Regional Disaster Health Response System Frequently Asked Questions

ASPR aims to better address gaps in coordinated patient care during disasters through the establishment and maturation of a RDHRS. Building a RDHRS is one of ASPR’s four main priorities.

The primary objectives of the RDHRS are to:

• Improve bidirectional communication and situational awareness of the medical needs and issues of the response between health care organizations and local, state, regional, and federal partners;
• Leverage, build, or augment the highly specialized clinical capabilities critical to unusual hazards or catastrophic events; and
• Augment the horizontal (whole of community) and vertical integration of key stakeholders that comprise health care coalitions with readily accessible and clinical capabilities that are largely missing from the current configuration of such coalitions.
• Increase healthcare coalition participation to ensure that states and multi-state regions maintain accessible and response-ready clinical capabilities that are essential in disasters and public health emergencies.

No. Applicants must focus on a smaller, more specific, part of that overall system – building partnerships that are able to expand medical surge capacity, coordinate patient and resource movement, and mobilize highly specialized clinical professionals at a state and regional (multi-state) level. The NOFO will fund one demonstration site to identify issues, develop promising practices, and demonstrate the potential effectiveness of this part of the overall RDHRS concept.

Building a fully functional RDHRS is a major undertaking that will require ongoing investment outside of the Partnership for Disaster Health Response Cooperative ​Agreement.

This NOFO does not aim to establish the RDHRS in its entirety, but instead funds a demonstration project that will help identify issues, develop promising practices, and demonstrate the potential effectiveness and viability of this concept. A key role of the measured success and impact of this demonstration site will be used to inform future decisions regarding funding and expectations of partnerships. While it is not expected that the results of this demonstration site will be generalizable across the entire United States, quarterly meetings between recipients and the government may include discussion of generalizability, including technical approach and operational capabilities.

The ACS sets the standards for Trauma Center Designation. A Trauma Center (TC) is designated in one of two ways: (1) TC directly contacts the ACS Verification Program or (2) The State has passed laws for its own designation process and the designations are done at the State level. ASPR strongly encourages partnerships to include an ACS/COT designated Level 1 trauma center.

Eligible applicants are defined in the statutory authority for this cooperative agreement, section 319C-2 of the Public Health Service (PHS) Act (42 U.S.C. § 247d-3b), as amended. Unless a health care system can be described as “one or more hospitals”, “one or more other local health care facilities”, or “one or more political subdivisions” or “one or more states” or “one or more emergency medical service organizations”, then it is not an eligible entity and thus cannot be a primary recipient.

This NOFO focuses primarily on the maturation of regional-level medical surge and specialty clinical care in response; however, strong foundations at the state level are key components and therefore the required partnerships include primarily state-level entities. The eligibility criteria in the statute does allow for a partnership to consist of “one or more states” or “one or more political subdivisions”. In addition, involvement of regional partners is a desired component across all 5 required capabilities and will therefore be considered as part of the overall application’s review.

Of note, there is also an applicable funding preference that can be applied for demonstration of “Regional Coordination” as described here: “The partnership demonstrates how it will enhance coordination among the hospitals and designated trauma center and between other local health care facilities, including clinics, health centers, community health centers, primary care facilities, mental health centers, mobile medical assets, or nursing homes and includes a significant percentage (greater than 51%) of the hospitals and health care facilities within the geographic area served by such partnership.”

Should applicants partner with entities across state lines, letters of support from the partnering state’s State Office of Public Health/Health, State Trauma Advisory Council (or equivalent), or State Office of Emergency Medical Services are not required unless the partnership is meant to be encompassing of “one or more states” in their entirety. For example, if the partnership is intended to be inclusive of the whole state of New York and the whole state of New Jersey, then letters of support from both states’ required entities will be requested. However, if the state of New Jersey would like to include New York City in their partnership, letters of support for state entities in New Jersey are required while those in New York are not.

Regions are defined as multi-state entities, or entities that cross state lines, irrespective of HHS Regional boundaries.

This NOFO focuses primarily on the maturation of regional-level medical surge and specialty clinical care in response; however, strong foundations at the state level are key components and therefore partnerships include primarily state-level entities. Accordingly, emphasis should be put on regional-level and state-level capabilities. In addition, involvement of regional partners is a desired component across all five required capabilities and will therefore be considered as part of the overall application’s review.

Of note, there is also an applicable funding preference that can be applied for demonstration of “Regional Coordination” as described here: “The partnership demonstrates how it will enhance coordination among the hospitals and designated trauma center and between other local health care facilities, including clinics, health centers, community health centers, primary care facilities, mental health centers, mobile medical assets, or nursing homes and includes a significant percentage (greater than 51%) of the hospitals and health care facilities within the geographic area served by such partnership.”

