Revised NOFO TP19-1901 May 3.pdf

Centers for Disease Control

Office of Public Health Preparedness and Response

Public Health Emergency Preparedness (PHEP) Cooperative Agreement

CDC-RFA-TP19-1901

Application Due Date: 05/03/2019

Public Health Emergency Preparedness (PHEP) Cooperative Agreement

CDC-RFA-TP19-1901

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-TP19-1901. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Public Health Emergency Preparedness (PHEP) Cooperative Agreement C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-TP19-1901

E. Assistance Listings (CFDA) Number:

93.069 F. Dates:

1. Due Date for Letter of Intent (LOI): N/A

2. Due Date for Applications: 05/03/2019, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

May 3, 2019, 11:59 p.m. EDT (Daylight Savings Time begins March 10, 2019)

3. Date for Informational Conference Call:

Wednesday, March 6, 2019, 2:30 p.m. to 4 p.m. EST Wednesday, March 13, 2019, 2:30 p.m. to 4 p.m. EDT Thursday, March 14, 2019, 1:30 p.m. to 3 p.m. EDT

G. Executive Summary:

1. Summary Paragraph:

State, local, tribal, and territorial public health systems must continue to sustain emergency preparedness and response capability and demonstrate operational readiness to respond to public health threats and emergencies. This notice of funding opportunity (NOFO) supports strengthening the capability of public health systems to effectively prepare for and respond to public health threats and emergencies. This announcement provides expectations and priorities for funded recipients to enhance their readiness to save lives during emergency incidents that exceed the day-to-day capacity and capability of public health response agencies. It serves as a roadmap to ensure that PHEP recipients develop strategies and activities that will increase https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov their ability to be operationally ready to execute plans, respond to, and recover from public health threats and emergencies. PHEP funding will ensure PHEP recipients continue to develop and sustain effective public health emergency management and response capability according to standards described in the Public Health Emergency Preparedness and Response Capabilities:

National Standards for State, Local, Tribal, and Territorial Public Health. These standards provide a framework to ensure that PHEP recipients, based on the PHEP logic model, apply findings from their jurisdictional risk assessments, capability self-assessments, and after-action reports to inform their strategic priorities and direct jurisdictional preparedness investments.

a. Eligible Applicants: Limited

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 62

d. Total Period of Performance Funding: $3,061,250,000

e. Average One Year Award Amount: $10,000,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 07/01/2019

h. Cost Sharing and / or Matching Requirements: Y CDC 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 CDC, the state will make available nonfederal contributions in the amount of 10% ($1 for each $10 of federal funds provided in the cooperative agreement) of the award, whether provided through financial or direct assistance. 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 nonfederal contributions.

Documentation of match, including methods and sources, must be included in recipient budgets each budget period, include calculations for both financial assistance and direct assistance, 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 New York City, Los Angeles County, or Chicago.

Pursuant to department grants policy implementing 48 U.S.C. 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 American Samoa, Guam, the U.S.

Virgin Islands, or the Northern Mariana Islands (other than those consolidated under other provisions of 48 U.S.C. 1469).”

Please refer to 45 CFR § 75.306 for more information.

https://www.cdc.gov/phpr/readiness/capabilities.htm

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Public health emergency preparedness and response capacity continues to be tested at national, state, local, tribal, and territorial levels. Since 9/11, CDC's Public Health Emergency Preparedness (PHEP) program has collaborated with state, local, and territorial health departments to prepare and plan for emergencies, resulting in measurable improvement.

However, ongoing risks related to chemical, biological, radiological, and nuclear incidents as well as cyberattacks further underscore the importance of updating and modernizing jurisdictional all-hazards public health preparedness and response strategies to address emerging technologies and new 21st century threats.

To address these challenges, PHEP recipients must increase or maintain their levels of effectiveness across six key public health preparedness domains and focus efforts on strengthening preparedness and response capabilities to prevent or reduce morbidity and mortality. As additional public health threats continue to emerge, CDC must ensure that state, local, tribal, and territorial public health systems remain effectively prepared and ready to respond to the public health consequences of incidents or events whose scale, rapid onset, or unpredictability stresses the public health system.

This 2019-2024 funding opportunity provides fiscal resources to state, local and territorial public health agencies to advance their ability to demonstrate response readiness by the end of the period of performance (performance period). This announcement also includes greater emphasis on programmatic, fiscal, and administrative accountability. Although the PHEP cooperative agreement is no longer aligned with the Hospital Preparedness Program (HPP) within a single funding opportunity, these two distinct federal preparedness programs must continue to be organized to enhance jurisdictional coordination and collaboration between the public health and the health care systems.

