage.

Ensure cross-discipline coordination.

· Recipients may use HPP funding to support coordination activities, such as planning activities between local health departments and HCCs, but must track the accomplishments and outcomes of these activities. Recipients should coordinate activities with state emergency management agencies, EMS providers (including the State Office of Emergency Medical Services), mental health agencies (including the State Mental Health Authority and the Disaster Behavioral Health Coordinator), HCCs, state aging offices, and educational agencies, state child care agencies, MRC, and ESAR-VHP programs.

Comply with SAFECOM requirements.

· Recipients and sub-recipients that use federal preparedness grant funds to support emergency communications activities must comply with current SAFECOM guidance for emergency communications grants, which is available on the SAFECOM webpage.

Cooperative agreement administrative requirements.

Recipients must submit required progress reports and program and financial data by the deadline, including budgets and work plans; progress in achieving evidence-based benchmarks and objective standards; performance measures data, including data from local health departments; outcomes of annual preparedness exercises including strengths, weaknesses and associated corrective actions; and accomplishments highlighting the impact and value of the HPP activities in their jurisdictions.

· In a cooperative agreement, the federal government is substantially involved in the program activities, above and beyond routine grant monitoring. During the project period, ASPR will monitor and evaluate the defined activities within the agreement and recipient progress in meeting work plan priorities. The recipient must ensure reasonable access by ASPR or their designees to all necessary sites, documentation, individuals and information to monitor, evaluate and verify the appropriate implementation the activities and use of ASPR funds under this agreement.

· Recipients must have in place fiscal and programmatic systems to document accountability and improvement, and must demonstrate these systems during site visits.

· Recipients must plan and participate in joint site visits at least once every 12-24 months.

· ASPR encourages recipients to invite HPP field project officers (FPOs) and senior ASPR staff to attend or observe events such as scheduled exercises, regional meetings, jurisdictional conferences, senior advisory committee meetings, and coalition meetings supported by HPP funding.

· Recipients must participate in mandatory meetings and trainings. ASPR considers the following meetings mandatory; recipients should budget travel funds accordingly:

· Annual preparedness summit sponsored by the National Association of County and City Health Officials

· Directors of Public Health Preparedness annual meeting sponsored by the Association of State and Territorial Health Officials

· National Health Care Coalition Preparedness Conference, as specified by ASPR

· Training for medical countermeasure (MCM) coordinators sponsored by ASPR and other MCM regional workshops

· Other mandatory training sessions that may be conducted via webinar or other remote meeting venues

· Recipients must maintain all program documentation for purposes of data verification and validation. ASPR strongly encourages recipients to develop internal electronic systems that allow jurisdictions to share documentation with HPP FPOs, including evidence of progress completing corrective actions for weaknesses identified during exercises and drills. In FY 2019/budget period 1, ASPR will increase the emphasis on verification and validation of requirements to identify strengths and potential gaps, better review and evaluate progress, and provide TA.

· Recipients must engage in TA planning. Recipients must actively work with their HPP FPOs to properly identify, manage, assess progress of, and update TA plans at least quarterly. ASPR encourages HCCs, health care organizations and other stakeholders supporting the provision of care during emergencies to use ASPR’s TRACIE system to identify existing TA resources.

Accountability Provisions Recipients that fail to “substantially meet” the benchmarks required by this FOA are subject to withholding of a statutorily mandated percentage of the award if a recipient fails substantially to meet established benchmarks for the immediately preceding fiscal year or fails to submit a satisfactory pandemic influenza plan.

HHS is required to treat each failure to substantially meet all the benchmarks and each failure to submit a satisfactory pandemic influenza plan as a separate withholding action. For example, a recipient failing substantially to meet benchmarks AND who fails to submit a satisfactory pandemic influenza plan could have 10 percent withheld for each failure for a total of 20 percent for the first year this happens. If this situation remains unchanged, HHS would then be required to assess 15 percent for each failure for a total of 30 percent for the second year this happens. Alternatively, if a recipient corrects one of the two failures in the second year but one remains, HHS is required to withhold 15 percent of the second-year funding.

