Maryland Department f Health and Mental Hygiene Framewrk fr Develpment f Healthcare Preparedness Calitins Versin 1.1 April 2014
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Maryland Department f Health and Mental Hygiene Framewrk fr Develpment f Healthcare Preparedness Calitins Cntents Frewrd Executive Summary Part One Maryland Framewrk I. Intrductin A. Purpse B. Scpe and Applicability II. Planning Backgrund A. Review f Existing Healthcare Calitins: Summary f Findings B. Federal Guidance fr Healthcare Preparedness Calitin Develpment III. State f Maryland Requirements and Recmmendatins fr Reginal Healthcare Preparedness Calitins A. Organizatin and Structure B. Leadership C. Membership and Vting Rights D. Calitin Dcumentatin: Frmal Agreements E. Rle f Reginal Crdinatr F. Reginal Planning: Functins and Respnsibilities f Calitins 1. Grants Management: Fiduciary Respnsibilities 2. Reginal Resurce/Assets Management 3. Reginal Preparedness Planning i
4. Calitin Strategic Planning IV. Guidance fr Future Calitin Develpment A. Expansin f Calitin Membership C. Frmatin f Nnprfit Organizatins D. Rle f Healthcare Calitins in Emergency Respnse V. References VI. Definitins Part Tw Appendices Appendix A Detailed Findings frm Review f Existing Healthcare Calitins Appendix B Summary Matrix: Healthcare Preparedness Capabilities Guidance fr A. Calitin Develpment Appendix C Hspital Preparedness Prgram Reginal Crdinatr Scpe f Wrk Appendix D Acrnyms Appendix E Healthcare Preparedness Calitin Framewrk Wrk Grup ii
Frewrd The U.S. Department f Health and Human Services (DHHS), Office f the Assistant Secretary fr Preparedness and Respnse (ASPR) has develped a natinal guidance dcument fr healthcare system preparedness called the Healthcare Preparedness Capabilities. This dcument is intended t assist health departments and healthcare system partners t identify gaps in preparedness, determine specific pririties, and develp plans fr building and sustaining healthcare specific capabilities. It als sets the parameters fr hspitals, healthcare systems, and Emergency Supprt Functin (ESF) #8 partners t prepare fr, respnd t and recver frm incidents that have a public health and medical impact. One f the primary functins utlined in the Capabilities cncerns the cllabratin f states and healthcare partners fr develpment f reginal calitins t supprt healthcare system preparedness. Accrding t the Healthcare Preparedness Capabilities, healthcare calitins are "a cllabrative netwrk f healthcare rganizatins and their respective public and private sectr respnse partners within a defined regin." They cnsist f members frm multiple disciplines, including healthcare, public health, emergency management, and behaviral health. Acting as multiagency crdinating grups, healthcare calitins assist emergency management and ESF #8 with preparedness, respnse, recvery, and mitigatin activities related t the disaster peratins f healthcare rganizatins. As such, they are essential t ESF #8 and are a key cmpnent in a cmprehensive, all-hazards preparedness planning system. The State f Maryland recgnizes five health and medical gegraphic regins, each f which is represented by a healthcare preparedness calitin. Regins I and II plan tgether and share a cllabrative calitin, while Regins III, IV, and V each have an individual healthcare calitin. The Maryland Framewrk fr Develpment f Healthcare Preparedness Calitins has been created in an effrt t blster these fur calitins, bth individually and as a grup making up part f Maryland s ESF #8 respnse. This dcument is a result f the cllabrative effrts amng the Department f Health and Mental Hygiene (DHMH) Office f Preparedness and Respnse (OP&R), healthcare system partners, lcal health department representatives, and healthcare calitin members. The final framewrk incrprates cmments and suggestins received frm a variety f stakehlders. Users f this Framewrk are encuraged t recmmend changes that will imprve the clarity, utility and applicatin f the dcument. Questins r cmments shuld be directed t: Maryland Department f Health and Mental Hygiene Office f Preparedness and Respnse 300 W. Prestn Street, Suite 202 Baltimre, MD 21201 410-767-0823 1
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Executive Summary The State f Maryland recgnizes five health and medical gegraphic regins, each f which is currently represented by a healthcare preparedness calitin. These calitins are: Regins I and II Health Care Cuncil Regin III Health and Medical Task Frce [Regin IV] Delmarva Reginal Healthcare Mutual Aid Grup (DRHMAG) Regin V Emergency Preparedness Calitin The purpse f this guidance dcument the Maryland Framewrk fr Develpment f Healthcare Preparedness Calitins is t utline standards, recmmendatins and minimum requirements in rder t facilitate successful implementatin f reginal healthcare calitins in the state. This Framewrk has been created t supprt the develpment f the fur calitins named abve, bth individually and as a grup making up part f the state's ESF #8 respnse. The cntents f this Maryland Framewrk are cnsistent with the gals and bjectives utlined in ASPR's Healthcare Preparedness Capabilities and the Centers fr Disease Cntrl and Preventin's Public Health Preparedness Capabilities. Areas f specific guidance include: calitin establishment and structure, leadership, membership and vting rights, the rle f Reginal Crdinatrs, and reginal preparedness planning respnsibilities. Recmmendatins fr future calitin develpment are als addressed in the dcument. The Maryland Framewrk fr Develpment f Healthcare Preparedness Calitins is the result f the cllabrative effrts f DHMH/OP&R, healthcare system partners, lcal health department representatives, and reginal healthcare calitin members and stakehlders. The infrmatin herein was assembled thrugh review and analysis f best practices frm established healthcare calitins arund the cuntry, as well as cnsideratin f existing calitins in Maryland and current state preparedness pririties. This Framewrk is nt meant t stand alne as a sle surce f guidance, nr is it intended t be the final wrd n healthcare preparedness calitins in Maryland. It shuld be cnsidered a living dcument that can and will evlve as ur calitins cntinue the prcess f grwth and develpment. 3
