Region 5 FY HHS Round 1 Meeting Minutes Calcasieu Parish OHSEP, Lake Charles August 21, :00 P.M. to 4:15 P.M.

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1 Region 5 FY HHS Round 1 Meeting Minutes Calcasieu Parish OHSEP, Lake Charles August 21, :00 P.M. to 4:15 P.M. Hospitals: 18 of 22 Hospitals (82%) attended. Allen Parish Hospital, T Meaux, L. Frizzell, K. Marler, M. Billodeaux Beauregard Memorial Hospital, Greg Neely Calcasieu Oaks Psychiatric Hospital, Charles Getwood Christus St. Patrick Hospital of Lake Charles, Scott Kyle Cornerstone Hospital of Southwest LA, none DeQuincy Memorial Hosp., Gayland Barrow Dubuis Hospital of Lake Charles, none Extended Care of SW Louisiana, W. Wilkie, B. Bromley Jennings American Legion, Ruth Carnes Jennings Senior Care, April Bearb Lake Charles Memorial Hospital, W. Wilkie, Becke Bromley Lake Charles Memorial Hospital for Women, W. Wilkie, Becke Bromley Oakdale Community Hospital, Phil Rider Oceans Behavioral Hospital of Deridder, C. Bennett Oceans Behavioral Hospital of Lake Charles, C. Bennett Rehab Hospital of DeQuincy, M. Waddle Rehabilitation Hospital of Jennings, none South Cameron Memorial Hospital, C. Getwood W.O. Moss Regional, R. Theard; J. Suns West Calcasieu Cameron, Deanne Smith MMO Jennings (WestEnd Hospital), none Women and Children s Hosp., M. Poche, L. Rilly EMS: 4 of 6 EMS (67%) attended. Acadian Air Med Services, Jane Owers Acadian Ambulance Service, Jane Owers Allen Parish Ambulance Service District, Jane Lormand, Cameron Parish Ambulance Service District Number Two, none Cameron Parish Emergency Medical Services, Byron Broussard West Calcasieu Cameron Hospital Ambulance Service, none Guests: Joy Griggs, OPH; Mike Parent, OPH Facilitators: Liz Harmon, Region 5 ADRC; Robert Daughdril, OHSEP; Asha Green, HHS/LHA; Karla Houston, EMS ADRC, Evon Smith, DHH-ESF8 WELCOME AND INTRODUCTIONS Mr. Robert Daughdril welcomed everyone to the meeting and asked everyone to introduce themselves. He shared a few announcements for the region and then handed the meeting over to Asha Green, the grant coordinator for the Hospital Preparedness Program for Louisiana. Ms. Green discussed the agenda items and mentioned that the group will break out into groups so that EMS and hospitals can meet separately to discuss their specific planning objectives. Ms. Green also indicated that the meeting was mandatory for participation in FY HHS Grant. Representatives need to make sure they sign the in-sheet as each facility will receive credit for attending. Region 5 HHS Round 1 Meeting Page 1of 7

2 Allocation Model and Grant Cycle Louisiana received $5,168,389 for the FY grant year. $2,466, will be allocated to hospitals and $844, to EMS providers. This is a decrease in funding from last year by $157,000. Although this is small amount, Louisiana lost about half million in the previous year, so facilities should expect to see a 10-20% decrease in their individual allocation amounts. The grant process begins July 1 every year. In August and September, the allocation model, awarding facility funds, will be developed and the first HHS Rounds Meeting will be held. Participation Agreements, with spending goals, are then developed and mailed out to the facilities. Site visit are also held beginning in November to ensure facilities are meeting the grant goals. Grant Directives The grant is directed more toward capabilities based planning and implementation. In past five years, the grant directives included increasing surge capacity, implementing bed tracking system, having redundant communication systems, developing PPE and pharmaceutical caches, and developing mass fatality, evacuation and shelter in place plans. As we move into this new grant cycle, the terms grant directive is no longer used. We now have seven (7) capabilities that we must work toward achieving. Although Capability is a new term, the goals in each capability are similar to what we have been working toward for the last 5 years. The table below reflects the new capabilities and which previous planning goal fits into each capability. The goals are the same, but in a different package. Capability FY (New Capabilities) FY (Grant Directives) 1 Healthcare System Preparedness NIMS, At Risk Population, Training & Education, Exercises and Drills, Mobile Assets 3 Healthcare System Recovery Conduct Hazard Vulnerability Analysis 5 Fatality Management Fatality Management 6 Information Sharing Bed Tracking, Communication Systems 10 Medical Surge Surge, Alternate Care Sites, Crisis Standard of Care, Shelter in Place and Evacuation Plans 14 Responder Health & Safety PPE, Pharmaceutical Cache & Decontamination Capabilities 15 Volunteer Management ESAR-VHP (LAVA) Other changes include: The Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) grants have been aligned Funding for both public health and hospital preparedness program are funneled to the States into one funding stream so as to ensure public health and other healthcare agencies are working closely together. Public Health has 15 capabilities. Of the 15 capabilities, the Hospital Preparedness Program (HPP) is mandated to 7 capabilities. Main goal of grant is to develop healthcare coalitions States must develop healthcare coalitions which will include not only hospitals and EMS providers but other healthcare organizations. The coalition will be required to meet the goals of the grant. In Louisiana, the coalitions were developed by regions, which Region 5 HHS Round 1 Meeting Page 2of 7

