Hospital Association COVID-19 Preparedness and Response Activities Cooperative Agreement FAQs

The topics areas for metrics will focus on both assessing the efficacy of the program and measuring preparedness, readiness, and response capabilities. It is ASPR's fiduciary responsibility to ensure this funding is used by recipients in accordance with the intent established by Congress, and the metrics will work to measure this. The metrics will also focus on the accomplishments with funding (e.g., whether the funding has improved surge capacities, whether funding reaches the health care facility and community level). This funding was not intended for testing or other supplies directly in clinical care or research; however, PPE is an appropriate use of funding.

Yes. The Notice of Funding Opportunity (NOFO) includes conceptual performance measures (quantitative and qualitative) that ASPR is currently considering. ASPR will provide recipients with the final performance measures.

Hospital association will access and use the cloud-based data reporting platform. Sub-recipients will report the data to the hospital associations via a web form, and then hospital associations will review this information before submitting to ASPR.

Yes. ASPR will provide a web form for sub-recipients to report their data to hospital associations. Hospital associations will review, validate, and submit to ASPR all data that sub-recipients submit to them. ASPR is also considering additional options hospital associations may use to collect data from sub-recipients, which would allow the hospital associations to enter data into the platform on behalf of the sub-recipients. Additional information will be forthcoming.

This cooperative agreement has high visibility at many different levels, including the congressional level, and is an attempt to deliver financial assistance to the community via a new funding mechanism. It's important to collect the most accurate and complete data possible, so we can assess whether this is a useful mechanism in ensuring that hospitals and other related health care entities have the resources they need to address health threats like COVID-19.

Yes. The cooperative agreement funding is available for use over the five-year project period, and recipients are required to submit a semi-annual and annual report for each twelve-month period of the project period.

ASPR understands that some activities conducted by recipients and sub-recipients (e.g., retroactive compensation for activities back to January 20, 2020) may not go through the full five years. In this case, you are required to report data only for the 12-month budget period during which the cooperative agreement funding was used. Other activities, such as creating an emergency plan and exercising and training that plan, may extend beyond the immediate timeframe and the performance for those activities could be tracked through the five-year project and budget period. In this case, you are required to report data for each 12-month budget period in the five-year project period.

ASPR will release the performance measures once they are validated by both internal and external reviewers. We anticipate that this will be complete by no later than October 2020, the mid-year of the cooperative agreement.

ASPR will share the draft performance measures to members of the Allied Associations Emergency Readiness Group (A2 ERG) for review and then schedule a meeting to discuss their comments/concerns live.

How much flexibility will the American Hospital Association’s Allied Associations Emergency Readiness Group (A2 ERG) have to make actual changes to the measures?

Hospital associations will only need to report performance measure data into the cloud-based system. We understand that state and local health departments have reporting requirements as well, and while these reporting requirements will not be impacted by this cooperative agreement, we will try to reconcile requirements as much as possible.

Applicants funded under this announcement will be required to electronically submit a semi-annual program progress report and Federal Financial Report (FFR) SF-425. In addition, applicants must submit an annual end-of-year program progress report and annual end-of-year Federal Financial Report, both due 90 days after each 12-month budget period ends. Recipients received instructions for both reports with their Notice of Award. Final performance and financial reports are due 90 days after the end of the project period.

All 53 hospital association recipients have a Payment Management Systems (PMS) account that is set up, and ASPR sent each new recipient a setup package with instructions.

No. Federal facilities, e.g., VA, are not eligible to receive this cooperative agreement funding.

ASPR provided funding directly to hospital associations to support the urgent preparedness and response needs of hospitals, health systems, and health care workers on the front lines of this pandemic in order to prepare them to safely and successfully identify, isolate, assess, transport, and treat patients with COVID-19 or persons under investigation (PUI) for COVID-19, and that it is well prepared for future special pathogen disease outbreaks. This funding cannot duplicate assistance that is provided by other HHS or other federal departments or agencies (e.g., Public Health Emergency Preparedness cooperative agreement, Public Health Crisis Response cooperative agreement, Public Health Epidemiology and Infection Control, FEMA public assistance, Provider Relief Fund). This funding should focus on health care activities. It is up to the recipient’s discretion on how to distribute funding.