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Part One Maryland Framewrk II. Intrductin A. Purpse The purpse f the Maryland Framewrk fr Develpment f Healthcare Preparedness Calitins is t utline standards, recmmendatins, and minimum requirements t facilitate the successful implementatin f reginal healthcare preparedness calitins in Maryland. Areas f specific guidance and recmmendatins include calitin establishment and structure, leadership, membership and vting rights, rle f Reginal Crdinatrs, and reginal planning respnsibilities. B. Scpe and Applicability The Maryland Framewrk fr Develpment f Healthcare Preparedness Calitins: 1. Will be used by and applied t the Maryland Regins I and II Health Care Cuncil, Regin III Health and Medical Task Frce, Regin IV Delmarva Reginal Healthcare Mutual Aid Grup (DRHMAG), and Regin V Emergency Preparedness Calitin. 2. Is intended as a guide and supplement t current federal guidance included in the ASPR Hspital Preparedness Prgram (HPP) and Centers fr Disease Cntrl and Preventin (CDC) Public Health Emergency Preparedness (PHEP) Cperative Agreements, and within ASPR's Healthcare Preparedness Capabilities and the CDC's Public Health Preparedness Capabilities. 3. Establishes standards, recmmendatins, and minimum requirements fr the building, maintenance, and imprvement f healthcare calitins in Maryland. 5
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III. Planning Backgrund In 2012, DHMH OP&R cnvened a wrk grup t develp a Healthcare Calitin Framewrk. Representatives t the grup were selected frm Maryland healthcare system partners, lcal health departments, EMS, and reginal healthcare calitin members and stakehlders. This dcument represents the prduct f wrk grup effrts. A. Review f Existing Healthcare Calitins: Summary f Findings As a first step in creating this framewrk, the wrk grup cnducted research t gather infrmatin n existing healthcare calitins. The fllwing rganizatins were chsen frm amng varius well-established rganizatins arund the cuntry: 1. DC Emergency Healthcare Calitin - Washingtn, DC 2. First Cast Disaster Cuncil - Nrtheastern Flrida 3. MESH - Indianaplis, IN 4. Miami-Dade Cunty Hspital Preparedness Cnsrtium - Flrida 5. Nrthern Utah Healthcare Calitin 6. Nrthern Virginia Hspital Alliance (NVHA)/Nrthern Virginia Emergency Respnse System (NVERS) 7. Nrthwest Healthcare Respnse Netwrk (NWHRN)- King Cunty and Pierce Cunty, WA 8. Partnership fr Effective Emergency Respnse (PEER) - Bstn, MA Fr detailed infrmatin n each f these healthcare calitins, see Appendix A. Characteristics f Established Reginal Healthcare Calitins Each f the selected calitins was reviewed using a specific set f criteria. These criteria included rganizatin type and structure, leadership, membership and vting rights, meeting frequency, establishment dcumentatin [e.g. charter, By-laws, Memrandum f Understanding (MOU)], respnse rles, and reginal planning. The research indicated that while these calitins all serve essentially the same verarching purpse, they vary widely in terms f structure, membership, and hw they functin as rganizatins. 1. Organizatin Type Varius rganizatin types were bserved amng the healthcare calitins studied. Fr discussin purpses, they can be divided int tw general categries: Cmmittee-like, vluntary rganizatins with pen membership Nnprfit rganizatins [e.g. 501(c)(3) r 501(c)(6)] The first grup cmmittee-like, vluntary rganizatins range frm fairly lsely structured calitins t mre tightly rganized grups with specific 7
membership and participatin requirements. These grups are mre cmparable t the existing calitins in Maryland. Tw examples are the Nrthern Utah Healthcare Calitin and the Nrthwest Healthcare Respnse Netwrk. Bth are true reginal calitins in that they cver multiple jurisdictins in their respective states. At the time that research was cnducted, bth were hsted and administered by lcal health departments. [Nrthwest Healthcare Respnse Netwrk is currently explring incrpratin as a 501(c)(3)]. Bth f these calitins are primarily funded with grant dllars frm the DHHS, ASPR Hspital Preparedness Prgram (HPP). Several f the calitins studied are incrprated as nnprfit rganizatins, and therefre have status as legal entities (e.g. First Cast Disaster Cuncil, MESH, Nrthern Virginia Hspital Alliance). These calitins exist independent f lcal, state r federal agencies. There is n need fr a separate fiduciary agent, because as legal entities these rganizatins can receive and administer funds n their wn behalf. Likewise, they can secure additinal surces f funding beynd existing federal preparedness grants (e.g. membership fees, dnatins, r crprate cntributins). Three single-jurisdictin calitins were als included in the research chrt: the DC Emergency Healthcare Calitin, First Cast Disaster Cuncil, and the Miami-Dade Cunty Hspital Preparedness Cnsrtium. All f Maryland's calitins are multi-jurisdictinal, and therefre are nt strictly cmparable. Hwever, t assess best practices it was deemed wrthwhile t als examine these single-jurisdictin calitins especially in light f the fact that thse selected are well-established and very active in their respective cmmunities. 2. Leadership ASPR's Healthcare Preparedness Capabilities dcument indicates that healthcare calitins shuld have a frmal leadership structure fr cllabrative versight and crdinated decisin-making. The calitins studied shwed a variety f gvernance arrangements, depending n the rganizatin type and its underlying structure. Sme had elected fficers, such as President and Vice- President r Chair and Vice-Chair. Others had an Executive Cuncil, r a lead cmmittee acting in that capacity. Sme calitins were led by an Executive Directr r Chief Executive Officer (CEO). The Miami-Dade Cunty Hspital Preparedness Cnsrtium has a unique leadership arrangement that features three C-Chairs, each serving as the leader f a separate standing cmmittee. 3. Calitin Structure and Membership Calitin membership arrangements tend t fllw frm the rganizatin type r directly reflect the underlying grup structure. A key feature f several f the calitins, particularly thse with pen membership, is the use f cmmittees t 8