This NOFO has been amended to clarify or update requirements. Red type, highlighted in yellow, indicates changes. Please see H. Other Information for more details.

b. Statutory Authorities

Section 319C-1 of the Public Health Service (PHS) Act (47 USC § 247d-3a), as amended.

c. Healthy People 2020 This NOFO addresses the "Healthy People 2020" focus area of Preparedness: https://www.healt hypeople.gov/2020/topics-objectives/topic/preparedness https://www.healthypeople.gov/2020/topics-objectives/topic/preparedness https://www.healthypeople.gov/2020/topics-objectives/topic/preparedness

d. Other National Public Health Priorities and Strategies

HHS Pandemic Influenza Plan Homeland Security Presidential Directives (HSPD) 5 and 21 Presidential Policy Directive 8 (PPD-8): National Preparedness National Health Security Strategy's National Health Security Strategy and Implementation

Plan National Biodefense Strategy 2018 Center for Medicare &; Medicaid Services Emergency Preparedness Rule (CMS-3178-F) Homeland Security Exercise and Evaluation Program (HSEEP) National Incident Management System (NIMS) National Preparedness Goal (NPG) National Response Framework (NRF) 2017-2022 Health Care Preparedness and Response Capabilities

e. Relevant Work This NOFO builds upon relevant current and emergent CDC-supported programmatic priorities, goals, guidance, and recommendations, including, but not limited to:

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

PHEP ORR Implementation Guidance PHEP BP1 (FY 2019) Performance Measures Specifications and Implementation Guida nce 2019-2024 PHEP Supplemental Guidance and Resources Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide for

Preparedness, Version 11

For a detailed listing of relevant work, please visit http://www.cdc.gov/phpr/coopagreement.htm.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

The Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health describes 15 capability standards for PHEP recipients to strengthen during the 2019-2024 performance period. The capability standards inform the PHEP logic model, which is a high-level description of the PHEP program’s general approach that displays “if-then” relationships between the program’s strategies, activities, and outcomes. The logic model also highlights priority strategies and activities, provides examples of consequent outputs, and characterizes the intended outcomes that will result from building jurisdictional capabilities.

https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf https://www.dhs.gov/publication/homeland-security-presidential-directive-5 https://fas.org/irp/offdocs/nspd/hspd-21.htm https://www.dhs.gov/presidential-policy-directive-8-national-preparedness https://www.phe.gov/Preparedness/planning/authority/nhss/Pages/strategy.aspx https://www.phe.gov/Preparedness/planning/authority/nhss/Pages/strategy.aspx https://www.phe.gov/Preparedness/biodefense-strategy/Pages/default.aspx https://www.whitehouse.gov/wp-content/uploads/2018/09/National-Biodefense-Strategy.pdf https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html https://www.fema.gov/hseep https://www.fema.gov/national-incident-management-system https://www.fema.gov/national-preparedness-goal https://www.fema.gov/media-library-data/1544099720628-f75cc84c16f2edd0027fd670c8b89083/Revised_NRF_Update_Information_Sheet.pdf https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf https://www.cdc.gov/cpr/readiness/phep.htm https://www.cdc.gov/cpr/readiness/phep.htm https://www.hsdl.org/?abstract&did=799144 https://www.hsdl.org/?abstract&did=799144 http://www.cdc.gov/phpr/coopagreement.htm

As reflected in the logic model, PHEP recipients are expected to show measurable progress toward achieving the short-term and long-term outcomes during this five-year performance period. CDC will use its Operational Readiness Review (ORR) evaluation process to measure PHEP recipient progress in achieving desired outcomes.

Subject to the availability of funding, CDC may introduce future projects that support advanced development of key public health preparedness capabilities in high population cities during the 2019-2024 performance period. This future project may support high population cities with identifying gaps and strengthening chemical and radiological preparedness.

i. Purpose The purpose of the 2019-2024 PHEP cooperative agreement is to strengthen state, local, tribal and territorial public health preparedness and response capability through a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action. An effective public health response will prevent or reduce morbidity and mortality from threats and emergencies whose scale, rapid onset, or unpredictability stresses the public health system and ensure the earliest possible recovery and return of the system to pre-incident levels or improved functioning.

ii. Outcomes By the end of the performance period, PHEP recipients should build or sustain the elements identified in the Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health. CDC expects recipients to demonstrate measurable progress across the six capability domains, with a goal of achieving “established” operational readiness in all capabilities by the end of the performance period in

2024. CDC will assess jurisdictional operational readiness through the ORR evaluation process, in which PHEP recipients provide specific program information and data regarding their progress in meeting operational readiness criteria.