The statutory authority requires three statements of assurance that are included in various areas within the NOFO. The first is to “prepare in consultation with the Chief Executive Officer and the lead health officials of the State, District, or territory in which the hospital and health care facilities in the partnership are located, and submit to the Secretary, an application at such time, in such manner, and containing such information as the Secretary may require.” The second is that the Secretary may not award a cooperative agreement to an eligible entity described in subsection (b)(1) unless the application submitted by the entity is coordinated and consistent with an applicable State All-Hazards Public Health Emergency Preparedness and Response Plan and relevant local plans, as determined by the Secretary in consultation with relevant State health officials.” The third is “an eligible entity shall, to the extent practicable, ensure that activities carried out under an award under subsection (a) are coordinated with activities of relevant local Metropolitan Medical Response Systems, local Medical Reserve Corp, the local Cities Readiness Initiative, and local emergency plans.”

The easiest way to fulfill all of the statutorily required assurance statements would be to include an attestation of all three requirements in the letter of support from the State Public Health/Health Office. If this is not a reasonable or feasible option for your partnership, there are other ways to fulfill this requirement. Only the first statement of assurance must come directly from the lead health officials in the state or territory; the other two can come from other appropriate parties (e.g. the primary applicant). If you seek to identify alternative means by which to fulfill the requirements, please request technical assistance from the program office.

Of note, there is no requirement for all key partners to provide equivalent statements of assurance in their letters of support. Each of the three statements of assurance need only be supplied once, so long as it is by the appropriate partner or official.

Due to the required partnerships and the statewide/regional focus of the cooperative agreement, ASPR strongly prefers that only one application be submitted per state. A primary goal of the cooperative agreement is to establish strong, statewide partnerships across health care, public health, emergency management, EMS, and other critical partners focused on specialized clinical care in disasters. Should a single state submit more than one application, it may suggest that the state was unable to obtain the collaboration necessary for the cooperative agreement objectives to be achieved.

Due to the required partnerships and the statewide/regional focus of the cooperative agreement, ASPR strongly prefers that only one application be submitted per state. A primary goal of the cooperative agreement is to establish strong, statewide partnerships across health care, public health, emergency management, EMS, and other critical partners focused on specialized clinical care in disasters. Ideally, all the required partners in a State will come together to decide on a single applicant.

Applicants must provide the following information:

• Project Overview: Applicants must provide a project narrative that includes an overview of their proposed project, along with a work plan/timeline, detailed description of the Partnership’s capabilities, and an evaluation and performance measurement plan.
• Partnership Documentation: Applicants will also need to provide:
• • MOAs/MOUs/partnership from statutorily required partners
  • Letters of Support from state Departments of Public Health/Health, Health Care Coalition leaders (or POC), state Trauma Advisory Councils (or equivalent), and the State Office of Emergency Medical Services.
  • A table describing required partners
  • CVs for key project personnel
• Budgetary Information:
  • Budget Narrative and Justification
  • Standard Forms – Application for Federal Assistance and Budget Information
  • Copy of applicant’s most recent indirect cost agreement, if applicable

ASPR will award additional points to approved applications that are able to demonstrate that the primary recipient in the partnership has the capability for ongoing, complex clinical management of patients requiring specialty expertise in (a) chemical; (b) radiation; (c) burn; (d) trauma; (e) high consequence infectious disease and/or (f) pediatrics.

As part of the project work plan, applicants should provide their proposed approach to all objectives and activities in:

• Capability 1: Build a Partnership for Disaster Health Response
• Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters 
• Capability 3: Increase Statewide and Regional Medical Surge Capacity
• Capability 4: Improve Statewide and Regional Situational Awareness
• Capability 5: Develop Readiness Metrics and Conduct an Exercise to Test Capabilities

ASPR provided Attachment C: Project Work Plan and Timeline as a suggested format for applicants to complete their work plan. Applicants must address all components included in the “objectives” and “activities” listed in Attachment C in their application. For example, an application should not only focus on one clinical specialty (e.g. pediatrics or infectious disease), when various clinical specialties are included in the objectives and activities.

Applications will be evaluated based on a four-step process:

• Initial Review: Applications will be reviewed to ensure they meet the administrative requirements. All applications that have the required components will be referred to an Objective Review Committee.
• Review by the Objective Review Committee: The Objective Review Committee will score the applications based on established Review and Selection Criteria as described in the NOFO.
• Application of Funding Preferences: ASPR will receive the scored applications and apply additional funding preferences as allowable under the authorizing statute and described above.
• Final Award by ASPR: ASPR will make the final award decisions. In making these decisions, ASPR will take into consideration 1) recommendations from the review panel, 2) reviews for programmatic and grants management compliance, 3) reasonableness of estimated cost to the government, and 4) likelihood that the proposed project will result in the benefits expected.

Each applicant will receive written notification of the outcome of the objective review process, including a summary of the expert committee’s assessment of the application’s strengths and weaknesses, and whether the application was recommended for approval. Applicants who are selected for funding may be required to respond in a satisfactory manner to Conditions placed on their application before funding can proceed. Letters of notification do not provide authorization to begin performance.

Additional information about the scoring system, including detail about funding priorities and preferences, is included in the notice of funding opportunity.

Each application will be reviewed in whole by three reviewers. The number of reviewers on the panel will be based on the number of applications expected.