rganize the grup and divide up the wrk. Sme calitins have standing cmmittees, while thers frm sub-cmmittees r wrk grups as needed fr specific purpses. Fr example, the Nrthwest Healthcare Respnse Netwrk (NWHRN) is a very large rganizatin that has several standing cmmittees fr cnducting calitin business. These include the Disaster Clinical Advisry Cmmittee, In-Hme Service Prviders Cmmittee, Nursing Hme Steering Cmmittee, and the Pediatric Cmmittee and Task Frce. In cntrast, the much smaller Nrthern Utah Healthcare Calitin has n standing cmmittees ther than an Executive Cmmittee. Instead, NUHC frms wrk grups frm the membership t address specific tasks. The three nnprfit rganizatins reviewed each had different structures and membership arrangements. The First Cast Disaster Cuncil (FCDC) has an pen, vluntary membership plicy. FCDC includes representatives frm all sectrs f the healthcare cmmunity, as well as traditinal respnse entities, mass transit agencies, and federal partners. Due t its specific missin, the membership f the Nrthern Virginia Hspital Alliance is limited t hspital and healthcare system partners nly. MESH has a unique membership structure that cnsists f Subscribing Healthcare Partners and Calitin Partners. The Subscribing Partners, primarily hspital and healthcare systems, pay fees t participate (n a sliding scale basis) and have cntractual bligatins t the calitin. MESH's Calitin Partners pay n membership fees. They include representatives f the Indiana Department f Health and Indiana Department f Hmeland Security, as well as Indiana University's Schl f Medicine and Schl f Nursing. 4. Vting Rights The wrk grup was nt able t btain specific infrmatin n vting arrangements fr every calitin. When this infrmatin was available, the key differences bserved amng the calitins invlved whether all participants have equal access t decisin-making prcesses i.e., whether r nt all calitin members get a vte. The Nrthern Utah Healthcare Calitin and Miami-Dade Cunty Hspital Preparedness Cnsrtium bth have vting arrangements t ensure that certain partner grups retain a vting majrity in the calitin. NUHC allws hspitals a set number f seats (and therefre vtes) n the Executive Cmmittee. The Miami Cnsrtium, as described abve, has a twtiered membership structure. Full calitin members are representatives frm Miami-Dade Cunty hspitals, all f whm have vting privileges. Assciate Members are representatives frm ther rganizatins wh are participants in the Cnsrtium, but d nt have vting privileges. 5. Frequency f Meetings All f the calitins reviewed have a set meeting schedule. The frequency f meetings appears t be related t the verall size and structure f the calitin. 9
Fr sme calitins, the full membership meets n a regular mnthly, bi-mnthly r quarterly basis. Within ther rganizatins, the cmmittees and wrk grups meet with greater frequency, while meetings f the full membership ccur much less ften. Fr example, the Nrthern Virginia Hspital Alliance hlds mnthly meetings f the hspital Emergency Managers and bimnthly hspital executive meetings, while the full membership meets nly nce a year. Similarly, the Nrthwest Healthcare Respnse Netwrk hlds quarterly meetings f its Executive Cuncil. The full calitin, which has a membership numbering in the hundreds, meets nly n an annual basis. 6. Frmal Dcumentatin f Establishment ASPR's Healthcare Preparedness Capabilities dcument indicates that calitins shuld have a frmal, written dcument shwing the establishment f the rganizatin fr the purpses f emergency preparedness. Many f the existing calitins reviewed had sme type f frmal dcumentatin in place. Fr example, First Cast Disaster Cuncil maintains Letters f Agreement (LOA) between the rganizatin and each f the participating hspitals. These agreements dictate hspital respnse actins in the event f an emergency. The Nrthern Utah Healthcare Calitin has a frmal charter fr the rganizatin, as well as a Memrandum f Understanding (MOU) signed by members. 7. Reginal Crdinatrs Since DHMH has pted t fund HPP Reginal Crdinatrs t wrk with Maryland's healthcare preparedness calitins, this feature was selected as ne f the review criteria. The wrk grup was nt able t btain detailed infrmatin n the use f reginal crdinatrs (r persns serving in a similar rle r functin) fr every calitin. When this infrmatin was available, it was apparent that the use f persnnel in this rle depended largely n the rganizatin type and structure. Amng the calitins reviewed, the fllwing nes have reginal crdinatrs, r designated persnnel that serve in a cmparable rle: Miami-Dade Cunty Hspital Preparedness Cnsrtium (perhaps nt applicable, since this is a single-jurisdictin calitin), Nrthern Utah Healthcare Calitin, and the Nrthwest Healthcare Respnse Netwrk. 8. Reginal Planning Planning is an imprtant functin f a reginal healthcare preparedness calitin. Presumably, all f the existing calitins that were reviewed engage in preparedness planning; hwever, the planning prcesses f multi-jurisdictin calitins is f particular interest fr ur purpses in Maryland. Sme f these calitins have written dcumentatin that demnstrates the prducts f planning prcesses (e.g. frmal written plans, MOU/MOAs, Interagency Agreements). Fr example, the Nrthern Utah Healthcare Calitin has a Reginal Medical Surge Plan, which was apprved by the Executive Cuncil and 10
enacted by vte f the entire calitin. The plan is reviewed n an annual basis, exercised ften, and revised r updated as needed. The Nrthwest Healthcare Respnse Netwrk has a very rbust reginal planning prcess. The large membership f this calitin allws fr the frmatin f subcmmittees that engage in fcused preparedness planning (e.g. Disaster Clinical Advisry Cmmittee, Hspital Strategy Wrkgrup, Nursing Hme Steering Cmmittee). 9. Emergency Respnse Rle The calitins reviewed vary widely with regard t rles and functins in emergency respnse. The single-jurisdictin calitins tend t have active, peratinal rles; hwever, the First Cast Disaster Cuncil is an exceptin. FCDC is a 501(c)(3) rganizatin that represents Flrida's Jacksnville/Duval Cunty jurisdictin. It perates in supprtive rle via ESF#8 in an emergency r disaster, with the calitin represented at the cmmand level by prxy thrugh the lcal health department. In cntrast, the DC Emergency Healthcare Calitin has an active rle in respnse. DC EHC maintains readiness by having a weekly Duty Officer n call (with back-up) and three Calitin Ntificatin Centers in cntinuus peratin. The DC EHC als has a Calitin Emergency Respnse Team that can be deplyed when events escalate. There was little cnsistency amng the multi-jurisdictin calitins with regard t their rles in emergency respnse. The respnse rles and functins f these calitins largely reflect the structure f the individual rganizatins, r their stated purpse and missin. B. Federal Guidance fr Healthcare Preparedness Calitin Develpment The U.S. Department f Health and Human Services, Office f the Assistant Secretary fr Preparedness and Respnse (ASPR) has published several dcuments t assist states and their preparedness partners in the develpment f reginal healthcare calitins. The yearly HPP-PHEP jint Funding Opprtunity Annuncements (FOA), the Healthcare Preparedness Capabilities dcument, and the HPP Prgram Measures all cntain infrmatin that is intended t supprt the calitin develpment prcess. HPP-PHEP Jint Funding Opprtunity Annuncement (FOA) The fllwing language was excerpted frm the HPP Budget Perid 1 (FY 2012) FOA: Awardees (i.e. states) are expected t develp r refine healthcare calitins as utlined in the fllwing: Capability 1: Healthcare System Preparedness; Functin 1: Develp, refine, and sustain healthcare calitins; and Capability 10: Medical Surge; Functin 1: The healthcare calitin assists with the crdinatin f the healthcare rganizatin respnse during incidents that require medical surge. 11
