PKG00262986-instructions.pdf

U.S. Department of Health and Human Services

Office of the Assistant Secretary for Preparedness and Response

Office of Operations and Resources

Emergency Management and Medical Operations

Division of Readiness

National Healthcare Preparedness Programs Branch

Notice of Funding Opportunity and Grant Application Instructions

Funding Opportunity Title:

Partnership for Disaster Health Response Cooperative Agreement

CFDA# 93.817

Funding Opportunity Number: EP-HIT-20-002

Application Due Date: September 11, 2020

Table of Contents

Table of Contents

I. FUNDING OPPORTUNITY DESCRIPTION

II. AWARD INFORMATION

III. ELIGIBILITY INFORMATION

IV. COST SHARING AND MATCHING

V. APPLICATION AND SUBMISSION INFORMATION

VI. APPLICATION REVIEW INFORMATION

VII. AWARD ADMINISTRATION INFORMATION

VIII. AGENCY CONTACTS

IX. OTHER INFORMATION

Attachment A: Instructions for Completing Required Forms (SF 424, Budget (SF 424A), Budget Narrative/Justification)

Attachment B: Budget Narrative/Justification – Sample Format

Attachment C: Project Work Plan and Timeline

Attachment D: Evaluation and Performance Measurement Plan

Attachment E: Quarterly and End-of-Year Report

Attachment F: After Action Report for Exercise

Attachment G: Corrective Action Plan

Attachment H: Table of Required Partners

Attachment I: Funding Priorities

Attachment J: Funding Preferences

Announcement Type: Cooperative Agreement

Funding Opportunity Number: EP-HIT-20-002

Catalog of Federal Domestic Assistance (CFDA) Number: 93.817

All applications must be submitted by: September 11, 2020 at 11:59 PM 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 health care 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 health care 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 health care coalitions (HCCs) – partnerships between core member stakeholders in health care, emergency medical services (EMS), public health, and emergency management. These coalitions are focused on facilitating an integrated and coordinated response across the local area.1

While significant progress has been made in many health care 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

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.

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf administration of intravenous anthrax countermeasures).

Health care is almost exclusively a private sector function, but holds public responsibilities during a disaster. Health care 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 annual HPP cooperative agreement 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 1).

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 health care 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 health care 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)2,3 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).

At all levels of RDHRS, activities aim to optimize clinical surge capacity, provide clinical expertise to support health care 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 health care 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 health care 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

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 https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf http://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx 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 Emerging Special Pathogens

Training and Education Center), radiologic (e.g., Radiation Injury Treatment Network), and trauma-

(trauma systems) based disasters.

Figure 1. Objectives of the Regional Disaster Health Response System

This Notice of Funding Opportunity (NOFO) does not aim to establish the RDHRS in its entirety, but instead seeks to fund a demonstration site that will advance the vision for a nationwide, regional response system, and that will help identify issues, develop best practices, and demonstrate the potential effectiveness and viability of this concept. The new award 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 health care system, coordination of patient and resource movement to support the response, and the swift involvement of specific clinical specialists, building on lessons learned from the two active demonstration sites established in 2018. The intent of this effort is to enhance response capabilities for both small- and large-scale emergencies and disasters. Whereas the health care coalition effort has successfully promoted

“horizontal integration” of key stakeholders in the emergency response system, including health care 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.

In FY 2018, ASPR awarded two pilots under the Partnership for Disaster Health Response cooperative agreement to address health care preparedness challenges, establish best practices for improving disaster readiness across the health care delivery system, and demonstrate the potential effectiveness and viability of a RDHRS. The pilot programs receiving funding were the Nebraska Regional Disaster Health

Response Ecosystem/Region 7 Partnership for Regional Health Disaster Response (NRDHRE/R7

RDHRS) and the Massachusetts/Region 1 Partnership for Regional Health Disaster Response (MA/R1

RDHRS). Thus far, the existing demonstration sites have produced over 50 tools and products to support training, organization and reporting structure, data collection and information sharing, telemedicine, state deployable medical teams (DMT), and navigating legal and policy challenges. Throughout the first year of the program, the pilot sites demonstrated significant impact and potential for return on investment. For example, the NRDHRE/R7 used partnerships formed in the first year of the pilot to create a state-wide

Medical Operations Center that meets daily to discuss key opportunities and vulnerabilities throughout the state, and conducted outreach with over 80 stakeholders across the state in both the public and private sector, many of whom had never collaborated prior to the convening activities of the NRDHRE/R7.