Many examples of how hospitals can use these funds were provided in the NOFO. Some examples include:

• Reconfigure patient flow in emergency departments to provide isolation capacity for PUIs for COVID-19 and other potentially infectious patients.
• Consider alternative or innovative models to reconfigure patient flow or transition to inpatient care, as necessary, such as leveraging alternative care sites (e.g., ambulatory surgical centers) or telemedicine to ensure all patients reach care.
• Identify alternate care sites (on facility grounds or within close proximity) and additional sites (offsite) for sub-acute care patients to increase capacity.

• Train health care workers on how to leverage telemedicine and telehealth to deliver care or how to incorporate telemedicine into daily workflows.
• Provide training and technical support, as necessary, to EMS agencies and 9-1-1/Public Safety Answering Points on screening 911 callers in order to direct non-acute patients to the appropriate care setting and to implement evolving protocols related to the dispatch of EMS for COVID-19 suspected patients, and EMS response in general.
• Ensure capability to maintain continuity of operations, leveraging alternative or innovative models, such as alternative care sites or telemedicine to support other critical operations.

Funding may be used for hospital staff salaries as long as they are contributing to, conducting, or supporting cooperative agreement activities. As a reminder, using cooperative agreement funds to pay salaries for clinical care is not permitted. As outlined in the NOFO, all recipient salaries are subject to the Congressional set CAP Executive Pay Level II, which is limited to $197,300 as of January 5, 2020.

ASPR hopes hospital associations can use the additional funding for activities beyond PPE and supply purchases. However, specific use of funding is left up to jurisdictions, with considerations made to how not to use this funding in a way that is not duplicative with other COVID-19 supplemental funding. A description of potential uses for the funding was included in the notice of award document.

The cooperative agreement budget period and project period is five years.

Audit requirements for Federal award recipients are detailed in OMB Circular A-133. Specifically, non-Federal entities that expend a total of $750,000 or more in Federal awards, during each Fiscal Year, are required to have an audit completed in accordance with OMB Circular A-133. The Circular defines Federal awards as Federal financial assistance (grants) and Federal cost-reimbursement (contracts) received both directly from a Federal awarding agency as well as indirectly from a pass-through entity and requires entities submit, to the Federal Audit Clearinghouse (FAC), a completed Data Collection Form (SF-SAC) along with the Audit Report, within the earlier of 30 days after receipt of the report or 9 months after the fiscal year end. The Data Collection Forms and Audit Reports MUST be submitted to the FAC electronically through the single audit submission portal. For questions and information concerning the submission process, please visit the FAC website or call the FAC 1-800-253-0696.

As described in the NOFO, funds can be used to “provide training of staff, specifically focusing on health care worker safety when caring for a COVID-19 patient (e.g., PPE donning/doffing, rapid identification and isolation of a patient, safe treatment protocols, and the integration of behavioral health support) and early recognition, isolation, and activation of the facility’s updated pandemic or other emergency preparedness plan.

Hospital associations will serve as the mechanism to distribute funding directly to hospitals and other related health care entities for special pathogen preparedness and response for their states and jurisdictions. These hospital associations will communicate health care situational awareness and response needs to ASPR through close collaboration across the health care systems in their respective states and jurisdictions.

Hospital associations are a new targeted recipient for HPP awards. ASPR believes this new funding mechanism will allow hospital associations to make rapid fund distribution decisions for health care entities rather than through the traditional route of public health departments, who are significantly burdened by their current COVID-19 response activities. This also allows for the number of recipients to be manageable without significant increased federal administrative costs and allows for limited competition. An open competition to directly fund any U.S. health care entity would delay federal obligations, and be difficult and potentially costly to manage at the federal level. ASPR aims to streamline the process by collecting only essential information to limit the amount of burden to the hospital associations.