Applications are due no later than September 20, 2021 at 11:59 p.m. ET. The Objective Review Committee and ASPR will commence review of the applications thereafter. Each applicant will receive written notification of the outcome of the objective review process, including a summary of the expert committee’s assessment of the application’s strengths and weaknesses, and whether the application was recommended for approval. Notification of award will be made no later than September 30, 20210, when the project period begins.

Applications will be scored according to the criteria set forth in the notice of funding opportunity. Depth and width of existing partnerships will be recognized through multiple aspects of the application, including but not limited to: the required MOAs/MOUs/partnership agreements and letters of support; demonstration of organizational capability of the partnership to complete the capabilities and objectives as required of the cooperative agreement; and any applied funding priorities and preferences.

Due to the 12-month project period, the strongest applicants will demonstrate existing partnerships and capabilities as described in the notice of funding opportunity.

While your overall budget will be reviewed as part of the application review process, there is no specific scoring criteria assigned to the designation of overhead rates that are applied to the cooperative agreement.

An arrangement to carry out a portion of the programmatic effort by a third-party or for the acquisition of goods or services is allowed under the cooperative agreement. Such arrangements may be in the form of sub awards (grants) or contracts. A consultant is a non-employee retained to provide advice and expertise in a specific program area for a fee. Accordingly, the costs for additional (optional) partners can be charged directly to the cooperative agreement so long as these participants are acting as an approved sub-recipient on the cooperative agreement.

The Budget Summary is used to determine reasonableness and allowability of costs for the project. All of the proposed costs listed, whether supported by federal funds or non-federal funds, must be reasonable, necessary to accomplish project objectives, allowable in accordance with applicable federal cost principles, auditable, and incurred during the budget period. Applicants must also briefly outline the scope of work, planned activities, and intended outcomes of work performed via sub-recipient contracts.

Applicants must designate an Executive Director and a Medical Director to act as leaders of clinical preparedness and response and neutral brokers among the partnership members and supporting organizations. The Executive Director and Medical Director position need not come from the same entity.

The Medical Director must meet or exceed the following qualifications:

• Physician with a current in-state license and demonstrated clinical experience.
• Board Certified in an American Board of Medical Specialties recognized specialty and clinically active.
• Familiarity with EMS, Emergency Management and Public Health laws and regulations.
• Education and/or experience with mass casualty, bioterrorism, nuclear, biological chemical, Weapons of Mass Destruction (WMD) and/or disaster preparedness.

While the position’s job responsibilities and salary are designed to encompass work of a .25 FTE, the expectation of the employer is not limited to a set number of work hours, but rather the completion of all necessary tasks to meet the objectives of the cooperative agreement that would naturally be attributed to the chief clinician.

State health departments and local health care coalitions are integral to disaster preparedness, response, recovery, and mitigation activities and ASPR is proud of the progress that the HPP and PHEP programs have made since their inception.

We recognize, however, that progress has not been achieved to the same extent across all health care preparedness and response capabilities. In particular, the medical aspects of disaster response (for example, those related to sharing strategic medical intelligence or to the complex medical management of large numbers of patients) have not been as well addressed.

The fiscal agent for this cooperative agreement is the primary applicant of the required partnership including one or more hospitals (including at least one designated trauma center), one or more local health care facilities, one or more political subdivisions and/or one or more States, or one or more emergency medical service organizations or emergency management organizations. The fiscal agent for this award could be any one of the entities described (e.g., a hospital, designated trauma center, a local health care facility, a political subdivision or state) applying on behalf of the partnership or a partnership or other legal entity consisting of all of the required members.

The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party or provider who is ineligible. The organizational capability statement should describe how the primary applicant agency and the required partner agencies are organized, the nature and scope of their work and/or the capabilities each possesses.

The Principal Investigator must be from the primary applicant that is also serving as the fiscal agent for this cooperative agreement (from among the required partners as defined in the statutory authority for this cooperative agreement, section 319C-2 of the Public Health Service (PHS) Act (42 U.S.C. § 247d-3b), as amended).

The Principal Investigator need not also serve as the Executive Director or Medical Director. The expectation of the employer is not limited to a set number of work hours, but rather the completion of all necessary tasks to meet the objectives of the cooperative agreement that would naturally be attributed to the Principal Investigator of a cooperative agreement.

Applicants must designate an Executive Director and a Medical Director to act as leaders of clinical preparedness and response and neutral brokers among the partnership members and supporting organizations. The Executive Director and Medical Director position need not come from the same entity.

While the job responsibilities and salary estimate of the Medical Director and Executive Director are designed to encompass work of a .25 FTE, the expectation of the employer is not limited to a set number of work hours, but rather the completion of all necessary tasks to meet the objectives of the cooperative agreement that would naturally be attributed to the chief clinician and chief executive.

Yes, grant funds may be used to cover costs of: personnel, consultants, equipment, supplies, grant-related travel, and other grant-related costs. The applicant is able to name and fill personnel positions as required to meet the objectives of the cooperative agreement, so long as they do not violate the funding restrictions listed in the NOFO.