Recipients should build or sustain their programs’ strategies and activities in accordance with the expectations and requirements within this funding opportunity. Ultimately, CDC expects PHEP recipients to achieve the following program outcomes during the 2019-2024 performance period.

Timely implementation of public health intervention and control measures Continuity of emergency operations throughout the surge of an emergency or incident Timely communication of situational awareness and risk information by public health partners Timely procurement and expedited staffing (hiring or reassignment) to support medical countermeasure distribution and dispensing Timely coordination and support of response activities with health care and other partners Earliest possible identification and investigation of an incident with public health impact

CDC expects these outcomes to lead to the following outcomes in future performance periods.

Established public health recommendations and control measures in place for all hazards Prioritized public health services and resources sustained throughout all phases of public health incidents Continuity of and access to public health and related services

Ultimately, these outcomes will:

Prevent or reduce morbidity and mortality from public health incidents whose scale, rapid onset or unpredictability stresses the public health system, and

Result in the earliest possible recovery and return of the public health system to pre-incident levels or improved functioning.

iii. Strategies and Activities The goal of the PHEP program is to develop effective public health emergency management and response programs nationwide. By the end of the performance period, PHEP recipients should build and sustain the public health emergency preparedness and response capabilities to achieve substantial, measurable progress across the six domains. Additionally, PHEP recipients are expected to demonstrate operational readiness across all domains by the end of the performance period.

CDC has developed supplemental resources to assist PHEP recipients in developing work plans that address the strategies and activities outlined in the PHEP logic model. The 2019-2024 PHEP Supplemental Guidance and Resources are available at https://www.cdc.gov/cpr/readiness/phep /library.htm.

For the 2019-2024 performance period, all PHEP recipients must address and comply with the following programmatic requirements for the PHEP logic model strategies and activities, building jurisdictional capability with the goal of achieving operational readiness for emerging infectious https://www.cdc.gov/cpr/readiness/phep/library.htm https://www.cdc.gov/cpr/readiness/phep/library.htm diseases (EIDs) such as pandemic influenza, an anthrax event, and other public health threats and hazards. In addition, PHEP recipients must meet all statutory requirements and HHS grant guidance requirements.

CDC has modified programmatic requirements for U.S.-Affiliated Pacific Islands (USAPI) and U.S. Virgin Islands (USVI) recipients. More information is available in the 2019-2024 PHEP Supplemental Guidance and Resources: Modified Requirements for USAPI and USVI Recipients.

CDC does not have modified requirements for Puerto Rico. For the purposes of this NOFO, Puerto Rico must meet the same requirements as the 50 states.

Programmatic Requirements By the end of the performance period, PHEP recipients are expected to show measurable progress toward meeting the outcomes in the PHEP logic model by implementing the following strategies and activities organized by capability domains. CDC will require evidence of domain strategies and activities in various ways, such as work plans and other application documentation; exercise and training plans; annual progress reports; quarterly action plans; ORR documentation; and after-action reports and improvement plans (AARs/IPs).

Domain 1: Strengthen Community Resilience Community resilience is the ability of a community, through public health agencies, to develop, maintain, and utilize collaborative relationships among government, private, and community organizations to develop and utilize shared plans for responding to and recovering from disasters and public health emergencies.

Associated Capabilities

Capability 1: Community Preparedness Capability 2: Community Recovery

Determine the Risks to the Health of the Jurisdiction Conduct public health jurisdictional risk assessments (JRA) once every five years, in collaboration with HPP, to identify potential hazards, vulnerabilities, and risks within the community that relate to the public health, medical, and mental/behavioral health systems and the access and functional needs of at-risk individuals. CDC recommends a collaborative and flexible risk assessment process that includes input from existing hazard and vulnerability analyses conducted by emergency management, health care coalitions (HCCs) and other health care organizations, as well as other community partners and stakeholders. PHEP recipients should analyze JRA results, and use diverse data sources such as the HHS Capabilities Planning Guide (CPG), previous risk assessments, jurisdictional incident AARs/IPs), site visit observations, jurisdictional data from the National Health Security Preparedness Index, and other jurisdictional priorities and strategies, to help determine their strategic priorities, identify program gaps, and, ultimately prioritize preparedness investments.