Stakeholders across the state are also using the information sharing platform established in the pilot, Knowledge Center, to submit Essential Elements of Information (EEI) to health care coalition and state leadership. Similarly, the MA/R1 RDHRS has made significant progress – the demonstration site found that 89 percent of surveyed organizations who participated in the pilot agreed that the RDHRS is addressing gaps within disaster health care preparedness and response that have not yet been addressed.

Additionally, 93 percent of participants surveyed agreed that the RDHRS can be an effective resource to provide medical expertise to public health and/or emergency management leaders to assist with decision-making related to health care operations during disasters. More information about the progress of the current RDHRS demonstration projects can be found in a Report to Congress, which was released in July

2020.

ASPR will fund one (1) new “Partnership” that will serve as a demonstration site for implementation of the RDHRS concept. The Partnership will bring together required members as described in the

Eligibility Criteria section and as required by section 319C-2(b)(1)(A)4 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 health care assets across the recipient’s state and is also poised to share information and medical assets with other states in their HHS region.

ASPR designed the capabilities included in this NOFO to be complementary to the Health Care

Preparedness and Response capabilities but emphasize the clinical coordination aspects of disaster response.

These are discussed in detail below and 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 one demonstration project that will help identify issues, develop best practices, and demonstrate the potential effectiveness and viability of the RDHRS concept. The RDHRS structure is conceptualized as a tiered system that builds upon the existing Medical Surge Capacity and Capability

(MSCC)5,6 foundation for local medical response (e.g., trauma systems and HCCs) by enhancing

4 Be a coalition that includes—(i) one or more hospitals, at least one of which shall be a designated trauma center, consistent with section 1213(c) of the PHS Act;(ii) 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; (iii) (I) one or more political subdivisions; (II) one or more States; or (III) one or more States and one or more political subdivisions; and (iv) one or more emergency medical service organizations or emergency management organizations.

5 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 6 MSCC: The Healthcare Coalition in Emergency Response and Recovery.

https://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx https://www.phe.gov/Preparedness/planning/RDHRS/Documents/RDHRS-RTC.pdf https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf http://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx 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).

Project Outcomes

The recipient will establish a statewide Partnership of health care 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. The recipient 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;7, 8

• 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; and

• One or more emergency medical service organizations or emergency management organizations.

A signed memorandum of agreement (MOA) or memorandum of understanding (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 a minimum, the following supporting organizations:

• State Office of Public Health/Health

• Health care 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.9

7 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 two 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.

8 ASPR strongly encourages partnerships to include an ACS/COT designated level 1 trauma center.

9 Grant funds may be used to pay a salary for each of these positions.

http://www.facs.org/trauma/ntdbacst.html

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 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 attention to demands on the health care system that would overwhelm existing local and regional capability and capacity.

Identify and document regional and statewide health care resources and services that are vital to continuity of health care delivery during a disaster (e.g., clinical services, infrastructure, supply chain, caches, health care 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.10

Identify and document surge capacity assets in the state and region required for a clinical

10 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.

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)11, 12 and the means by which such systems would complement the conventional delivery of health care services (e.g., telemedicine, electronic prescribing, triage lines).

Define the indicators and triggers needed to initiate crisis standards of care.13

Identify barriers and gaps related to the use of conventional, contingency, and crisis care strategies.14

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 health care 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 health care 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 health care 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).

11 Institute of Medicine. (2012). Crisis Standards of Care. A Systems Framework for Catastrophic Disaster Response. Volume 5: Alternate Care

Systems.

12 Alternate Care Systems: Stratification of Care. Hanfling D. (2009). https://www.ncbi.nlm.nih.gov/books/NBK32849/

13 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.

14 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.

http://www.ncbi.nlm.nih.gov/books/NBK32849/

Document existing laws, regulations, and policies that impact interstate (i.e., regional) coordination of health care 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 Health Care and Medical Workforce

Activity 1: Educate and train the health care 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), health care 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 training related to health care 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 health care 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, Radiation Injury

Treatment Network, 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 health care settings (e.g., retail pharmacies, clinics, hospitals, long-term care, 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 Health Care Surge Professionals

Activity 1: Draft a plan for the use of health care 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 health care 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 health care providers (e.g., licensing and credentialing agreements) to support statewide medical response efforts.