Yes, grant funds may be used to cover costs of: personnel, consultants, equipment, supplies, grant-related travel, and other grant-related costs. The applicant is able to name and fill personnel positions as required to meet the objectives of the cooperative agreement, so long as they do not violate the funding restrictions listed in the NOFO.

Yes, the applicant is able to name and fill personnel positions as required to meet the objectives of the cooperative agreement, so long as they do not violate the funding restrictions as listed in the notice of funding opportunity. While the Principal Investigator must be from the primary applicant that is also serving as the fiscal agent for this cooperative agreement, any Co-Investigators need not be.

Designation of the Executive Director and Medical Director is at the discretion of the partnership. The Executive Director and Medical Director must, however, meet the qualifications and requirements set forth in the notice of funding opportunity.

All required partners must submit a memorandum of understanding, memoranda of agreement, partnership agreement, or other similar agreement that can be used to describe performance expectations.

The funded programs would be expected to respond to an actual emergency as appropriate for existing state and local plans. Should recipients use demonstration project mechanisms in an actual response, a prior approval request for any redirected funds must be submitted. All redirects must be within scope of the approved project activity and budget. Decisions are made on a case by case basis.

The PI/PD is generally an employee of the award recipient (in this case the primary recipient). If the PI/PD is not an employee of that organization, you must provide a formal written agreement between the PI/PD and the primary recipient that specifies an official relationship between the parties even if the relationship does not involve a salary of other form of remuneration. If the PI/PD is not an employee of the applicant organization, the program office will assess whether the arrangement will result in the organization being able to fulfill its responsibilities under the cooperative agreement, if awarded.

Accordingly, in addition to the formal written agreement, the program office will do a thorough review of the PI's curriculum vitae or biosketch to ensure that the arrangement will allow the organization and the PI to fulfill their respective responsibilities under the award. Please also be sure to consider whether the PI is able to make fiduciary decisions related to the cooperative agreement if he is not an employee of the primary recipient, as it may be helpful to clarify in the formal written agreement who specifically will be responsible for that role.

You can also refer to the Grants Policy Statement link in the NOFO for additional guidance.

With the application package, applicants must submit a Curriculum Vitae (CV) or biosketch of Key Personnel, including that of the Executive Director and Medical Director, as well as of any technical consultants that are essential to the execution of this cooperative agreement.

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

Each CV or biosketch should be no more than 5 pages each, and while there is no required format, CVs or biosketches should be double-spaced, on 8 ½” x 11” plain white paper with 1” margins on all sides, and a font size of not less than 11.

CVs or biosketches should clearly convey the required qualifications of the position (if defined in the notice of funding opportunity) and/or any specialized expertise and experience that enables the personnel to complete the assigned roles and responsibilities under the cooperative agreement.

To ensure that state health departments and health care coalitions, specifically, are included, ASPR requires letters of support from State Public Health/Health Departments and health care coalition leaders (or points of contact) be submitted with the application package.

HPP supports regional health care system preparedness, though not necessarily though the development of a RDHRS. The capabilities included in this NOFO are designed to be complementary to the HPP capabilities but emphasize the clinical coordination aspects of disaster response.

To ensure that health care coalitions, specifically, are included ASPR will also require letters of support from health care coalitions to be submitted with the application package. Additionally, regional coordination – demonstrating the ability to coordinate among greater than 51% of the health care facilities and hospitals in the geographic area served by the partnership – is specified as a funding preference in the authorizing legislation. This qualification may be demonstrated, for example, by the submission of letters of support from a majority or all of the healthcare coalition leaders (or POC) in the state.

The HHS RDHRS cooperative agreements are separate and distinct from the DHS Metropolitan Medical Response System (MMRS) grants. However, conceptually the two programs share certain elements. For example, RDHRS aims to ensure that local health care systems and facilities are included in and influence state- and regional-level disaster planning and response efforts. Like MMRS, RDHRS aims to bring together various elements of emergency response, including health care, public health, emergency management, EMS, and specialty expertise in areas such as chemical, biological, pediatric, and infectious disease readiness.

Furthermore, the authorizing statutory language for this award states that “recipients shall, to the extent practicable, ensure that activities carried out under this award are coordinated with activities of relevant local Metropolitan Medical Response System (MMRS), local Medical Reserve Corps (MRC), and the Cities Readiness Initiative (CRI)” and the Memorandum of Understanding (MOU) or Letter of Support from the State, Territory, or directly funded metropolitan area public health agenc(ies) participating in the partnership must include a statement of assurance to this effect.

The health care coalitions (HCCs) funded by HPP serve as collaborating and responding entities that bring together hospitals, EMS, public health, emergency management, and other partners. Together, the HCC examines the region’s hazards and threats via a hazard vulnerability analysis, conducts a gap analysis, and engages in joint planning, training, exercising, and equipment acquisition. The HCC plans for and responds to hazards that can compromise the ability to provide care such as utility failure. The HCC also tries to prevent future surges of patients by acting to mitigate a disaster. The HCC also works on patient distribution and tracking. In short, the HCC exists to ensure the medical system impact from a disaster is mitigated or kept to a minimum, and that existing patients and new patients resulting from emergencies can receive high quality care at an appropriate facility.