Ensure HPP Coordination Continue assessing risk, planning, coordinating, and exercising with HPP counterparts, including HCCs. The purpose of this collaboration is to ensure a shared approach to delivering public health services alongside health care services to mitigate the public health consequences of emergencies. PHEP resources cannot be used to supplant HPP programmatic activities. However, there are areas where coordinated planning and collaboration between the programs are beneficial, including exercising and training. PHEP recipients must conduct one statewide or regional full-scale exercise (FSE) within the five-year performance period to test preparedness capabilities. Exercises must include participation from HCCs and include, at a minimum, hospitals, public health departments, emergency management agencies, emergency medical services (EMS), and public health jurisdictions. To help minimize the burden on exercise planners and participants, CDC recommends meeting multiple program requirements with this exercise, including PHEP, HPP, medical countermeasure (MCM) planning, and Cities Readiness Initiative (CRI) requirements.

Plan for the Whole Community Working in collaboration with HPP, continue to build and sustain state and community partnerships to ensure that activities have the widest possible reach with the strongest possible ties to the community. PHEP recipients should focus on two activities simultaneously:

Coordination with state partners and stakeholders to review collaboration efforts with local agencies they represent across the state; and

Review efforts of local jurisdictions to engage community partners who have established relationships with diverse at-risk populations.

Develop and maintain plans, conduct training and exercises, and respond to public health threats and emergencies using a whole-community approach to preparedness management. Plan for individuals with disabilities and others with access and functional needs. Use a flexible approach to define populations at risk to jurisdictional threats and hazards. Address a broad set of common access and functional needs using the CMIST Framework (Communication, Maintaining Health, Independence, Services and Support, and Transportation). Ultimately, the access and functional needs of individuals must be included within federal, territorial, tribal, state and local emergency and disaster plans.

CDC expects PHEP recipients to work with partners across several sectors to meet the needs of the whole community. PHEP recipients must work with partners and stakeholders on the following activities.

Identify populations at risk of being disproportionately impacted by incidents or events.

Have procedures in place to identify individuals with access and functional needs that may be at risk of being disproportionately impacted by incidents with public health consequences.

Individuals with access and functional needs are those that are at particular risk of poor physical, psychological or social health after an emergency. Examples of populations with access and functional needs include, but are not limited to, children, pregnant women, postpartum and lactating women, racial and ethnic minorities, older adults, persons with disability, persons with chronic disease, persons with limited English proficiency, persons with limited transportation, persons experiencing homelessness, and disenfranchised populations.

Coordinate with community-based organizations.

Identify community partners and stakeholders with established relationships with diverse at-risk populations, such as social services or faith-based organizations, and use available tools to better anticipate the potential access and functional needs of the community before, during, and after an emergency. Identify and integrate preferred communication messages and strategies for populations with access and functional needs.

Engage with key community organizations to plan and implement preparedness and response activities tailored to that community’s needs. Key community partners include public health, medical, and mental/behavioral health social networks, as well as organizations representing citizens and at-risk populations. Recipients should convene partners and stakeholders and establish clearly delineated roles and responsibilities for each partner across all hazards.

Integrate access and functional needs of individuals.

Describe the structure or processes in place to integrate the access and functional needs of individuals during a public health emergency. Use available tools to better anticipate the potential access and functional needs of at-risk community members before, during, and after an emergency.

Develop or expand child-focused planning and partnerships.

In coordination with HPP, ensure emergency preparedness and response planning and coordination with designated educational agencies and lead childcare agencies in the jurisdictions. Collaborate with child-serving institutions such as schools and daycare centers to ensure crisis preparedness plans are in place.

Consider family reunification plans for schools and day care centers, either as part of crisis preparedness plans or as separate plans for reunification. Coordinate messages and plans for reunification and for identifying the public health role in addressing children’s mental health needs following emergencies.

Engage the state office on aging.

Engage the state office on aging or an equivalent office in addressing the public health emergency preparedness, response, and recovery needs of older adults.

Engage mental/behavioral health partners and stakeholders.

Engage with state, health care, and community mental/behavioral health organizations to plan and implement preparedness and response activities tailored to that community’s needs. PHEP recipients should convene partners and stakeholders, and establish clearly delineated roles and responsibilities for each partner across all hazards.