The FY 2012 FOA als utlined a prcess fr staged develpment f healthcare calitins during the current HPP five-year prject perid. This staged apprach was based n initial assessment f the capabilities, functins, and assciated resurce elements f Capability 1, Functin 1. The fllwing utlines the three prpsed stages f healthcare calitin develpment: Stage 1: Determine reginal apprach and bundaries Establish awardee supprt and partnership Determine gvernance structure Establish the healthcare calitin fr purpses f preparedness thrugh apprpriate dcumentatin Stage 2: Maintain the abve healthcare calitin Stage 1 requirements thrugh sustainment and preparedness activities Perfrm preparedness activities as utlined in Capability 1: Healthcare System Preparedness Stage 3: Determine hw healthcare calitins will address multiagency crdinatin during respnse and perfrm reginal exercises t test this capability. Healthcare calitin multiagency crdinatin is utlined in Capability 3: Emergency Operatins Crdinatin and Capability 10: Medical Surge [Refer t Appendix B f this dcument fr a Summary Matrix f the federal guidance cntained in Healthcare Preparedness Capabilities, Capability 1: Healthcare Systems Preparedness and Capability 10: Medical Surge.] HPP Prgram Measures In recent years, ASPR/HPP has sught a means f accurately assessing verall natinal healthcare preparedness, as well as demnstrating awardee prgress in meeting the prgram's established gals and bjectives. The HPP Prgram Measures (frmerly referred t as "perfrmance measures") were develped t meet this need, prviding "critical infrmatin needed t assess and reprt n hw well this federal investment has imprved the natin's ability t prepare fr and respnd t medical emergencies." The Prgram Measures als cntain guidance fr healthcare preparedness calitin develpment including specific benchmarks and targets that align with the Healthcare Preparedness Capabilities and the Natinal Health Security Strategy (NHSS). In FY 2012, the perfrmance measures underwent realignment with the Natinal Health Security Strategy. As a result f this prcess, the initial set f eight perfrmance measures have nw been re-categrized under tw brad HPP Prgram Measures: Medical Surge and Cntinuity f Healthcare Operatins. The Medical Surge Prgram 12
Measure is intended t evaluate the increase in surge capacities and capabilities f awardees (e.g. states), healthcare calitins, and their member rganizatins fr preparedness, respnse, recvery and mitigatin activities. The Cntinuity f Healthcare Operatins measure is intended t assess the maintenance f vital public health and medical services t allw fr ptimal federal, state and lcal peratins in the event f a public health emergency. The successful cmpletin f the activities utlined in these Prgram Measures will ultimately enhance cmmunity resilience thrugh the cntinued delivery f essential healthcare services t the cmmunity pst-disaster, as well as establish a strng emergency respnse system that will prvide effective management fr surges f patients, deaths and cncerned citizens. The Prgram Measure refinement prcess has als resulted in the creatin f a Healthcare Calitin Develpmental Assessment Factrs Tl (HCCDA), which is intended t assess hw well healthcare calitins are functining within the Hspital Preparedness Prgram. The HCCDA was designed t assess: (1) the prcesses invlved in develping and frming a calitin; (2) hw calitins are functining t meet the gals and bjectives f HPP; and (3) the reliability f wrk plans and prgram indicatrs in mnitring prgress ver time. Fr mre infrmatin n the Prgram Measures, see the Hspital Preparedness Prgram Measure Manual: Implementatin Guidance fr the HPP Prgram Measures. Healthcare partners are encuraged t refer t these and ther federal resurce dcuments fr additinal guidance as the calitin develpment prcess cntinues. 13
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IV. State f Maryland Requirements and Recmmendatins fr Reginal Healthcare Preparedness Calitins A. Organizatin and Structure Maryland's healthcare preparedness calitins are nt limited t a particular type f rganizatin r structure. The calitin may functin as a cmpnent f a larger rganizatin, r be incrprated int a pre-existing planning bdy (e.g. a reginal EMS calitin). Alternatively, reginal partners may chse t develp entirely new rganizatins. Once the calitin is firmly established, partners may seek t incrprate as a nnprfit rganizatin [e.g. 501(c)(3) r ther designatin]. [Fr additinal guidance n this tpic, refer t Sectin IV. Guidance fr Future Calitin Develpment.] DHMH has determined that the five pre-defined health and medical regins recgnized by the state f Maryland will serve as bundaries fr the calitins. Fr the purpses f administering ASPR/HPP reginal funds fr healthcare preparedness, Regins I and II shall be cmbined int ne regin and be served by a single reginal calitin. Therefre, DHMH fficially recgnizes fur (4) healthcare preparedness calitins fr the state f Maryland [see Figure 1]. Figure 1. Reginal Healthcare Preparedness Calitins in Maryland 15