The RDHRS will be built on a tiered regional framework that emphasizes the collaboration among local health care coalitions, trauma centers, public and private health care facilities, and emergency medical services to expand access to specialty care expertise and increase medical surge capacity.

The primary objectives of the RDHRS are to better coordinate across local, state, regional, and federal health care response assets (including to help coordinate across HCCs); improve bidirectional communication and situational awareness of the medical needs and issues in response; identify and further develop the highly specialized clinical capabilities critical to unusual hazards or catastrophic events; and increase health care sector participation in preparedness efforts.

Given the role of health care coalitions as the foundation of the RDHRS, there must be collaboration between this cooperative agreement and the state’s Hospital Preparedness Program and its associated HCCs.

While it is certainly acceptable, it is important to note that the HCC requirements for the HPP cooperative agreement must still be accomplished thoroughly and in a timely manner. If the HCC Coordinator has additional time to dedicate to the demonstration project, serving in both roles is acceptable.

There will be a dedicated project officer for the RDHRS demonstration sites. However, all 11 ASPR-HPP Field Project Officers (FPOs) serve as invested stakeholders in the success of RDHRS demonstration sites. The FPO in the selected recipient’s region will serve as a primary touch point in coordinating health care preparedness and response activities.

Grant funds may be used to cover the costs of personnel, consultants, equipment, supplies, grant-related travel, and other grant-related costs.

Please refer to the NOFO for a complete list of funding restrictions.

ASPR is not designating a specific percentage of funding for management and admin costs. The Budget Summary is used to determine reasonableness and allowability of costs for the project. All of the proposed costs listed, whether supported by federal funds or non-federal funds, must be reasonable, necessary to accomplish project objectives, allowable in accordance with applicable federal cost principles, auditable, and incurred during the budget period.

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

The purpose of this NOFO is to fund one demonstration project that will help identify issues, develop promising practices, and demonstrate the potential effectiveness and viability of the RDHRS concept. Specifically, the Partnership will implement and demonstrate the 5 specific capabilities listed in the NOFO, each with a number of associated objectives and activities. Accordingly, funding for this NOFO is meant to implement a demonstration project rather than conceptualize a concept.

Grant funds may be used to cover costs of: personnel, consultants, equipment, supplies, grant-related travel, and other grant-related costs. Applicants should include personnel costs in the required Budget Narrative/Justification as shown in Attachment B.

All costs directly related to the Partnership for Disaster Health Response Cooperative Agreement Notice of Funding Opportunity project activity and within scope of the approved budget that are consistent with the statutory authority for this award (section 319C-2 of the PHS Act, as amended) and applicable regulations including the Cost Principles in 45 CFR. Part 75, subpart E may be charged directly to the cooperative agreement. “Reimbursable expenses” are only paid through the subcontract cost category of the budget and such expenses are direct charges to the cooperative agreement. Attachment B “Budget Narrative/Justification - Sample Format” provides example and definitions of the cost categories.

Applicants may reference Attachment B “Budget Narrative/Justification - Sample Format” and Attachment C “Project Work Plan and Timeline - Sample Template” for guidance in preparing their budgets.

Recipients must submit a prior approval request to redirect funds. All redirects must be within scope of the approved project Activity and Budget. Approval decisions for the redirection of funds are made on a case by case basis.

Recipients are expected to use all awarded funds for the approved project Activity and Budget.

There is not a cap on Personnel support funding or number of personnel.

Travel costs for partners, sub-contractors and sub-recipients of the Partnership for Disaster Health Response Cooperative Agreement Notice of Funding Opportunity award to participate in site visits are allowable as direct costs to the cooperative agreement provided the recipient has policies and procedures for site visits and travel of personnel and such costs are in the approved budget.

Applicants may reference various tools via the internet to determine the labor market rate for professions. ASPR does not endorse any internet tools. Applicants may also reference the Bureau of Labor and Statistics for compensation ranges.

Yes. Applicants are encouraged to demonstrate their organizational capacity of executing the tasks provided in the Partnership for Disaster Health Response Cooperative Agreement Notice of Funding Opportunity.

Yes. Such tasks must support the Partnership for Disaster Health Response Cooperative Agreement Notice of Funding Opportunity as detailed in the proposed budget.

Yes. Admin assistant/support must be included as personnel of the applicant or partnership.

Funds are only allowable for Project related costs. Should a Steering Committee be established to support, for example, the requirements under Capability 1, Activity 2 to “Propose an overall governance structure for the Partnership, including the roles and responsibilities of all participating entities and organizations,” “convene Partnership members in person at least quarterly,” and “Identify and document governance promising practices” it may be considered an allowable cost.

There are multiple ways to compensate consultants or sub-contracts under this award, and we recommend that you seek additional technical assistance from the program office by con​​tacting Jennifer.Hannah@hhs.gov to ensure the establishment of a “permanent” position is allowable.

There is no cost sharing or match requirement for this project. This project does include maintenance of effort requirement as specified in section 319C-2(h).