Focus on Tribal Planning and Engagement Federally recognized American Indian and Alaska Native tribes are sovereign nations having a unique legal and political trust relationship with the United States, serving as key partners in the states and communities in which they live. In the area of public health emergency preparedness and response, state and local health departments must engage with tribes in a meaningful and mutually beneficial way to ensure that all tribes and their members are fully served, while also recognizing the inherent responsibility of those nations to support their members in a culturally appropriate manner. Further, tribal nations can provide unique resources to their neighboring states and communities in many emergency situations.

The PHEP program awards federal funds to states whose boundaries include tribal reservations and tribal communities. States have a responsibility to work with tribes to ensure appropriate efforts are made to develop public health preparedness and response capability.

At a minimum, this NOFO requires joint planning with federally recognized American Indian and Alaska Native tribes within applicable PHEP jurisdictions. Recipients must describe joint planning effort in their project narratives, work plans, and as appropriate, budgets, to include:

How each tribe within the state participates in planning activities and exercises.

How the state manages this engagement, such as through a tribal liaison or committee.

How funding or support for tribal preparedness activities is determined; for instance, do tribes get direct funding from the state or does the state provide services in lieu of funding?

How tribal preparedness activities are monitored.

How technical assistance is provided, including training related to the public health preparedness and response capability standards.

How tribes funded by PHEP-recipients are held accountable for preparedness activities, including financial or administrative reports, plans, or AARs.

How states are planning for tribal populations when engagement is limited.

Ensure Emergency Support Function (ESF) Cross-Discipline Coordination and Partner and Stakeholder Collaboration Coordinate with ESF partners and stakeholders to include, but not limited to, other public health and health care programs, HCCs, emergency management agencies, EMS providers, behavioral/mental health agencies, community organizations, older adult-serving organizations, and educational agencies and state child care lead agencies as applicable.

Establish and Maintain Senior Advisory Committee Maintain advisory committee(s) comprised of senior officials from governmental and nongovernmental partners to integrate preparedness efforts across jurisdictions and to leverage funding streams. CDC strongly encourages PHEP recipients to broaden advisory committee membership to include senior representatives from multiple disciplines and partner organizations including, but not limited to:

State administrative agency (SAA) State office on aging Jurisdictional HPP director, principal investigator, or coordinator Jurisdictional PHEP director or principal investigator Jurisdictional emergency management agency representative Jurisdictional EMS representative Jurisdictional medical examiner Jurisdictional hospital representative Jurisdictional immunization representative Tribal representatives Jurisdictional HCC coordinator(s) Jurisdictional mental/behavioral health representative Local health department governing board representative, local jurisdictions and associations, or regional working groups Community-based partners representing at-risk populations serving individuals with disabilities and others with access and functional needs Citizen representation to obtain public input and comment on emergency preparedness planning

Strengthen and Implement Plans through Training and Exercising Consistent with the Homeland Security and Evaluation Program (HSEEP) approach to exercise planning, PHEP recipients are expected to create a progressive, multiyear training and exercise program with increasingly complex exercises to improve operational readiness across multiple hazards. HSEEP guidance is available at https://www.fema.gov/media-library/assets/documents /32326.

At a minimum, PHEP recipients are expected to strengthen their training and exercising efforts through the following activities.

Develop and maintain plans.

Develop and maintain training and exercise plans for building and/or sustaining public health preparedness and response capability. PHEP recipients should identify gaps in preparedness through their JRA and CPG, determine their priorities, and develop plans for building and sustaining capabilities.

Develop and maintain current versions of the following plans (may be included as annexes or components in larger plans):

All-hazards preparedness and response plan Infectious disease response plan Pandemic influenza plan Medical countermeasure distribution and dispensing plans Continuity of operations (COOP) plans Chemical, biological, radiological, and nuclear (CBRN) threat response plans Plan(s) that support the Emergency System for Advance Registration of Volunteer Health

Professionals (ESAR-VHP) or volunteer management plan Communications plan

Listed plans must be reviewed, updated, and signed by the respective partners at least once every three years. Additionally, all plans must be accessible to CDC upon request and made available for review prior to site visits and ORRs.

Coordinate training, exercise planning, and implementation.

Participate in the jurisdictional annual training, exercise, and planning workshop (TEPW).

Develop and provide multiyear training and exercise plans (MYTEPs) that specify at least two years of trainings and exercises. The MYTEP should address the needs and priorities identified in previous AARs/IPs; demonstrate coordination with applicable entities, partners, and stakeholders;

and describe methods to leverage and allocate resources to the maximum extent possible.

MYTEPs must be submitted in DCIPHER no later than May 3, 2019.