B. Leadership The healthcare calitin must have a clearly defined, dcumented gvernance structure. There are varius types f leadership arrangements that may be emplyed, depending upn the needs f the calitin. Examples f viable leadership structures include, but are nt limited t: President, Vice-President, Secretary, etc. Chair (with r withut Vice Chair) C-Chairs Executive Cmmittee r Cuncil Executive Directr (with Bard f Directrs) DHMH recmmends that calitin leaders be elected by a majrity vte f the membership. Electin f leaders shuld be cnducted accrding t frmally agreed upn prcedures and shuld take place at set, regular intervals. Because these calitins are intended t fster cmprehensive healthcare system preparedness, DHMH strngly recmmends that the executive r mst senir calitin leader be selected frm amng healthcare system representatives (excluding public health). Examples f a senir level leadership psitin include Chair, President, r Executive Directr. If the calitin pts t frm an Executive Cuncil, that bdy must cntain healthcare system representatin. Fr calitins that pt t use C-Chairs, DHMH strngly recmmends that ne f them be selected frm amng healthcare system representatives. [Fr the purpses f this Framewrk, the term "healthcare system" refers t all agencies, rganizatins and facilities that prvide healthcare within a specified gegraphic area nt just hspitals. This includes Cmmunity Health Center/FQHCs, DHMH State Facilities, and lng-term care/skilled nursing facilities.] C. Membership and Vting Rights Membership The ASPR Healthcare Preparedness Capabilities dcument indicates that the rle f healthcare calitin members is t prvide input fr preparedness and ensure the prper crdinatin f respnse and recvery activities. Primary r cre membership in the calitin is dependent t a certain extent n hw the calitin is rganized. Regardless f a calitin's structure r vting arrangements, membership shuld reflect thse partners wh are essential t ensure the prper crdinatin f preparedness, respnse and recvery activities fr the entire regin. This includes all relevant cmmunity healthcare and respnse rganizatins and stakehlders. The fllwing are examples f essential preparedness partners that shuld be represented in healthcare calitin membership: 16
Acute care hspitals Cmmunity Health Centers/FQHCs Cre Service Agencies (cmmunity mental/behaviral health) DHMH (as nn-vting members) DHMH State Facilities Fire Departments Lcal Area Agencies n Aging Lcal EMA Lcal EMS Lcal public health Lng-term care prviders Maryland Hspital Assciatin (as nn-vting members) State f Maryland reginal EMA (MEMA) Reginal EMS (MIEMSS) Because each regin in Maryland is unique, each has its wn particular preparedness challenges and cnsideratins. Healthcare calitins are encuraged t seek active participatin frm additinal cmmunity partner rganizatins and subject matter experts (SMEs) as relevant fr their respective regins. Examples f these additinal rganizatins include: Cmmunity-based and Faith-based rganizatins (CBOs, FBOs) Federal entities Lcal law enfrcement Primary care prviders Private and/r nn-gvernmental rganizatins Public Wrks Specialty service prviders (e.g. dialysis, pediatrics, wman's health, urgent care) Supprt service prviders Vluntary Organizatins Active in Disaster (VOAD) Vlunteer medical rganizatins (e.g. American Red Crss) The state rle in healthcare calitins is t frm a partnership with and prvide supprt fr healthcare rganizatins in the effrt fr multiagency crdinatin. The multidisciplinary cmpnent is ne f the mst essential aspects f the healthcare preparedness calitins. Having a diverse set f partners allws fr mre cmprehensive and effective planning and preparedness effrts. Vting Rights Reginal healthcare calitins shuld have a frmal decisin-making prcess that allws fr direct input f members and member rganizatins. Fr purpses f preparedness planning and decisin making with regard t HPP grant-funded prjects and activities, DHMH recmmends ne vte per rganizatin/agency as a minimum requirement fr calitins. Fr example: 17
1 vte per each acute care hspital 1 vte per each Cmmunity Health Center/FQHC parent rganizatin 1 vte per regin n behalf f Cre Service Agencies 1 vte per regin n behalf f DHMH State Facilities 1 vte per regin n behalf f EMS 1 vte per regin n behalf f lcal Area Agencies n Aging 1 vte per each lcal health department (jurisdictinal) 1 vte per each Lng Term Care facility parent rganizatin 1 vte per State f Maryland reginal EMA rganizatin Alternatively, reginal healthcare calitins may chse a vting arrangement that includes a mix f vting and nn-vting members (fr example, a tw-tiered structure with "full members" wh have vting rights and "assciate members", wh participate in the calitin but d nt have vting rights). One f Maryland's healthcare preparedness calitins is unique in that its bundaries extend utside the state. DRHMAG, the Regin IV calitin, als includes partner rganizatins frm Delaware and Virginia (lcated at the nrthern and suthern ends f the Delmarva Peninsula). These entities wrk tgether acrss state lines n a daily basis; therefre, it is certainly apprpriate that they wuld cllabrate fr the purpses f reginal preparedness planning. Hwever, fr the purpses f decisin making n HPPfunding related matters, nly recgnized entities within the state f Maryland shuld be allwed t vte. Organizatins frm ut f state may nt participate in decisins regarding the allcatin f Maryland HPP funding. The status f vting members and any ther participatry requirements as they relate t vting members will be established by each healthcare calitin. Hwever, calitin vting arrangements fr the cnduct f HPP funding-related business are subject t DHMH apprval t ensure the apprpriate partner representatin in the decisinmaking prcess. DHMH encurages healthcare calitins t develp mre inclusive vting arrangements based n their particular reginal preparedness needs. Calitin leaders may find that granting participatin in the decisin-making prcess via vting rights fsters active invlvement frm a wider range f partners. D. Calitin Dcumentatin: Frmal Agreements ASPR's Healthcare Preparedness Capabilities guidance indicates that calitins must have a frmal, written dcument shwing the establishment f the rganizatin fr the purpses f emergency preparedness. Acceptable types f dcumentatin may include a frmal charter, a set f by-laws, memrandum f understanding (MOU) r agreement (MOA), an interagency agreement (IAA), r a frmal cntract. The dcument shuld include, at a minimum, the rules and guidelines fr participatin in the calitin, as well 18