Table 1. FY 2019 Benchmarks

HPP BENCHMARKS: All recipients

10%

X

X

X

10%

Evaluation and Performance Measurement To measure and evaluate HPP performance, ASPR developed a variety of measures at the input-, activity,- output-, and outcome-level to address the information needs of various stakeholders. See Appendix D for a list of the FY 2019/budget period 1 HPP performance measures.

ASPR will update the 2017-2022 Hospital Preparedness Program Performance Measures Implementation Guidance in the spring of 2019 to incorporate minor changes to the performance measures for FY 2019/budget period 1.

ASPR will review and evaluate HPP recipients based on a number of sources of information including performance measure data, information gathered during site visits, produced AAR/IPs, and HCC response plans. ASPR will also use this information to identify program areas to be improved, program successes, and key areas of TA to provide to recipients and their HCCs. The HPP performance measures monitor implementation of the program, and are intended to help assess an HCC’s readiness to respond in an emergency.

E. ASPR Activities Field Project Officer FPOs serve as the federal liaisons to each designated HHS region and coordinate between HPP and its cooperative agreement recipients. FPOs provide TA on programmatic activities and grants, conduct recipient and HCC site visits, and monitor activity and project funds. Note that many requirements of this cooperative agreement request the submission of HCC documentation to the FPOs, importantly including data during an actual emergency response.

ASPR TRACIE

ASPR TRACIE provides information and TA to HCCs, providers, emergency managers, and others working in health care system preparedness and disaster medicine. It offers support in three main areas: a self-service collection of disaster medical, health care and public health materials searchable by keyword and functional area; one-on-one TA support to request documentation and resources; and a peer-to-peer closed forum where providers and responders can communicate in a timely way. For example, ASPR TRACIE can provide users with TA and resources to support specific capability development. ASPR encourages HCCs, health care organizations and other stakeholders supporting the provision of care during emergencies to use ASPR’s TRACIE system.

ASPR Grants Management Office The ASPR Grants Management Office is responsible for the business management aspects of HPP cooperative agreements, including review, negotiation, award, and administration. These activities include, but are not limited to, evaluating applications for administrative content and compliance with statutes, regulations, and guidelines; negotiating grants; providing consultation and TA to recipients; and administering grants after award.

Health Care Coalition Response Leadership Course The Health Care Coalition Response Leadership Course sponsored by the Center for Domestic Preparedness in Anniston, Alabama, will be available to HCCs to provide guidance and training. The Center for Domestic Preparedness will cover travel, lodging, and training costs. Recipients and HCCs do not need to budget for these travel and training costs.

Evaluation and Monitoring of Program In a cooperative agreement, the federal government is substantially involved in the program activities, above and beyond routine grant monitoring. During the project period, ASPR will monitor and evaluate the defined activities within the agreement and recipient progress in meeting work plan priorities. The recipient must ensure reasonable access by ASPR or their designees to all necessary sites, documentation, individuals and information to monitor, evaluate, and verify the appropriate implementation the activities and use of ASPR funding under this agreement.

Collaborations

1. HPP and PHEP HPP and PHEP remain programmatically aligned and are proud to be the first aligned grant programs in the federal government. The programs were initially aligned in 2012 in order to better coordinate the private health care sector and state and local public health sector for improved preparedness and response. HPP and PHEP funds are not interchangeable, although funding flows through the same 62 state, local, and territorial recipients. HPP builds resilience among health care delivery system entities by increasing their collective ability to maintain operations and expand health care capacity during a medical surge. Primary sub-recipients are HCCs and individual health care facilities. The PHEP program builds capacity within state, local, territorial, and tribal public health agencies to assure that the nation’s public health system is resilient and “response ready” for any type of public health event or disaster.

1. HPP Partner Community HPP continues to develop a partner community of external stakeholders to ensure an exchange of ideas and demonstrate mutual relationship value. These stakeholders include national trade associations representing health care providers and public health, foundations, academic institutions, and other non-profits whose missions align with HPP’s preparedness, response, and recovery efforts.

Emergency Medical Services for Children (EMSC) HPP recipients and the Health Resources and Services Administration (HRSA) EMSC program recipients within their jurisdictions must provide a joint letter of support indicating that EMSC and HPP are linked at the recipient level. HPP recipients must provide a letter of support with their funding applications at the beginning of each budget period throughout the five-year project period.

Please note: funding cannot be used for activities already covered by other federal grants or cooperative agreements.