Plan and participate in, at a minimum, one joint exercises with HPP and emergency management at least once every five years. Recipients can meet this requirement with a functional exercise (FE), an FSE, or a real incident.

Training and planning templates can be found in the in the FEMA HSEEP preparedness toolkit at https://preptoolkit.fema.gov/web/hseep-resources.

https://www.fema.gov/media-library/assets/documents/32326 https://www.fema.gov/media-library/assets/documents/32326 https://preptoolkit.fema.gov/web/hseep-resources

Conduct evaluation and improvement planning.

Develop evaluative processes to review, revise, and maintain plans based on the resulting priorities, needs, findings, and corrective actions of exercises, real incidents, trainings, or needs assessments. These processes must be used to develop and inform AARs/IPs.

Complete and submit AARs/IPs within 120 days after every FE, FSE, or incident involving public health. To ensure compliance with exercise requirements, PHEP recipients must submit AAR/IP forms as well as upload a copy of the AAR/IP file.

Obtain Public Comment and Input Obtain public comment and input on public health emergency preparedness and response plans and their implementation, using existing advisory committees or a similar mechanism, to ensure continuous input from other state, local, and tribal stakeholders and the general public, including members of at-risk populations.

See Capability 1: Community Preparedness and Capability 2: Community Recovery in Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health for more information.

Domain 2: Strengthen Incident Management Incident management is the ability to activate, coordinate, and manage public health emergency operations throughout all phases of an incident through use of a flexible and scalable incident command structure that is consistent with the NIMS and coordinated with the jurisdictional incident, unified, or area command structure.

Associated Capability

Capability 3: Emergency Operations Coordination

Activate and Coordinate Public Health Emergency Operations Have written plans and procedures in place to activate, coordinate, manage, sustain, and demobilize public health emergency operations throughout all phases of an emergency. To meet this expectation, PHEP recipients should conduct the following activities to strengthen incident management.

Update critical contact information.

Update jurisdictional points of contact twice during each budget period (December 31 and June 30), or as changes occur, to facilitate time-sensitive, accurate information sharing within the jurisdiction and between CDC and the jurisdiction.

Maintain updated all-hazards preparedness and response plans.

Maintain a current all-hazards public health preparedness and response plan, with applicable annexes. Such plans, which should be developed in conjunction with HPP, should include activities to be conducted to meet the preparedness goals described in sections 2802(b)(1), (2), (4), (5), and (6) of the PHS Act (42 U.S.C. § 300hh-1). Plans must also include descriptions of activities that address chemical, biological, radiological, or nuclear threats, whether naturally occurring, unintentional, or deliberate and describe how jurisdictions will partner with relevant public and private partners and stakeholders during responses. PHEP recipients also should include provisions for mobilizing other state and local personnel from their jurisdictions when reassigned to preparedness and response activities during a public health emergency.

https://www.cdc.gov/phpr/readiness/capabilities.htm

Updated all-hazards preparedness and response plans should include but not be limited to:

Procedures for how preliminary assessments are conducted to determine the need for activation of public health emergency operations;

Process for establishing a flexible and scalable public health incident management structure that is consistent with NIMS and jurisdictional standards and authorities;

Procedures for activating, operating, managing, and staffing the public health emergency operations center or implementing public health functions within another emergency operations center;

Designation of primary and alternate locations, including virtual communication structures, for the public health emergency operations center;

Procedures for demobilizing public health emergency operations; and A description of how the jurisdiction will use Emergency Management Assistance

Compact (EMAC) or other mutual aid agreements for public health and medical mutual aid to support coordinated activities and to share resources, facilities, services, and other potential support required when responding to emergencies that impact the public’s health. At minimum, this plan should include the following:

o Procedures for evaluating, responding to, and seeking reimbursement for resources deployed under EMAC;

o Description of how information will be shared between relevant partners for a resource request;

o Processes, procedures, and threshold(s) for deploying a requested resource;

o Documented roles and responsibilities during a resource request within the state public health agency;

o Redundant points of contact for all state’s public health and medical Mission

Ready Packages (MRPs) as applicable; and o Description of reimbursement processes following a deployment for both the deployed personnel and the key internal staff.

For more information see FEMA Comprehensive Preparedness Guide 101: Developing and Maint aining Emergence Operations Plans.

Maintain and exercise continuity of operations (COOP) plans.

Maintain a current COOP plan that includes the following elements.