3 include the hospital and EMS DRC's, our Public Health Emergency Response Coordinators (PHERCs), and individual hospitals and EMS providers. Nursing homes and Mass Fatality DRCs will also be included. More integration into ESF 8 network as response component Coalitions should not only prepare for certain types of events, but should actively respond to events. When the grant was originally given to States it really only focused on preparedness efforts. As the years have passed, response language was added to the grant guidance. Louisiana has been working in the preparedness and also response capacity for years. GRANT PARTICIPATION REQUIREMENTS Ms. Green further discussed the three (3) requirements that facilities must achieve in order to participate in FY 2012: Step 1 Complete and submit the following documents to HHS Grant Staff: A. Letter of Intent The letter of intent must be completed and signed by the facility s CEO/Director indicating your facility wishes to participate. Letter of Intent also indicates that NIMS Compliance Worksheet must be submitted and that facilities must send representative to mandatory meeting in order to eligible to participate in the FY grant year. The Letter of Intent must be returned by August 31, B. NIMS Compliance Worksheet It is a federal requirement that facilities be in compliance with the 11 National Incident Management System (NIMS) elements. Facilities not in compliance are not eligible to receive any federal funding, including the HPP grant funds. Ms. Green discussed the 11 elements and the action items facilities can do to achieve each element. The list of action items is not an exclusive list. Facilities are encouraged to review all plans to ensure all NIMS principles have been meet and to document compliance activities. The NIMS compliance worksheet and the list of the action items can be found at on the NIMS page of the Emergency Preparedness section. NIMS Compliance worksheet are also due by August 31, C. Attend mandatory Rounds meeting in August 2012 Facility must attend a mandatory meeting held in August Facility must sign attendance list to receive credit. Facilities representing more than one (1) facility, must sign in for both facilities. If facilities do not attend meeting or sign in, the facility will NOT be included in allocation model and be awarded funds. Step 2 Once the allocation model is developed and Participation Agreements are mailed, facilities must: A. Identify gaps and develop plan of action on how grant goals will be met & how funds will be spent by developing a budget proposal. The spending goals will be discussed during the respective break-out sessions. B. Submit signed Participation Agreement, Budget Proposal and other requested documents. The deadline in which to submit documentation has not be determined as of yet, but will be included in the Participation Agreement packages once they are made available. C. Spend funds and submit the Acceptable Documentation of Proof of Payment as indicated in Participation Agreement. Acceptable Documentation of Proof of Payment must be dated between July 1, 2012 and May 31, 2013 and includes: Region 5 HHS Round 1 Meeting Page 3of 7