Demonstrate knowledge of available interstate medical resources and personnel (e.g., Emergency Management Assistance Compact (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

(ED) 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 health care 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 Health Care 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 health care 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 health care 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 health care 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 health care situational awareness.

Coordinate statewide/regional health care situational awareness through a centralized

Medical Operations Coordination Cell (MOCC) 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 MOCC.

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) health care 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 health care system.

Activity 2: Identify information access and data protection procedures.

Establish necessary data use agreements, policies, and data protection procedures to protect health care 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 health care providers and health care 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 health care 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 coordination 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.

Recipient 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 recipient, 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.

Kickoff and Quarterly Meetings (with Government). The recipient 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 in 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 kickoff and quarterly meetings with ASPR, HHS, and/or other U.S. Government personnel. These meetings may be conducted virtually (e.g., phone or videoconference) 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 recipients 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 the

National Association of County and City Health Officials and the National Healthcare Coalition

Preparedness Conference hosted by MESH.

Reporting Requirements

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

The recipient 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: $3 million dollars

Estimated Funding Amount: Up to $3 million dollars subject to availability of funds

Award Floor: $3 million

Award Ceiling: $3 million

Anticipated Number of Awards: 1

Project Period Length: 12 months (one year)

Anticipated Start Date: September 30, 2020

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 like 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 recipient 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.

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.

2. Review of proposed contracts.

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

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

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

6. 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 individuals with access or functional needs.

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 project will be used to inform future decisions regarding funding and expectations of partnerships. Additional demonstration projects may be supported in the future. 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 $3 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,15, 16 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;

one or more political subdivisions; one or more States or one or more states and one or more political subdivisions; and one or more emergency medical service organizations or emergency management organizations.

The applicant will have to designate a primary recipient, which according to the statutory authority for this cooperative agreement can be any of the entities listed above (for example, a hospital, or a local health care facility, or a State, or an EMS organization). That primary recipient must represent a multi-entity partnership comprised of the required members described above. While the partnership must include the required members described, there is no limitation on the total number of entities that can participate in the partnership.

Eligible applicants are defined in the statutory authority for this cooperative agreement, section 319C-

15 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 two 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.

16 ASPR strongly encourages partnerships to include an ACS/COT designated level 1 trauma center.

http://www.facs.org/trauma/ntdbacst.html

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

Special Requirements

Required Letters of Support

In addition, the recipient should:

Have demonstrated past performance of coordinating with health care organizations and health care coalitions across the state.

Submit with the application package letters of support from:

• State Offices Public Health/Health

• Health care 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

The recipient should also collaborate with the following individuals and entities within the state, at a 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 may receive additional credit in the application scoring criteria for additional letters of support:

• NDMS hospitals

• Deployable State Medical Teams17

• State Office of Emergency Management

• State Children’s Hospital Network (or equivalent)

• Radiation Injury Treatment Network centers

• Acute Care Hospitals/Medical Centers

Note: In the table provided in Attachment I, please clearly signify which, if any, letters of support in the desired letters of support attachment should be taken into account when evaluating funding priorities and denote the name of each entity and the relevant page number within the application.

Table of Required Partners

Applicants must provide a table reflecting the names and affiliations of all required members in the

17 Deployable State Medical Teams refers to disaster medical assistance teams generally (e.g., NGO-, state-, or health care system-run disaster medical assistance teams),and is not synonymous with federal National Disaster Medical System (NDMS) DMAT teams.

partnership, using the template provided in Appendix H.

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

Executive Director and Medical Director Qualifications

With the application package, the recipient must submit a curriculum vitae (CV) or biosketch 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.

Key personnel are defined as all individuals who contribute in a substantive, meaningful way to the scientific development or execution of the project, whether or not salaries are requested.

Each CV or biosketch should be no more than five pages each, and while there is no required format, CVs or biosketches should be double-spaced, on 8 ½” x 11” plain white paper with 1” margins on all sides, and a font size of not less than 11.

CVs or biosketches should clearly convey the required…