• In general, an entity that receives an award under this section shall maintain expenditures for health care preparedness at a level that is not less than the average level of such expenditures maintained by the entity for the preceding 2-year period.
• Rule of construction: Nothing in this section shall be construed to prohibit the use of awards under this section to pay salary and related expenses of public health and other professionals employed by State, local, or tribal agencies who are carrying out activities supported by such awards (regardless of whether the primary assignment of such personnel is to carry out such activities). SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanisms, at a rate in excess of Executive Level II.

Applicants are expected to budget for requested funds within the solicited period of performance. Recipients can contact the awarding agency for technical assistance during the period of performance. The recipients are also allowed and encouraged to establish contractual relationships in order to secure the subject matter and technical expertise needed to achieve the cooperative agreement objectives. No cost extensions require prior approval; are requested in the last year of the period of performance; are requested when the recipient cannot complete their approved project activity within the period of performance and cannot be requested to expend funds.

Understanding that many of your institutions consider MOUs to be binding legal documents, we will also accept MOAs or partnership agreements in place of the MOU. The MOU should be between the primary applicant (in other words the organization that the PI comes from) and the partner organization – ASPR need not be named.

The MOUs (or MOA or partnership agreements) should be specific to this award and detail the roles and responsibilities of each partners in conducting the work needed to meet the objectives of this cooperative agreement.

The names of individuals need not be named in the MOUs and position titles and organization names may be used instead.

Applicants may request funding that does not exceed the ceiling award amount of $3 million.

The $3 million budget includes both direct and indirect costs. Indirect costs can only be claimed on federal funds, more specifically, they are to only be claimed on the federal share of the award. For instance, an applicant may charge the approved negotiated rate for indirect costs to a federal share of $3 million. If indirect costs are to be included in the application, a current copy of the approved indirect cost agreement must be included in the application. Further, if any subcontractors or sub-recipients are requesting indirect costs, copies of their most current indirect cost agreements must also be included with the application. Otherwise, applicants may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) which may be used indefinitely. Costs must be consistently charged as either indirect or direct costs but may not be double charged or inconsistently charged as both. If chosen, this methodology once elected must be used consistently for all federal awards until such time as the recipient decides to negotiate for a rate.

The NOFO will fund one non- research cooperative agreement.

In general, an entity that receives an award under this section shall maintain expenditures for health care preparedness at a level that is not less than the average level of such expenditures maintained by the entity for the preceding 2 year period.

These expenditures encompass all funds spent by the entity for health care preparedness regardless of the source of funds. The recipient will be required to report on maintenance of effort upon receipt of the award. Maintenance of effort activities will not include those already being reported on under the Hospital Preparedness Program and Public Health Emergency Preparedness Program cooperative agreements.

To be eligible for funding under this announcement, the entity must demonstrate in the budget narrative that they intend to budget at least, and not less than, the average of their FY 19 and FY 20 total spending for health care preparedness. See the example below:

MAINTENANCE OF FUNDING: EXAMPLE

STATE EXPENDITURES - HEALTH CARE PREPAREDNESS

FOR FY 21, STATE X SHALL MAINTAIN EXPENDITURES FOR HEALTH CARE PREPAREDNESS OF AT LEAST $4,850,000.

No cost extensions require prior approval. A recipient may request a no cost extension 10 days towards the end of the period of performance for the purpose of completing the project activity.

Recipients must comply with the Uniform Administrative Requirements, Cost Principles, and Audit requirements in 45 CFR Part 75. These regulations address financial management and standards for financial management systems (45 CFR 75.302) and performance and financial monitoring and reporting (45 CFR 75.341-343), among other things. Recipients are required to submit to ASPR an annual Federal Financial Form (SF-425) reflecting authorized funding and expenditures. In addition, recipients must report cash disbursements quarterly to the Division of Payment Management Services (DPMS).

States and non-federal entity’s financial systems must be sufficient to permit the preparation of reports required by general and program-specific terms and conditions; and the tracing of funds in accordance with Federal statutes, regulations and the terms and conditions of the federal award.

The initial budget request is considered the approved budget of record for recipients. Prior approval is required for change of scope, significant budget revisions of 25% or more of the total award and change in key personnel. Recipients may submit a revised budget at any time during the period of performance via a Grant Note in GrantSolutions.

A federally approved negotiated indirect cost rate agreement provides an indirect cost rate that is used when calculating proposed indirect costs for an application.

The negotiated indirect cost rate agreement must be conducted by a cognizant federal agency. Applicants may refer to the HHS Program Support Center for detailed information on negotiated indirect cost agreements and cost allocation plans.

Any non-federal entity that has never received a negotiated indirect cost rate, may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) which may be used indefinitely or until a federal agency negotiates an indirect rate agreement.

Yes. Applicants may use the 10% de minimis rate of 10% for sub-contracts that do not have negotiated indirect cost rate agreement.

Non-federal entities with a negotiated indirect cost rate agreement (NICRAs) that wish to use lower rates than their NICRA may provide a description of the basis for the rate they are requesting to use for this award.