4 Receipts stamped Paid along with the check number and date paid. Copies of the corresponding check(s) used to pay invoice/receipt. Invoice(s) indicating items have been paid with a credit card. Credit card payments must be accompanied by the credit card statement and proof of payment of the credit card statement. If claiming sales taxes that are not listed on the invoice/receipt, documentation supporting your tax percentage should be submitted. If purchases were paid using an electronic transfer of funds (ETF), a tracking or reference number along with the date of the transfer and signature authorizing this payment method should be written on the invoice. 10% Match When spending funds, facilities should be mindful that they have to match funds by 10%. Facilities may account for match by spending over and above reimbursable limit. They may also document their 10% match by documenting staff time for attending emergency preparedness meetings, mileage for attending emergency preparedness meetings and on-campus storage and/or meeting space. The grant summary worksheet should be used to account for all in-kind contribution and cash expenditures. If the facility chooses to demonstrate the match in staff time, required documentation such as sign-in sheets, meeting agenda and a meeting summary showing a reasonable dollar value must be submitted so as to support the dollar amount of the in-kind staff time. Grant Management System Documentation must be submitted through the electronic grant management system. Grant Management System has been redesigned. New system will be operational by October New system has same look and feel as ESF 8 portal. Signed Participation Agreements & Budget Proposal must be uploaded to new system. The expenditure process will be the same but system will be easier to maneuver. Training/webinars dates for system will be sent out at a later date. The grant management system will also be integrated in ESF 8 portal by October 2012, which means there will be a single sign on. Facilities will now need to log into the ESF 8 portal to gain access to the grant management system. The Grant Manager position will be added to list of positions/roles in ESF 8 portal so that users can gain access to system. D. Continue participation in HHS Emergency Preparedness activities. Facilities should not only attend the mandatory meetings but also participate in other regional and state activities such as radio roll calls, regional and state drills and exercises, other regional meetings and ESF 8 portal activities. Step 3 To ensure facilities are meeting grant goals, site visits to 20% of the facilities will be performed every year. Approximately 55 hospitals and 11 EMS providers will receive visits sometime between November 2012 and March Every hospital and EMS provider will be visited over the next 5 years regardless of whether they participated in the last grant cycle. Site visits are more comprehensive than in the past. In addition to grant purchases, HHS grant staff will be reviewing and confirming: NIMS compliance, Survey responses, Compliance with Participation Agreement (Attachment A for hospitals) and to ensure hospitals have surge plans. If a red flag is found in site visit, corrective action measures will be taken. Facilities may no longer be eligible to receive grant funds until measures have been met. Facilities may be asked to return a portion of grant funds received or facilities may be asked to provide justification as to why measure cannot been met. A more detailed discussion was held during the individual break-out sessions. FREQUENTLY ASKED QUESTIONS Ms. Green discussed a few Frequently Asked Questions (FAQs), which includes questions about who owns the equipment purchased with grant funds, how to dispose of broken or unused grant equipment, what is the Region 5 HHS Round 1 Meeting Page 4of 7

5 appropriate use of grant funds, whether equipment can be used to respond to in-state and out-of-state events, the importance and how to develop an inventory list and what facilities must do to meet audit requirements. A handout of FAQs was provided to the group. The list may also be found at under the Emergency Preparedness section. HOSPITAL AND EMS BREAK OUTS SESSIONS Hospital Session: The group discussed the hospital spending goals and how the hospitals should go about identifying their gaps. The following were discussed. Surge Beds The surge bed goal is based on the number of beds hospitals have available over their daily average census. Anything over and above the daily average census can be counted toward the facility s surge goal. During site visits, HHS Staff will be reviewing the hospital s survey responses to ensure they are accurate and that the surge goals listed on Attachment A of the hospital s participation agreement have been met. To meet surge goal facilities should first determine their average daily census and then subtract this number from licensed beds. When using this formula facilities must have physical bed available. Hospitals should also consider number of beds available after discharging patients. If surge goal cannot be met with the above formula, hospitals should purchase cots, stretchers, and/ or air mattresses to meet surge goal. Supporting equipment such as IV poles, monitors, carts, etc. can also be purchased. Facilities should also identify in response plan location of surge beds and where the cots and stretchers will be placed in facility. If facility cannot meet surge goal due to space limitation, facilities should document steps taken to achieve goal and reasons why goal could not be met. Critical Care Surge Beds The critical care bed goal is in addition to the surge bed goal. Based on the altered Critical Care bed definition, each critical care bed should include an electrical outlet, a 50 PSI oxygen outlet, a 50 PSI air outlet, a suction outlet or portable suction outlet, and a portable pulse oximetry. Hospitals should consider using empty patient care beds as critical care surge beds and increasing medical surge surge beds by purchasing cots or stretchers. Facilities should also consider doubling up beds in patient care rooms that have the appropriate outlets. If facility cannot meet their critical care surge goal due to space limitation, facilities should document steps taken to achieve goal and reasons why goal could not be met. Ventilator Cache - Facilities should count all ventilators capable of providing full ventilatory support of a patient. (i.e. fixed, portable or disposable ventilators). To determine whether ventilator goal as listed in Attachment A has been met, subtract the number of ventilators in use from the number of ventilator in your possession. Facilities may also purchase additional circuits and filters, and other associated accessories including sufficient oxygen. Facilities should mention ventilator cache in their emergency plans and also develop contingency plans to include redundancy options. Personal Protection Equipment (PPE) Facilities should determine and document formula used to determine amounts in cache. A sample formula was given to the group. Hospitals should determine what formula works best for them and stockpile according to that formula. Formula should be documented and made available during site visit. PPE cache should include, but is not limited to, gloves and masks. As storage becomes a problem, hospitals need to document steps taken to achieve goal and reasons why goal could not be met. Facilities should consider other alternatives, such as outside storage areas. The located of cache, the amount and what equipment is in cache should be documented and mentioned in emergency plans. Region 5 HHS Round 1 Meeting Page 5of 7