as rles and respnsibilities f each member type r rganizatin. The chsen frm f dcumentatin must be apprved, enacted and signed (if applicable) by calitin member rganizatins. E. Rle f Reginal Crdinatrs As evidenced by the new Healthcare Preparedness Capabilities: Natinal Guidance fr Healthcare System Preparedness, ASPR's preferred apprach is nw ne f cllabrative planning, with reginal healthcare calitins playing a key rle. In respnse t this paradigm shift, DHMH OP&R established five (5) cntract psitins fr HPP Reginal Crdinatrs (fur reginal field placements, plus a Crdinatr Team Lead t be based at the main ffice in Baltimre). This sectin will describe the intended purpse and scpe f wrk fr the field-based Reginal Crdinatr psitins. Maryland's HPP endrses fur (4) reginal healthcare preparedness calitins, whse bundaries crrespnd t the state's designated health and medical regins. These calitins are: Regins I and II Health Care Cuncil Regin III Health and Medical Task Frce Delmarva Reginal Healthcare Mutual Aid Grup (DRHMAG) Regin V Emergency Preparedness Calitin [Regins I and II plan tgether and share a cllabrative calitin.] Each field-based HPP Reginal Crdinatr is assigned t wrk directly with a reginal calitin. The verarching purpse f the HPP Reginal Crdinatr psitin is t assist the Maryland HPP, reginal healthcare calitins, and participating partners with identifying and carrying ut the emergency preparedness gals and bjectives f each regin, as well as the state's verall gals. HPP Reginal Crdinatrs: Scpe f Wrk HPP Reginal Crdinatrs are full-time, cntract emplyees f the state f Maryland wh are based within lcal health departments. Placing the Reginal Crdinatrs ut in the field has distinct advantages. It allws the Crdinatrs t be mre visible and available t lcal level partners, which is key t facilitating cmmunicatin and building relatinships. Additinally, being placed in the field prvides greater pprtunities fr direct participatin in lcal and reginal preparedness planning and activities. A significant prtin f Reginal Crdinatrs' respnsibilities are assciated with the reginal healthcare preparedness calitins. It is DHMH's expectatin that the Crdinatrs will play a key rle in strategic planning, relatinship develpment, and prject management fr the calitins. They shuld be fully engaged in all aspects f the reginal planning prcess. The fllwing sectin describes activities that fall within the Reginal Crdinatrs' scpe f wrk. 19
1. Reginal Planning and Prject Management a. Prviding crdinatin t ensure reginal integratin f the Gvernr's Cre Gals fr preparedness, as well as the gals and bjectives f HPP fr Healthcare System Preparedness and CDC fr Public Health Emergency Preparedness (PHEP). b. Clse cllabratin with healthcare calitin partners in the planning, design, implementatin and evaluatin f HPP-funded reginal prjects and activities. c. Active, regular participatin in reginal healthcare calitin meetings, as well as meetings f lcal-level preparedness rganizatins (e.g. ESF-8, HERC, LEPC, etc.). e. Prviding crdinatin fr activities related t the cmpletin f jurisdictinal public health risk assessments and healthcare situatinal assessments. f. Assisting calitin leadership with the preparatin and submissin f yearly reginal funding applicatins. g. Assisting calitin leadership with meeting reginal grant reprting requirements and prgrammatic deadlines. 2. Inventry Management a. Maintaining a cmprehensive, accurate, and up-t-date inventry f reginal supplies and materials. b. Ensuring that reginal supplies and materials have apprpriate asset and prperty tags and are entered and tracked in the State's inventry management system. c. Ensuring that reginal supplies and materials are prperly stred and maintained fr ptimal use. 3. Training and Exercises a. Cllabratin with calitin partners t identify preparedness training gaps and needs thrugh review f risk assessments, gap analyses and imprvement plans. b. Assisting with develpment, cnduct and evaluatin f reginal drills and exercises in cllabratin with the DHMH Exercise Crdinatr and reginal partners. c. Assisting with crdinatin f reginal training events in cllabratin with the DHMH Training Crdinatr and reginal partners. d. Prmting training events t ensure that partners are aware f available reginal and state-level training pprtunities. 20
4. Prcurement and Expenditure Tracking a. Clse cllabratin with calitin leadership, OP&R's Prcurement Officer, and HPP staff t submit reginal prjects and purchases fr prcessing thrugh DHMH Prcurement. -ORb. Clse cllabratin with calitin leadership, designated reginal fiduciary agent, and HPP staff t prcess reginal prjects and purchases. c. Develpment f reginal spending plans in cllabratin with calitin leadership in rder t ensure apprpriate allcatin f funding and resurces. 5. Technical Assistance a. Prviding technical assistance t partners with cmpletin f HPP facility-level funding applicatins (giving instructins, answering questins, interpreting federal and state-level prgram guidance, etc.). b. Prviding technical assistance t partners with cmpletin f HPP facility-level Mid- and End-f-Year reprting requirements. 6. Emergency Respnse In the event f public health emergency r disaster, HPP Reginal Crdinatrs may be required t participate in the respnse effrt. The Crdinatrs d nt have a set, pre-designated rle in a respnse; rather, this psitin has the flexibility t perfrm multiple rles as assigned by DHMH, OP&R. The types f activities Reginal Crdinatrs may be asked t perfrm in a public health respnse include, but are nt limited t the fllwing: Serving as a reginal liaisn with healthcare and lcal public health in rder t facilitate cmmunicatin/infrmatin sharing amng reginal healthcare preparedness calitin members, respnse partners, and the State. Serving as a member f the DHMH OP&R Emergency Respnse Team. [Reginal Crdinatrs have been designated as emergency essential staff members.] Serving as a DHMH Liaisn Officer at the State Emergency Operatins Center (SEOC). F. Reginal Planning: Functins and Respnsibilities f Calitins Maryland's healthcare preparedness calitins, as recipients f HPP reginal grant award funding, have certain respnsibilities with regard t financial management, assets management, and reginal planning. The fllwing activities are t be undertaken by 21