Definitions, identification, and prioritization of essential services needed to sustain public health agency mission and operations, including laboratory services that ensure the ability to conduct ongoing testing of routine and emerging public health threats

Procedures to sustain essential services regardless of the nature of the incident (all-hazards planning);

Positions, skills, and personnel needed to continue essential services and functions (human capital management);

Identification of public health agency and personnel roles and responsibilities in support of ESF #8;

Scalable workforce expansion and reduction, in response to needs of the incident;

Limited access to facilities due to issues such as structural safety or security concerns;

https://www.fema.gov/media-library/assets/documents/25975 https://www.fema.gov/media-library/assets/documents/25975

Broad-based implementation of social distancing policies;

Identification of agency vital records (such as legal documents, payroll, personnel assignments) that must be preserved to support essential functions or for other reasons;

Alternate and virtual work sites;

Devolution of uninterruptible services for scaled down operations;

Reconstitution of uninterruptible services; and Cost of additional services to augment recovery.

PHEP recipients must test their COOP plans, including their jurisdictional public health laboratory COOP plans, during a real incident, a tabletop exercise (TTX), an FE, or an FSE at least once every five years. CDC strongly encourages recipients to coordinate with HPP to complete this requirement, either separately or as part of a broader exercise.

Maintain personnel lists.

Maintain a list of personnel with necessary skills to fulfill required incident command and public health incident management roles. Test staff assembly processes for notifying personnel to report physically or virtually to the public health emergency operations center or jurisdictional emergency operations center during a drill or real-time incidents at least once during the budget period.

Maintain and Exercise Fiscal and Administrative Preparedness Plans The fiscal, legal, and administrative authorities and practices that govern funding, procurement, contracting, and hiring must be appropriately integrated into all stages of emergency preparedness and response. Identifying and removing barriers that prevent the timely implementation of response activities will speed the acquisition of goods and services, the hiring or assignment of response personnel, the disposition of emergency funds, and legal determinations needed to implement protective health measures during a public health response.

Describe standard fiscal operating procedures.

Document the time it takes to move funds from the state public health agency to local public health agencies, both during emergencies and during routine grant administration.

Submit administrative preparedness plans to speed hiring and contracting during emergencies.

Update and submit a plan to speed hiring, contracting, and dispensing funds during emergencies to CDC at least once every five years. At minimum, the plan should include the following elements and processes.

Fiscal Planning: Alignment of the PHEP administrative processes to describe how funds will be managed, including processes for:

o Streamlining and consolidating contracting procedures; and o Tracking PHEP and other CDC grants or cooperative agreements separately as, according to federal appropriations law and HHS grant guidance, PHEP funds must maintain their unique identity and must be used for their intended purposes.

Emergency Legal Authority: Describe and provide PHEP recipient citations (as applicable) for emergency legal authorities applicable to the Public Health Emergency Law Competency Model, including authorities addressing:

Procedures for the declaration of disasters or emergencies and accompanying emergency authorities for designated officials;

Expedited procedures for receiving, allocating, and spending emergency funds, including the ability to quickly move emergency funds from the state level to local governments;

Powers and procedures for the use of public health interventions including isolation, quarantine, and the seizure and reallocation of supplies;

Emergency suspensions, waivers, or similar legal processes that can be used to minimize the potential conflicts between federal authorities applicable to medical countermeasures and state-based pharmaceutical, prescribing, labeling, and other drug-related laws; if no waivers or similar legal processes exist, PHEP recipients must describe laws that may potentially conflict with emergency use authorizations (EUAs), emergency use instructions (EUI), and investigational new drug (IND) and investigational device exemptions;

Protocol or formal memoranda of understanding or agreement (MOU/MOA) between health authorities and other preparedness partners including law enforcement for implementation of public health activities, such as joint investigations of intentional threats or incidents that impact the public’s health, signed and executed between state public health departments, including local public health departments where relevant, such as in home rule states; and

Protection of volunteers against tort liability and licensure penalties, and the provision of workers’ compensation claims, excluding federal mechanisms such as the Public Readiness and Emergency Preparedness Act. PHEP recipients should distinguish between in-state and out-of-state volunteers and indicate whether the state can use EMAC to send or receive volunteers.