Applicants intending to apply subcontracts to their proposals must comply with 45 CFR 75 federal procurement provisions 45 CFR 75.326; competition 45 CFR 75.328; and procurement procedures 45 CFR 75.329. Effective 6/20/18, the threshold for micro-purchases is $10,000 and $250,000 for simplified acquisitions. Under the micro-purchase procurements with federal award funds (e.g. 45 CFR 75.329(a)), the purchases at or under the established threshold may be awarded without soliciting competitive quotations.

There are two primary methods of selecting a subcontractor: sole/single source selection or competitive bidding. A detailed justification is required with the proposal for all types of procurements.

1. Single or Sole Source Selection is most common in projects where a recipient/prime wishes to collaborate with an identified organization offering unique expertise or facilities. Single and Sole Source selections require ASPR prior approval and a written agreement on letter with dual signature from the Authorizing Official Representative (AOR) and Project Investigator (PI).
2. 1. Single source selection occurs when a Subcontractor is a preferred Subcontractor for completion of the Statement of Work which may be available from more than one source, but for reasons of location, price, Facilities, availability, etc., one of the qualified Subcontractors is preferred over the others.
   2. Sole source selection occurs when a project requires performance from one particular Subcontractor for completion of the Statement of Work which cannot be obtained from any other source. Sole source selection in the second scenario is not justified simply by the fact that there has been continuing collaboration between organizations. A sole source justification in these situations must be further justified with respect to the unavailability of the services or expertise from other sources. 
3. Competitive bidding is often used as the method of Subcontractor selection when purchasing goods or services or when the recipient does not have a preferred Subcontractor in mind either at the time of proposal or post award. This method requires the recipient to solicit proposals make a final Subcontractor selection from those responding based on technical merit and cost objectives. This may be based on a combination of price and qualifications.

Cost Reimbursement agreements are generally the means used for payment to contracts for allowable, allocable and reasonable costs incurred during the period of performance of the contract. However, recipients have the discretion to utilize fixed price subcontracts agreements and may consult 45 CFR 75.329 for procurement procedures.

Recipients are required to submit three types of reports:

• Quarterly Progress Reports: The recipient will be required to submit quarterly progress reports, including an End of Year report using an ASPR-provided template.
• Exercise Reports: The recipient will also be required to submit an After Action Report and Corrective Action Plan as a result of their required exercise.
• Evaluation and Performance Management Plan and Report: The recipient is asked to create an Evaluation and Performance Measurement Plan that describes how they will evaluate progress, and whether the identified outcomes have been achieved. To guide this process, ASPR has provided 7 performance metrics in the NOFO. These performance measures are separate and different from the “readiness metrics” that the applicant is asked to develop under Capability 5 of the award.

The following performance measures are included as reporting requirements (see NOFO section Reporting Requirements/Performance Measures):

• The Partnership demonstrates clearly defined, cooperative, and ongoing relationships to accomplish its mission with the required partners, supporting organizations, additional partners, and with local, regional, and/or state public health agencies and emergency management agencies
• The Partnership has identified critical clinical capabilities and gaps in existing disaster plans, aligned existing coalition and state response plans to facilitate coordinated
• The Partnership has improved medical surge capacity and capability
• The Partnership has developed a comprehensive statewide or regional situational awareness (SA) capability that integrates medical resources in order to improve early detection of, response to, and clinical management of all public health and medical emergencies
• The Partnership develops and implements readiness metrics for peer review assessments, monitoring, recognition reporting, and a “Response Ready” designation program
• The Partnership conducts at least one readiness exercise during the project period that measures the readiness of the coalitions’ surge capacity and demonstrates the ability to coordinate health care service delivery at the statewide or regional (i.e. multistate) level
• The Partnership has submitted timely and complete data for the required reports (quarterly progress and end of year reports)

Partnerships shall maintain all documentation that substantiates the answers to these measures (site visits, surveys, exercises, etc.) and make those documents available to federal staff as requested during site visits or through other requests. The required mid-year and end-of-year reports should also include status updates related to these performance measures.

The recipient will be required to submit quarterly progress reports, including an end of year report using the template provided in Attachment E. This template requests that the recipient also “include as attachments any supporting documents to demonstrate completion or success of the deliverable.” 

The recipient will be required to submit an annual After Action Report and Corrective Action Plan as a result of the exercise conducted as part of Capability 5 using the templates in Attachments F and G, respectively.

Further, for monitoring purposes, the primary recipient must allow the Project Officer access to any documentation requested.

ASPR recognizes that some of the data provided by the recipients will be business-sensitive. In general, ASPR does not disclose such information to the public unless required by the law. While we cannot guarantee that all submitted data will be confidential, any HHS- or ASPR-derived reporting will, where possible, use de-identified and aggregated information to convey general trends, promising practices, and findings.

The notice of funding opportunity provides general formatting requirements for the application submission but has omitted some specific requirements as follows: please use 1” margins at the top, left, right, and bottom of the Project Narrative submission; page numbers, footnotes, running heads, and other information that is generally located in the header or footer of the page may be placed in the margins; any citations should be collated and attached as an appendix that does not count toward the 12 page limit; you may use any citation style (e.g. APA, AMA, MLS, etc.) but please use the same style throughout the submission.