the healthcare calitins in cllabratin with their respective Reginal Crdinatrs and designated reginal fiduciary agents, as applicable. 1. Grants Management: Fiduciary Respnsibilities Reginal healthcare calitin leaders (r their designees) will: a. Serve as pint f cntact with DHMH, OP&R fr administratin, management, and reprting related t HPP reginal grant awards. b. Cllabrate with HPP Reginal Crdinatrs t cnduct prcurement activities fr the calitin. c. Cllabrate with HPP Reginal Crdinatrs t mnitr activities supprted by HPP award funds, ensuring cmpliance with ASPR and DHMH requirements. d. Establish and maintain accunting systems and financial recrds t accurately track funds distributed and purchases made. 2. Reginal Resurce/Assets Management Reginal healthcare calitin leaders (r their designees) will: a. Cllabrate with HPP Reginal Crdinatrs t cnduct planning related t reginal resurce management. b. Cllabrate with HPP Reginal Crdinatrs t cnduct inventry assessments and mnitr supplies and materials purchased n an nging basis. Assciated tasks include the fllwing: Labeling f materials with DHMH prperty tags and HPP asset tags as apprpriate. Entering data n supplies and materials purchased with HPP funds int the state's inventry management system and tracking n an nging basis. c. Cllabrate with HPP Reginal Crdinatrs t maintain HPP supplies and materials, rtating items as applicable. This will ensure the ptimal shelf life and functinality f the items. 3. Reginal Preparedness Planning Healthcare calitin leaders will als be respnsible fr the cnduct f reginallevel planning activities. These include, but are nt limited t the fllwing: a. Develpment f lcal and state all-hazards and ESF #8 plans, including annexes t address specific healthcare delivery pririties (e.g. Medical Surge Management, Fatality Management, Cmmunicatins, etc.). 22
b. Cnducting healthcare system situatinal assessments t identify and priritize ptential threats, as well as identify the critical healthcare assets and essential services that are vital fr healthcare delivery. c. Participatin in reginal Medical Surge planning activities. In recgnitin f the fact that Maryland's existing healthcare preparedness calitins represent diverse ppulatins and gegraphic areas, calitin partners are encuraged t engage in sub-reginal planning as apprpriate t address their individual preparedness gals and bjectives. Calitins are encuraged t frm wrk grups r subcmmittees t address the needs and cncerns f particular sub-reginal areas. 4. Calitin Strategic Planning Strategic planning is a prcess that is cmmnly used t fster rganizatinal develpment. A frmal, written "strategic plan" is nly ne f the prducts f this prcess. A strategic plan describes an rganizatin and what it intends t achieve (i.e. gals, bjectives) within a given time frame usually three t five years and utlines strategies that the rganizatin will use t reach the stated gals and bjectives. Maryland's healthcare preparedness calitins are expected t engage in a frmal strategic planning prcess that includes the input and participatin f their membership. As part f the strategic planning prcess, healthcare preparedness calitins shuld cmplete the fllwing tasks, at minimum: Cmpse a missin statement fr the calitin that describes its verall purpse and verarching gal(s). Identify the primary r cre membership f the calitin ("stakehlders"). Identify the essential partners wh shuld als be invlved in rder fr the rganizatin t achieve its missin ("partners"). Develp a gvernance structure, with a clearly defined prcess fr calitin members t select and appint leadership. Clearly define the rles and respnsibilities f participating members, especially regarding disaster preparedness, respnse and recvery. Develp a strategy t engage healthcare system executives in calitin activities. Begin planning fr financial sustainment f the calitin beynd the availability f federal funding. The ASPR Healthcare Preparedness Capabilities and the HPP Prgram Measures bth cntain additinal detailed guidance n preparedness planning activities that are relevant fr healthcare calitins. 23
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V. Guidance fr Future Calitin Develpment At present, Maryland's healthcare preparedness calitins are still in a relatively early phase f develpment. Preparedness partners shuld refer t ASPR's three stages f calitin develpment (as utlined in Sectin II.B. f this dcument) t determine the benchmarks that have been met, and thse that their calitin has yet t attain. These stages can be bradly described as fllws: Stage One deals with activities related t establishing a calitin. Stage Tw addresses calitin sustainment and engaging in preparedness-related activities. Stage Three invlves sustaining preparedness activities and determining hw the calitin will address multiagency crdinatin during respnse. ASPR's Healthcare Preparedness Capabilities prvides additinal detailed guidance fr healthcare calitin develpment. Capability 1: Healthcare System Preparedness and Capability 10: Medical Surge are especially applicable fr rganizatins that are still in the earlier stages f develpment. [Fr a graphical summary f the guidance cntained in these tw capabilities, see Appendix B f this dcument.] Each healthcare calitin must take charge f its wn develpment prcess, accrding t the particular reginal preparedness gals and bjectives that have been identified. Hwever, it is DHMH's recmmendatin that calitins shuld have substantially met the requirements f a given stage f develpment befre mving ahead t address the next ne. This will allw each calitin t establish a firm fundatin and set a clear visin fr cntinued grwth. DHMH has set the target that all Maryland healthcare calitins shuld be addressing Stage 3 requirements by the end f the current HPP funding cycle (June 2017). A. Expansin f Calitin Membership Given that Maryland's healthcare preparedness calitins are still in the earlier stages f develpment, their membership may nt include all f the partners deemed essential fr ensuring the prper crdinatin f preparedness, respnse and recvery activities. Bringing all f the relevant cmmunity healthcare and respnse rganizatins and stakehlders t the planning table n a cnsistent basis can be a challenge. Calitins are encuraged t wrk as a grup t identify their primary stakehlders and essential partners based n the calitin's missin, cre services, and the area it represents. Calitins shuld create and implement a plan t engage these partners and encurage and facilitate their active participatin in reginal preparedness planning. B. Frmatin f Nnprfit Organizatins A number f healthcare calitin partners and stakehlders in Maryland have expressed interest in incrprating their rganizatins as nnprfit entities. There are a wide 25