Fiscal and Administrative Emergency Processes: Describe expedited fiscal and other administrative processes and identify procedures to test fiscal preparedness planning for such activities, including:

Emergency procurement and contracting authorities and processes and how they differ from day-to-day business processes;

Receiving emergency funds during a real incident or exercise, as well as reducing the cycle time for contracting or procurement during a real incident or exercise;

Emergency hiring processes (workforce surge) and how they differ from customary hiring processes;

Reporting and monitoring methodology to ensure payment efficiency and funding accountability;

Emergency procedures for allocating funds to local and tribal health departments and other subrecipients;

Internal controls related to subrecipient monitoring and any negative audit findings resulting from suboptimal internal controls; and

Internal controls that allow recipients to receive other federal preparedness and response grant funding without the potential for supplanting or commingling of funds.

Conduct a fiscal and administrative preparedness tabletop exercise.

http://lawatlas.org/datasets/emergency-powers

Test fiscal and administrative preparedness processes during a real incident or tabletop exercise (TTX) at least once every five years. CDC strongly encourages recipients to coordinate with HPP to complete this requirement See Capability 3: Emergency Operations Coordination in Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health for more information.

Domain 3: Strengthen Information Management Information management is the ability to develop and maintain systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, and warnings using a whole community approach. It also includes the ability to exchange health information and situational awareness with federal, state, local, territorial, and tribal governments and partners.

Associated Capabilities

Capability 4: Emergency Public Information and Warning Capability 6: Information Sharing

Maintain Situational Awareness during Incidents Establish a common operating picture (COP), or situational awareness tool, that facilitates coordinated information sharing among all public health, health care, and necessary partners and stakeholders. This includes state, local, tribal, and territorial public health agencies and their respective preparedness programs, public health laboratories, communicable disease programs, and programs addressing health care-acquired infections. Information sharing is the ability to share real-time information related to the emergency, such as capacity, capability, and stress on health care facilities and situational awareness across the various response organizations and different levels of government. Accomplishing these activities will enable public health and other organizations and responders to contribute to responses to coordinate efforts before, during, and after emergencies; maintain situational awareness; and effectively communicate with the public.

To reduce undue burden on PHEP and HPP recipients, CDC and ASPR will coordinate both within HHS and with interagency federal partners to reduce duplicative requests for information.

Recipients and subrecipients may provide requested information in any format used by their organizations, such as a situation report (SITREP) or a spot report (SPOTREP).

Coordinate Information Sharing Have or have access to communication systems that maintain or improve reliable, resilient, interoperable, and redundant information and communication systems and platforms, including those for bed availability, EMS data, and patient tracking, and provide access to HCC members and other partners and stakeholders. Such systems, whether they are internally managed or externally hosted on shared platforms, must be capable of supporting syndromic surveillance, integrated surveillance, active and/or passive mortality surveillance, public health registries, situational awareness dashboards, and other public health and preparedness activities. CDC recommends that PHEP recipients conduct training on coordinated information sharing to develop competent personnel to manage and support these systems.

Have plans in place that identify redundant communication platforms (primary and secondary) https://www.cdc.gov/phpr/readiness/capabilities.htm and a cycle of maintenance and testing of these platforms every six months.

Provide situational awareness data to CDC during emergency response operations and at other times, as requested.

See the 2019-2024 PHEP Supplemental Guidance and Resources: Public Health Informatics for more information.

Coordinate Emergency Information and Warning In conjunction with HPP, develop, coordinate, and disseminate information, alerts, warnings, and notifications to the public.

Have plans in place to stand up joint information communication centers when needed. Have plans in place that demonstrate ability to monitor jurisdictional media, conduct press briefings, and provide rumor control for media outlets, using the principles of the NIMS for organizing and coordinating incident-related communications.

Complete the following:

Have a communication plan that identifies the public information officer (PIO) and supporting personnel responsible for implementing jurisdictional public information and communication strategies. Plans must outline requirements and duties; roles and responsibilities; and required qualifications or skills for PIO personnel.

Use crisis and emergency risk emergency communication (CERC) principles to disseminate critical health and safety information to alert the media, public, community-based organizations, and other stakeholders to potential health risks and reduce the risk of exposure. Develop message templates based on planning or risk scenarios identified in risk assessments and incorporate these into the communication plans as applicable.

Ensure that PIOs, or other personnel, receive training in topics including, but not limited to: CERC, health communication, and cultural competency; and are able to employ these principles in an emergency.

Ensure that communication plans have processes for coordinating public messaging during infectious disease outbreaks and information sharing regarding monitoring and tracking of cases of persons under investigation to ensure maximum coordination and consistency of messaging.

Ensure communication plans have a process for coordinating messages for government officials, first responders, and community leaders during highly infectious disease responses.

See Capability 4: Emergency Public…