Emergency Preparedness Grant Coordination (EPGC) Federal agencies participating in the EPGC process are working to identify current preparedness activities and areas for collaboration across federal grants with public health and health care preparedness components. The participating federal agencies include:

· HHS ASPR

· Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA)

· HHS Centers for Disease Control and Prevention (CDC)

· HHS Health Resources and Services Administration (HRSA)

· Department of Transportation (DOT) National Highway Traffic Safety Administration (NHTSA) Federal agencies are actively coordinating guidance and TA and encourage all recipients to actively coordinate preparedness activities for their jurisdictions.

More information on the EPGC process can be found on the EPGC webpage.

F. Other Important Notes about this Funding Opportunity Announcement Target Populations This FOA targets, in broad terms, the entire U.S. population and the health care systems within the U.S. and its territories and freely associated states. Specifically, funds are intended to support the needs of any community impacted by a public health emergency or disaster and to ensure that health care systems are ready and capable of keeping their communities safe and mitigating the impacts of any public health emergency. There is a special emphasis on preparing for the health needs of at-risk populations, including tribal entities. Accommodations for at-risk populations should be incorporated into all plans and exercises and any access or functional needs of at-risk populations that may interfere with their ability to access or receive medical care before, during, or after a disaster or emergency should be considered.

Health Disparities Recipients must show evidence that they are integrating accommodations for the access and functional needs of at-risk and vulnerable population(s) as indicated into their planning. Recipients must describe the structure or processes in place to integrate accommodations for the access and functional needs of at-risk individuals, including but not limited to children, pregnant women, older adults, people with disabilities, and people with limited English proficiency and non-English speaking populations. Strategies to integrate the access and functional needs of at-risk individuals involve inclusion in public health, health care, and behavioral health response strategies; furthermore, these strategies are identified and addressed in operational work plans. ASPR encourages recipients, sub-recipients, and HCCs to identify community partners with established relationships with diverse at-risk populations, such as social services organizations, and to use demographic tools such as the Social Vulnerability Index and the U.S. Census/American Community Survey to better anticipate the potential access and functional needs of at-risk community members before, during, and after an emergency. Applicants must also ensure inclusive planning with tribes.

II. AWARD INFORMATION

FOA Title: Hospital Preparedness Program Cooperative Agreement Type of Award: Cooperative agreement Fiscal Year Funds: FY 2019-2023 Approximate Total Funding: $231,500,000 USD This amount is subject to availability of funds. Includes direct and indirect costs.

Approximate Number of Awards: 62 Approximate Average Award: $3,733,871 USD Floor of Individual Award Range: $256,518 USD Ceiling of Individual Award Range: $23,274,780 USD Anticipated Award Date: July 1, 2019 Budget Period Length: July 1, 2019 through June 30, 2020 Project Period Length: July 1, 2019 through June 30, 2024

III. ELIGIBILITY INFORMATION

A. Eligible Applicants As defined in sections 319C-1 and 319C-2 of the PHS Act, eligible applicants for this funding opportunity are states, a consortium of states, or eligible political subdivisions that prepare and submit a sufficient application compliant with the statutory and administrative requirements described in this document. For the purposes of this announcement, the term “state” may include a state, territory, or freely associated state.

B. Funding Strategy ASPR calculates the distribution of HPP funds using a formula established under section 319C-1(h) of the PHS Act, as amended. States and U.S. territories and freely associated states receive the greater of a minimum amount prescribed by the formula or a base amount, as determined by the Secretary, supplemented by a population-based formula, and possible additional funding based on findings about significant unmet needs or high degree of risk. Eligible political subdivisions receive an amount determined by the Secretary and possible additional funding based on findings about significant unmet needs or high degree of risk.

C. Cost Sharing and Match ASPR may not award a cooperative agreement to a state or consortium of states under these programs unless the recipient agrees that, with respect to the amount of the cooperative agreements awarded by ASPR, the state will make available non-federal contributions in the amount of 10 percent ($1 for each $10 of federal funds provided in the cooperative agreement) of the award.

Match may be provided directly or through donations from public or private entities and may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the federal government or services assisted or subsidized to any significant extent by the federal government may not be included in determining the amount of such non-federal contributions.