When you prepare your application, do not number the Table of Contents page, begin with the number 1 after this page, and proceed with the numbering until the very end of your application including the Appendix pages. Please contact ASPR Grants Management (asprgrants.@hhs.gov) if you have direct questions about your application.

No. If you choose to fill out and submit Attachment C, it will not count toward the 12-page limit. However, any narrative drafted to accompany Attachment C and fulfill the required “Work Plan and Timeline of Proposed Activities” section of the project narrative will be included in the 12 pages.

The RDHRS structure is conceptualized as a tiered system that builds upon the existing Medical Surge Capacity and Capability (MSCC) foundation for local medical response (e.g. trauma systems and HCC s) by enhancing coordination mechanisms and incorporating discrete clinical and administrative capabilities at the state and regional levels. At the state level, RDHRS specifically aims to establish more robust situational awareness of health care system capability and capacity, coordination and prioritization mechanisms for patient transfers, process and policy for resource management, and access to clinical specialists in areas such as pediatrics, trauma and burn care, and infectious disease. The maturation of these capabilities will better enable states to respond to health care crises within their geographic boundaries and increase their ability to support resource requests from other states.

It is an expectation of this cooperative agreement that applicants will demonstrate the partnerships necessary to build and/or deploy the aforementioned capabilities across the entire state, and not just in one specific town, city, county, or sub-state region.

Letters of support from the following statewide agencies are required as part of the application:

• State Offices Public Health/Health
• Health care coalitions leaders (or points of contact) in the state
• State Trauma Advisory Council (or equivalent)
• State Office of Emergency Medical Services

Furthermore, according to the statutory requirements, the Secretary may not award a cooperative agreement to an eligible entity unless the application submitted by the entity is coordinated and consistent with an applicable State All-Hazards Public Health Emergency Preparedness and Response plan and relevant local plans.

Funding preference is able to be applied for applicants that can demonstrate the ability to coordinate among greater than 51% of the health care facilities and hospitals in the geographic area served by the partnership.

It is important to note that the directly funded cities through HPP (New York City, Chicago, and LA County) are not considered states for the purposes of this NOFO. If they wish to apply, they must coordinate with their states, New York State, Illinois, and California.

As part of the project work plan, applicants should provide their proposed approach to all objectives and activities in:

• Capability 1: Build a Partnership for Disaster Health Response
• Capability 2: Align Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters
• Capability 3: Increase Statewide and Regional Medical Surge Capacity
• Capability 4: Improve Statewide and Regional Situational Awareness
• Capability 5: Develop Readiness Metrics and Conduct an Exercise to Test Capabilities

ASPR provided Attachment C: Project Work Plan and Timeline as a suggested format for applicants to complete their work plan. Applicants must address all components included in the “objectives” and “activities” listed in Attachment C in their application. For example, an application should not only focus on one clinical specialty (e.g. pediatrics or infectious disease), when various clinical specialties are included in the objectives and activities.

Listing the projected cost to be spent for consultants per activity will be sufficient.

On or before September 30, 2021

The funds will be available to the primary recipient at the start of the project period, September 30, 2021.

Yes, the primary recipient is expected to serve as the fiduciary for the cooperative agreement.

There are fillable templates available on the Grants.gov webpage for this notice of funding opportunity.

The plan gap analysis should be conducted for the home state of the partnership. Efforts to scale the effort across any additional partner states will be appreciated but not required.

The measured success and impact of the current Partnership demonstration projects will be used to inform future decisions regarding funding and expectations of partnerships. Additional demonstration projects may be supported in the future. Applicants who are successful in obtaining awards under this solicitation will be eligible to compete for additional demonstration project awards, should funding be available. As with all federal grants future offerings are dependent on the availability of appropriated funds in subsequent fiscal years and a decision that funding is in the best interest of the Federal government.

Please contact hpp@hhs.gov for specific questions about eligibility as a required partner that are not already covered in this FAQ page.

The required exercise should be at minimum a tabletop; operations-based, functional, or full-scale exercises are preferred.

The notice of funding opportunity lists required meetings and training opportunities for the recipients. Questions about additional trainings and workshops can be directed to the ASPR program staff.

No, Attachment C is meant to be a guide specifically to the work plan. It includes a budget column to help ensure that applicants appropriately account for all activity expenses in Attachment B, which is the authoritative document for budget allocations. We recognize that there will be some activities that are very difficult to develop precise accounting for; in those cases, you can use N/A or $0 designation (as applicable) or simply refer the reviewer to Attachment B.

ASPR will not provide legal technical assistance in connection with this award. There are non-federal entities that provide legal assistance to public health officials such as the Network for Public Health Law.

The measured success and impact of the current Partnership demonstration projects will be used to inform future decisions regarding funding and expectations of partnerships. Additional demonstration projects may be supported in the future. Applicants who are successful in obtaining an award under this solicitation will be eligible to compete for additional demonstration project awards, should funding be available. As with all federal grants, future offerings are dependent on the availability of appropriated funds in subsequent fiscal years and a decision that funding is in the best interest of the federal government.