ASPR worked with its stakeholder partner, the American Hospital Association, to determine where there are hospital associations in the 50 states, the U.S., directly funded cities, territories, and the freely associated states. Puerto Rico is the only territory that has a hospital association and is eligible for the planned hospital association awards. The other territories and freely associated states do not have hospital associations. These jurisdictions will be covered by CDC’s Public Health Emergency Preparedness (PHEP) Program cooperative agreement and the Hospital Preparedness Program cooperative agreement supplement. New York City was the only directly funded city with a hospital association. While Chicago and Los Angeles are HPP recipients, they do not have their own hospital associations and will receive funding through the Illinois and California hospital associations

Hospital associations may distribute funds to hospitals and other health care entities in their state or jurisdiction at their discretion. As part of their streamlined applications, hospital associations were required to include a written description at the time of application of how they plan to distribute funds within 30 days of award to subrecipients (hospitals and related health care entities within their state or jurisdiction), including any criteria or methodology used to distribute the funds.

This is fully at the hospital association’s discretion. ASPR only asks that recipients provide a description of the criteria or methodology used to distribute funds as part of the initial, streamlined application.

Regardless of how funds are distributed, subrecipients must provide the hospital associations with information on how the funds are spent.

Yes. Funding can be distributed to other non-hospital health care entities.

Hospital associations may distribute funds to hospitals and other health care entities in their state or jurisdiction at their discretion.

No. However, funds can be used for minor renovations and alterations. Exact requirements for minor renovations and alterations are specified in the NOFO.

Yes. Provided the registration fees are part of the training, per diem is allowable for training. Also, recipients must follow the GSA Federal per diem requirements (please reference GSA.gov).

There is no match or maintenance of funding required for this cooperative agreement.

No. HPP does not require hospitals to spend their own money first and submit receipts for this emergency supplemental funding for COVID-19. However, for retroactive compensation (paying for activities conducted beginning January 20, 2020), recipients must follow instructions provided in the NOFO. For forward costs, ASPR recommend requesting invoices for auditing purposes; however, this is not required.

ASPR understands that some activities done by the recipient (e.g., distributing funds to subrecipients within 30 days) are not intended to go through the full five years. Additionally, some activities conducted by the subrecipients (e.g., retroactive compensation for activities back to Jan 20, 2020) may not go through the full five years. However, some activities, such as creating an emergency plan and exercising and training that plan, may extend beyond the immediate timeframe and the performance for those activities could be tracked through the five-year project and budget period.

It is a 5-year budget period, so recipients will be able to spend the funds at their discretion over those 5 years.

Financial and progress reporting are required for all federal financial assistance programs.

Yes. Please reference 45 CFR 75 Part F Audits.

Yes. Applicants must submit an initial plan for distribution of funding with their streamlined application, but they may make modifications to this plan, including adding more detail, in their subsequent content submission 60 days after receiving the award.

Yes, HPP Field Project Officers (FPO) will provide technical assistance and guidance. Refer to the notice for award for second round for the assigned FPO.

Yes. The HPP Field Project Office will provide technical assistance to recipients.

All 53 hospital associations in all 50 states, the District of Columbia, New York City, and Puerto Rico are eligible, regardless of non-profit designation - 501(c)(6), 501(c)(3), etc. Other hospital associations – for example, children’s hospital associations or public hospital associations that also exist within the state or jurisdiction – are not eligible.

If the foundation will apply on behalf of the hospital association, ASPR would recommend the inclusion of a letter from the hospital association that states that the foundation is the authorized fiscal and administrative agent on behalf of the hospital association, in order to avoid issues during screening for eligibility.

Hospital association applicants may collaborate with other hospital association applicants on their workplans and activities; however, each hospital association must submit their own individual application. Funding can only be distributed to hospitals and other health care entities within the hospital association’s state or jurisdiction; however, recipients may collaborate with one another and distribute the funding at their discretion in such a way that would support joint objectives.

If the applicant plans to use a contracting vehicle to distribute funds to subrecipients, they should categorize as a contract. If the applicant plans to use a letter of commitment or another non-contract vehicle to distribute the funds, they should categorize as “other.” It is at the recipient’s discretion to select the vehicle for distributing funds; the most important thing is the recipients provide ASPR with a description to ensure their understanding of how the funds were distributed.

ASPR Field Project Officers (FPO) will review submissions, and if they have questions, they will reach out for more information. FPOs will then provide feedback on the submissions, including strengths and weaknesses. Recipients may be required to submit additional documentation to address significant programmatic and budgetary weaknesses.

Hospital association recipients are not required to distribute funds to health care coalitions, as funding will be distributed to them through other awards. However, recipients are encouraged to collaborate with health care coalitions or other community partners at their discretion.