Cooperative Agreement AND Pediatric Care Requirements and Hospital Preparedness Program: New 2017 Cooperative Agreement AND CMS Emergency Preparedness Rules Related to Pediatric Care May 23rd, 2017 Teresa Ehnert| Chief-Bureau of Public Health Emergency Preparedness

AGENDA Review of Pediatric Care Requirements for the Hospital Preparedness Program (HPP) in New 2017 Cooperative Agreement Review of CMS Rules Related to Children/Pediatric Care Discussion on collaboration between HPP and Emergency Medical Services for Children (EMSC) OPEN DISCUSSION

Goal Pediatric Care Requirements HPP-2017 Cooperative Agreement and CMS Requirements Goal The goal is to understand 2017 Cooperative Agreement and HPP Requirements related to Health Care Coalition (HCC), Pediatric Care and Emergency Medical Services for Children (EMSC)

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 1 Strategy: Strengthen Community Resilience Activity 1: Partner with Stakeholders by Developing and Maturing Health Care Coalitions HPP Requirements: Identify HCC Members Awardees and HCCs should expand HCC membership to include additional types of members …….. HCCs also should include specialty patient referral centers such as pediatric, burn, trauma, and psychiatric centers, as HCC members within its geographic boundaries. They may also serve as referral centers to other HCCs where that specialty care does not exist.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 1 Strategy: Strengthen Community Resilience Activity 2: Characterize the Probable Risks to the Jurisdiction and the HCC Joint Requirements-Jurisdictional Risk Assessments HPP Requirements: Assess Hazard Vulnerabilities and Risks Each awardee-funded HCC must complete an annual hazard vulnerability analysis (HVA) to identify and plan for risks, in collaboration with the awardee. The assessment components should address population characteristics, including demographics, and consider those individuals who might require additional help in an emergency including children, pregnant women, seniors, and individuals with access and functional needs, including people with disabilities and others with unique needs.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 1 Strategy: Strengthen Community Resilience Activity 3: Characterize Populations at Risk HPP Requirements : HPP awardees and HCCs must obtain de-identified data from the U.S. Department of Health and Human Services emPOWER map every six months to identify populations with unique health care needs … As part of inclusive planning for populations at risk conducted by HPP awardees, HPP-funded HCCs must: Support public health agencies with situational awareness and information technology (IT) tools already in use that can help identify children, seniors, pregnant women, people with disabilities, and others with unique needs PHEP Requirements : To address the needs of infants and children, awardees should collaborate with child-serving institutions such as schools and daycare centers to assure crisis preparedness plans are in place.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 2 Strategy: Strengthen Incident Management Activity 4: Ensure HCC Integration and Collaboration with Emergency Support Function-8 (ESF-8)-HCC Response Plan Each HCC funded by the awardee must develop a response plan that is informed by its members’ individual emergency operations plans and submit the plan to ASPR by the end of Budget Period 2 with annual progress reports. Each HCC’s response plan must clearly outline: Activation and notification processes for initiating and implementing medical surge response coordination among HCC members and other topics related to medical surge, including: Strategies to implement if the emergency overwhelms regional capacity or specialty care including trauma, burn, and pediatric capability.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 3 Strategy: Strengthen Information Management Activity 2. Share Emergency Information and Warnings across Disciplines, Jurisdictions, and HCCs and their Members Joint Requirements: Coordinate Emergency Information Sharing between Public Health and Health Care. The following are factors that HCCs, in coordination with HPP and PHEP awardees and other public health agency members, should consider when developing processes and procedures to rapidly acquire and share clinical knowledge. Processes and procedures should address a variety of emergencies such as chemical, biological, radiological, nuclear, or explosive (CBRNE), trauma, burn, pediatrics, or highly infectious disease outbreaks

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 5 Strategy: Strengthen Surge Management Activity 2: Address Surge Needs Joint Requirements: Family Reunification During a public health incident or crisis, families are at risk for becoming disconnected. HPP awardees and HCCs must serve as planning resources and SMEs to PHEP awardees and public health agencies as they develop or augment existing response plans for affected populations, including mechanisms for family reunification. These plans should give consideration to: • Reunification considerations for children

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 5 Strategy: Strengthen Surge Management Activity 4: Address Specialty Surge HPP Requirements: Pediatric Care HPP awardees must collaborate with the EMSC program within its jurisdiction to better meet the needs of children receiving emergency medical care. Following are specific areas of collaboration: The HRSA administer the EMSC program at the federal level, and this program works to ensure that critically ill and injured children receive optimal pediatric emergency care.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement Domain 5 Strategy: Strengthen Surge Management Activity 4: Address Specialty Surge HPP Requirements: Pediatric Care (Contd.) Following are specific areas of collaboration. HPP and the EMSC program awardees within their jurisdictions must provide a joint letter of support indicating that EMSC and HPP are linked at the awardee level. HPP awardees must provide the initial letter of support with their funding applications at the beginning of each budget period throughout the five-year project period. HPP awardees must work with HCCs and EMSC to ensure that all hospitals are prepared to receive, stabilize, and manage pediatric patients. At the end of each budget period, HRSA will provide HPP with data regarding each hospital’s capability to manage pediatric medical emergencies to assist with this work.