Please refer to title 45 of the Code of Federal Regulations (CFR) § 75.306 for match requirements, including descriptions of acceptable match resources. Documentation of match, including methods and sources, must be included in the FY 2019/budget period 1 application for funds, follow procedures for generally accepted accounting practices, and meet audit requirements.

Exceptions to Matching Funds Requirement:

· The match requirement does not apply to the political subdivisions of Chicago, Los Angeles County, or New York City.

· Pursuant to department grants policy implementing 48 USC 1469a(d), any required matching (including in-kind contributions) of less than $200,000 is waived with respect to cooperative agreements to the governments of AS, Guam, USVI, or CNMI (other than those consolidated under other provisions of 48 USC 1469). For instance, if 10 percent (the match requirement) of the award is less than $200,000, then the entire match requirement is waived. If 10 percent of the award is greater than $200,000, then the first $200,000 is waived, and the rest must be paid as match.

· The match requirement is also waived for the freely associated states, including PW, FSM, and RMI.

· Matching does not apply to future contingent emergency response awards that may be authorized under section 311 of the PHS Act unless such a requirement were imposed by statute or administrative process at the time.

D. Maintenance of Effort According to section 319C-2 of the PHS Act, recipients must maintain expenditures for health care preparedness at a level that is not less than the average level of such expenditures maintained by the recipient for the preceding two-year period. This represents a recipient’s historical level of contributions or expenditures (money spent) related to federal programmatic activities that have been made prior to the receipt of federal funds. The maintenance of effort (MOE) is used as an indicator of non-federal support for health care preparedness before the infusion of federal funds. These expenditures are calculated by the recipient without reference to any federal funding that also may have contributed to such programmatic activities in the past. The definition of eligible state expenditures for health care preparedness includes:

· Appropriations specifically designed to support health care preparedness as expended by the entity receiving the award; and

· Funds not specifically appropriated for health care preparedness activities, but which support health care preparedness activities, such as personnel assigned to health care preparedness responsibilities, supplies, or equipment purchased for health care preparedness from general funds or other lines within the operating budget of the entity receiving the award.

Recipients must document the total dollar amount in the budget narrative within cooperative agreement funding applications. Recipients must be able to account for MOE separate from accounting for federal funds and separate from accounting for any matching funds requirements; this accounting is subject to ongoing monitoring, oversight, and audit. MOE may not include any sub-recipient matching funds requirement where applicable.

MOE does not apply to future contingent emergency response awards that may be authorized under section 311 of the PHS Act unless such a requirement were imposed by statute or administrative process at the time.

E. Special Requirements HPP General Funding Guidance HPP funding must primarily support strengthening health care system preparedness through the collaborative development of HCCs that prepare and respond as an entire regional health system, rather than individual health care organizations. HPP recognizes that, at the conclusion of the previous project period (FY 2017-2018), some recipients only funded HCCs, some funded individual health care entities (with a requirement that they participate in regional preparedness efforts), and others funded a mixture of HCCs and individual health care entities.

During this project period (FY 2019-2023), beginning in FY 2019/budget period 1, all recipients must allocate at least a portion of funding to HCCs. For FY 2019/budget period 1, ASPR still permits providing direct funding from the recipient to individual health care entities for regional preparedness efforts; however, ASPR requests that, as the project period progresses, recipients provide a greater percentage of their total award to HCCs each year over the five-year project period.

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

Recipient Level Direct Costs Recipients may retain direct costs for the management and monitoring of the HPP cooperative agreement during the FY 2019-2023 project period. Because the goal of HPP is to support HCCs and their health care system partners, in FY 2019/budget period 1, recipients must limit their costs for personnel, fringe benefits, and travel to no more than 18 percent of the HPP cooperative agreement award. HPP requests that recipients continue to strive to decrease these costs to allow more funds to be available to HCCs. By the end of FY 2023/budget period 5, recipients must limit these costs to no more than 15 percent of the HPP cooperative agreement award.

ASPR will consider requests for exemptions on a case-by-case basis. Requests for exemption must be submitted annually with the application (in Grants.gov) in the format of a letter to the HPP Director (please see contact information at the end of this announcement). The letter should contain the amount and percentage of funds the recipient requests to use for personnel, fringe benefits, and travel, and a justification explaining the reasons for the additional costs and the recipient’s plan for reducing these costs in future fiscal years. Recipients must request exemptions with the application, as post-award exemption requests will not be accepted. Letters of support from the HCCs and the jurisdiction’s hospital association will strengthen requests for exemption, indicating these entities understand and agree with the amount the recipient is retaining for personnel, fringe benefits, and travel.