variety f nnprfit types and classificatins; as such, it is beynd the scpe f this dcument t utline the benefits and drawbacks f each. Hwever, if calitins elect t seek legal status as nnprfit entities, the fllwing recmmendatins shuld be taken int cnsideratin. 1. Calitin Status: Establishment, Membership It is DHMH's recmmendatin that healthcare preparedness calitins shuld be firmly established prir t beginning the prcess f incrpratin as a legal nnprfit. Calitins shuld have a frmal, written dcument that demnstrates the establishment f the rganizatin fr purpses f emergency preparedness. [Fr additinal details, see Sectin III.D.] In additin, it is strngly recmmended that the full cmplement f essential preparedness partners and all necessary ESF #8 respnse rganizatins and stakehlder agencies be represented in calitin membership prir t beginning this prcess [see Sectin III.C.]. This is key t ensuring the prper crdinatin f preparedness, respnse and recvery activities. 2. Lcal Health Department Participatin in Nnprfits Given that lcal health departments are key preparedness planning and respnse rganizatins, it is essential that they be represented in the membership f reginal healthcare calitins. Hwever, given that lcal health department staff are emplyees f the State f Maryland, the ptential fr cnflict f interest (actual r perceived) may arise frm lcal health department participatin in private nnprfit rganizatins. DHMH has received specific guidance n this tpic frm the Office f the Maryland Attrney General. In rder t minimize the risk f inadvertent cnflict f interest arising frm participatin in the gvernance f nnprfit rganizatins, the fllwing measures are recmmended: a. Lcal health fficer psitin descriptins (State frm MS-22) may be amended expressly t authrize the health fficer r his/her designee t participate in the gvernance f the rganizatin. Suggested language may include: "With the apprval f the appinting authrity, the Health Officer (r his r her designated staff f the lcal health department) may represent the lcal health department and serve, withut cmpensatin, as an ex ffici member f the gverning bard f a bdy that has been designated as the lcal health planning agency fr a cunty, a lcal health 27
imprvement calitin, r ther private nnprfit cmmunity health rganizatin." b. The healthcare calitin's charter and by-laws shuld expressly prvide fr lcal health department representatin in the rganizatin's gverning bdy, and shuld indicate that the lcal health fficer (r his/her duly designated representative) shall serve withut cmpensatin in an ex ffici capacity. c. The lcal health fficer (r his/her duly designated representative) wh serves in the reginal healthcare calitin may wish t apprise the rganizatin that he/she is required t recuse him/herself frm deliberatins and decisins n any business matters (including but nt limited t prcurement, grants, cntracts, and hiring f persnnel) that wuld prvide a direct mnetary benefit t the lcal health department r its prgrams r staff. Further, the health fficer r his/her designee shuld be prepared t recuse him/herself frm deliberating and vting n such matters. d. Lcal health fficers may als wish t cnsult with the Maryland State Ethics Cmmissin t assure that any special circumstances specific t their participatin in the reginal healthcare calitin are in accrdance with the State's Public Ethics Law. C. Rle f Healthcare Calitins in Emergency Respnse As demnstrated by the review f existing rganizatins frm arund the cuntry, healthcare preparedness calitins vary widely with regard t their rles and functins in emergency respnse. Sme calitins have mre active, peratinal rles, with an rganizatinal structure and designated persnnel t supprt such activities. Other calitins have little t n actual functin as an rganizatin during respnse. Instead, they may simply be represented by prxy thrugh the auspices f anther agency (e.g. lcal health department). Given that Maryland's healthcare preparedness calitins are still relatively yung, the rle that they will serve in an emergency respnse is still being defined. It is necessary t take existing state rules and regulatins (i.e. the current peratinal envirnment) as well as federal guidance fr calitin develpment int accunt when cnsidering this issue. In Maryland, the authrity rests with lcal jurisdictins in an emergency respnse. Because ur calitins are reginal bdies that represent multiple jurisdictins, defining an peratinal respnse rle fr the calitins may nt be feasible. Hwever, it is essential that healthcare rganizatins have a vice in incident management decisins during a respnse. Thrugh rbust planning and prper crdinatin, this representatin can be ensured. 28
Healthcare preparedness calitins will be expected t serve tw main functins during an emergency incident: (1) Infrmatin Sharing, and (2) Resurce Allcatin. 1. Infrmatin Sharing The Healthcare Preparedness Capabilities dcument describes "infrmatin sharing" as the multijurisdictinal, multidisciplinary exchange f medical and public health related infrmatin and situatinal awareness amng healthcare system partners; lcal, state and federal levels f gvernment; and the private sectr. It is a prcess that is intended t fster the nging exchange f infrmatin t supprt an incident cmmn perating picture during emergency respnse. Healthcare preparedness calitins that receive HPP funds will be required t develp a crdinated Infrmatin Sharing Plan that cntains the fllwing: a. Prtcls fr healthcare rganizatins t prvide multiagency crdinatin f infrmatin t and frm the ESF #8 liaisn/incident management. b. Prtcls fr healthcare rganizatins t prvide and receive infrmatin abut the incident, the status f healthcare delivery in the cmmunity and the perating status f healthcare rganizatins, and healthcare rganizatin immediate resurce needs. The calitin's Infrmatin Sharing Plan shuld als identify the healthcare "essential elements f infrmatin" t be reprted and shared during respnse. [Fr additinal guidance n healthcare essential elements f infrmatin, refer t the Healthcare Preparedness Capabilities, Capability 6: Infrmatin Sharing.] Healthcare preparedness calitins shuld cnduct the necessary planning t determine hw they will perate during a respnse. This includes develping an ICS structure fr the calitin t supprt and facilitate infrmatin sharing. 2. Resurce Allcatin The secnd essential functin f healthcare preparedness calitins during an emergency respnse is resurce allcatin. Activities t supprt resurce allcatin during respnse begin prir t the nset f an emergency. Healthcare calitins shuld cnduct the necessary planning t ensure that resurces are allcated in the mst efficient and effective manner pssible. This includes the develpment f MOUs and resurce management plans; cnducting healthcare rganizatin resurce assessments that identify and priritize essential assets and services, and identify resurce gaps fr incident respnse; and establishing prcesses fr healthcare rganizatins t request and btain resurces during emergency respnse and recvery. 29