Pediatric Care Requirements for HCC HIGHLIGHTS-2017 Cooperative Agreement HPP Evaluation and Performance Measurement Strategy To measure and evaluate HPP performance, a variety of measures were developed at the input-, activity-, output-, or outcome-level. The 2017-2022 HPP performance measures target output and outcome measures to address the information needs of various stakeholders. One of the 22 HPP performance measures and the six measures (23-28) for select U.S. territories and freely associated states is: Percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Comments on CMS EP Rules for Pediatric Care and CMS Response: Comment-1: Joint Guidelines for Care of Children in the Emergency Department, developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association, as a resource for the final rule. Response to Comment 1: …We also want to thank commenters for their recommendations for additional resources on emergency preparedness. We provided an extensive list of resources in the proposed and have included links to various resources in this final rule that facilities can use as resources during the development of their emergency preparedness plans. However, we note that these lists are not comprehensive,…… since we intend to allow facilities flexibility as they implement the emergency preparedness requirements….Omissions from the list of resources set out in the proposed rule do not indicate any intention on our part to exclude other resources from use by facilities.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Comment-2: A commenter recommended that emergency preparedness plans should account for children's special needs during an emergency. The commenter stated that emergency preparedness plans should include children's medication and medical device needs, challenges regarding patient transfer for neonatal and pediatric intensive care patients, and issues involving behavioral health and family reunification. Comment-3: A commenter recommended that CMS collaborate closely with the Emergency Medical Services for Children (EMSC) program administered by the Health Resources and Services Administration (HRSA). The commenter noted that this program focuses on improving the pediatric components of the EMS system.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Response to Comment 2 & 3: We appreciate the commenter's concerns. As required in § 482.15(a)(1), (2), and (3), when a provider or supplier develops an emergency preparedness plan, we will expect that the provider/supplier will use a facility-based and community-based risk assessment to develop a plan that addresses that facility's patient population, including at-risk populations. If the provider serves children, or if the majority of its patient population is children, as is the case for children's hospitals, we will expect the provider to take into account children's access and functional needs during an emergency or disaster in its emergency preparedness plan.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Comment-4: A commenter recommended that we include the Joint Guidelines for Care of Children in the Emergency Department, developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association, as a resource for the final rule. Response to Comment 4: At § 482.15(a)(3), we proposed that a hospital's emergency plan address its patient population, including, but not limited to, persons at-risk. We also discussed in the preamble of the proposed rule that “at-risk populations” are individuals who may need additional response assistance, including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency or are non-English speaking, lack transportation, have chronic medical disorders, or have Start Printed Page 63875pharmacological dependency. According to the section 2802 of the PHS Act (42 U.S.C. 300hh-1) as added by Pandemic and All-Hazards Preparedness Act (PAHPA) in 2006, in “at-risk individuals” means children, pregnant women, senior citizens and other individuals who have special needs in the event of a public health emergency as determined by the Secretary.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Comment-5: A commenter stated that it could be difficult for children's hospitals to maintain a comprehensive list of people and entities, as required for a hospital's communication plan. The commenter gave an example of a hospital that maintains a listing for most managers Start Printed Page 63884and above, but not for all general staff and volunteers. Response to Comment 5: …We disagree with the commenters who suggested that it would be overly burdensome for hospitals to maintain a current contact list. As a best practice, most hospitals maintain an up-to-date list of their current staff for staffing directories and human resource management. In addition, most hospitals have procedures or systems in place to handle their roster of volunteers. We believe that a hospital would have a comprehensive list of their staff, given that these lists are necessary to maintain operations and formulate a payroll..... Furthermore, we clarify that we are not requiring hospitals to include in their communication plan contact information for the families of staff, or the families of patients who are not directly involved in the patient's care, or contractors not currently providing services under arrangement.

Pediatric Care Requirements CMS Emergency Preparedness Rule 2016 Comment-6: A commenter recommended that CMS consider including non-healthcare facilities in the communication plan, such as child care programs and schools, where children with disabilities and other access and functional needs may be sheltering in place. Response to Comment 6: We do not believe that it is appropriate to require hospitals to include other providers of services, such as child care programs and schools, in their communication plan in these conditions of participation. However, we have allowed facilities the flexibility and the discretion to include such providers in their communication plans if deemed appropriate for that facility and patient population.

CMS EMERGENCY PREPAREDNESS NEW RULE: RESOURCES AND ADHS-BPHEP TECHNICAL ASSISTANCE IMPORTANT LINK 2017 Performance Measures: 2017-2022 HPP Performance Measures Implementation Guidance ASPR-TRACIE: https://asprtracie.hhs.gov/ Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid

THANK YOU Teresa Ehnert| Chief-Bureau of Public Health Emergency Preparedness teresa.ehnert@azdhs.gov | 602-364-3571 azhealth.gov @azdhs facebook.com/azdhs