Funding Restrictions Restrictions that must be considered while planning the programs and writing the budget are:

· Recipients may not use funds for research.

· Recipients may not use funds for clinical care except as allowed by law. For the purposes of this FOA, clinical care is defined as "directly managing the medical care and treatment of patients.”

· Recipients may use funds only for reasonable program purposes, including personnel, travel, supplies, and services.

· Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spending must be clearly identified in the budget.

· Pursuant to the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 (Public Law (PL)115-245), recipients may not use funds for lobbying activities:

· Recipients shall not use any funds from an award made under this announcement for other than normal and recognized executive legislative relationships. Recipients shall not use funds for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat the enactment of legislation before the U.S. Congress or any state or local legislature or legislative body, except in presentation to the U.S. Congress or any state or local legislature itself, or designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any state or local government, except in presentation to the executive branch of any state or local government itself.

· Recipients shall not use any funds from an award made under this announcement to pay the salary or expenses of any employee or subrecipient, or agent acting for you, related to any activity designed to influence the enactment of legislation, appropriations, regulations, administrative action, or executive order proposed or pending before the U.S. Congress or any state government, state legislature or local legislative body, other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a state, local or tribal government in policymaking and administrative processes within the executive branch of that government.

· The above prohibitions include any activity to advocate or promote any proposed, pending, or future federal, state or local tax increase, or any proposed, pending, or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.

· Recipients may not use funds to carry out any program of distributing sterile needles or syringes for hypodermic injections of any illegal drug.

· Recipients may not use funds to advocate or promote gun control.

· Recipients may not use funds for antibiotics for treatment of secondary infections.

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

· Recipients may not use funds for construction or major renovations.

· Recipients may supplement but not supplant existing state or federal funds for activities described in the budget.

· Recipients may not use funds for fundraising.

· Payment or reimbursement of backfilling costs for staff is not allowed.

· Recipients may not use funds for the cost of money even if part of the negotiated indirect cost rate agreement.

· Salaries may not exceed the rate of $189,600 USD per year: the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 (PL 115-245) limits the salary amount that recipients may award and charge to HHS/ASPR grants and cooperative agreements. Award funds should not be budgeted to pay the salary of an individual at a rate in excess of Executive Level II. Currently, the Executive Level II salary of the Federal Executive Pay scale is $189,600 USD. This amount reflects an individual’s base salary exclusive of fringe and any income that an individual may be permitted to earn outside of the duties to the applicant organization. This salary limitation also applies to subawards/subcontracts under an HHS/ASPR grant or cooperative agreement.

· Funding under these awards may only be used for minor alteration and renovation (A&R) activities. Construction and major A&R activities are not permitted. A&R of real property generally is defined as work required to change the interior arrangements or installed equipment in an existing facility so that it may be more effectively utilized for its currently designated purpose or be adapted for an alternative use to meet a programmatic requirement. The work may be categorized as improvement, conversion, rearrangement, rehabilitation, remodeling, or modernization, but it does not include expansion, new construction, development, or repair of parking lots, or activities that would change the “footprint” of an existing facility (e.g., relocation of existing exterior walls, roofs, or floors; attachment of fire escapes). Minor A&R may include activities and associated costs that will result in:

· Changes to physical characteristics (interior dimensions, surfaces, and finishes); internal environments (temperature, humidity, ventilation, and acoustics); or utility services (plumbing, electricity, gas, vacuum, and other laboratory fittings);

· Installation of fixed equipment (including casework, fume hoods, large autoclaves, biological safety cabinets);

· Replacement, removal, or reconfiguration of interior non-load bearing walls, doors, framed, or windows in order to place equipment in a permanent location;

· Making unfinished shell space suitable for purposes other than human occupancy, such as storage of pharmaceuticals; or,

· Alterations to meet requirements for accessibility by physically-disabled individuals.

· HPP funds may not be used to purchase clothing for promotional purposes, such as those items with recipient, HCC, and/or health care organization names/logos, as HPP funding is intended to address acute care patient surge.