6 Mass Fatality Tier 1 and Tier 2 facilities should have a written mass fatality plan. Mass Fatality plans should include how remains will be handled during a disaster. The mass fatality plan may be part of the facility s surge or emergency operations plan. As per their participation agreements, facilities should also be stockpiling body bags as listed on Attachment A. Pharmaceutical Tier 1 and Tier 2 facilities should have a biological drug cache for their inpatients, staff members and their staff s family members for 72 hours. To determine the quantity of drugs your facility should be stockpiling, facility should multiply the number of staff members by 3.5, and then add the number of inpatient beds at your facility to this number. To calculate a three (3) day supply, this amount should be multiplied by three (3). Biological cache should include at least one of the following drugs: Doxycycline, Ciprofloxacin, Levaquin, and Gentamicin. Tier 2 hospitals with no pharmacy should obtain letter from local pharmacy saying local pharmacy will stockpile cache and deliver cache upon notice. Facilities must also have a mass prophylaxis plan indicating how drugs will be distributed. Communication Depending on the regions, both Tier 1 and Tier 2 hospitals should have either a 700 MHz radio or HEAR. Hospital should also have communication plan which includes language about their redundant communication systems, including the ESF 8 portal. Decontamination Tier 1 hospitals should have five (5) member A and B decontamination team. Each team member should have access to 2 disposable suits and 1 PAPR. Tier 1 facilities should have plan on how decontamination team is activated and listing of decontamination team members and their contact information. If goals have not been met, facilities need to purchase additional equipment for those areas and include this on their budget proposal for FY The goals as listed in the Participation Agreements and Attachment A will not change this grant cycle. FY will be used as a make-up year. Budget Proposal When developing budget proposal, facilities should include the spending category as listed in their Participation Agreement, the description of item and the estimated cost of the item. Budgets should also include an assurance statement. The Assurance statement is ensuring that HHS grant funds will not be spent in the "Other Spending Areas" as listed in your Participation Agreement, until after the Communication and other goals listed Attachment A have been met. Other Spending Areas include Pharmaceutical, Isolation and Decontamination. It is recommended that facilities use the budget template developed by HHS Staff that is located on the website. However, if facilities wish to develop their own template, they need to make sure these things are included in their budget proposal. When providing an estimated amount for cash expenditures, facilities need to make sure the cash expenditure amount is equal to or greater than the reimbursement limit. Non-cash in-kind should only include expenditures in which facilities do not have actual receipts. If facilities have proof of payment, they may claim it under cash expenditures. Please note that in-kind staff-time can only be claimed under in kind contributions. Grant funds cannot be used to pay for staff-time. The hospital session was closed by showing the hospitals some pictures of the site visits from last year. EMS Session The groups discussed the Grant Staff Transition and the changes to documentation and payment processing that will occur in the upcoming grant year. The topics were as followed: Reimbursement checks Reimbursements have been mailed with the exception of a few providers. Grant Guidance document- Every participating provider has been given a Grant Guidance Document. It has necessary reference material including a GMS power point and submission dates. Region 5 HHS Round 1 Meeting Page 6of 7

7 Needs assessments- Recently submitted needs assessments will be used for upcoming Grant Year. The HHS Grant Staff will use this data to identify gaps and future spending goals. At this time, spending goals have not been determined for the grant year. CPG s CPG s will now be the focus of the grant. The DRC s will have more of a leadership role to fulfill and providers will have to purchase items according to the current CPG being assessed that grant year. More detail will be giving about each CPG as we progress through the grant year. Webinars- On-line training sessions will be conducted by the Grant Management Staff to facilitate understanding of the grant system (GMS) and the ESF-8 portal. These trainings will be available to EMS providers. Log in and password information will be re-distributed. Acceptable Documentation In order to ensure that all requests are interpreted according to grant guidelines, a Justification letter will be required for those items needing clarification such as laptops or unfamiliar equipment. The specific question that needs to be considered before submission is How does your request tie back to the grant to make it important for preparedness and response? Any language barriers will be discussed to ensure compliance and facilitate eligible purchasing. Means of Submission- In order to ensure documentation is maintained and correctly tracked after submission, outside of the GMS, s and faxes, respectively, are the preferred methods of submission. Participation points will be added to the next grant model but not being implemented for this year. Training- Though specific spending goals have not been assessed, this year a focus will be placed on training across all areas of surge response and preparedness. The grant staff will be sure to pass along any training opportunities and asked that all participants do the same. Adjournment The meeting ended at 4:15 p.m. Region 5 HHS Round 1 Meeting Page 7of 7