Alternate Care Site Toolkit: Third Edition

1 I Federal Healthcare Resilience Task Force Alternate care site Toolkit Third Edition NOTE: This resource was published in 2020 and is not being maintained. While information contained within was current when published, it may be outdated, and some links may not Purpose: This Alternate care site (ACS) Toolkit is medical operations guidance and was developed with the intent to help state, local, tribal, and territorial (SLTT) entities address potential capacity and capability gaps in health care systems during the 2020 SARS-CoV-2 virus (COVID-19) pandemic. It is intended to provide medical operations guidance and technical assistance to SLTT entities in establishing and operationalizing an ACS used to care for COVID-19-positive patients, presumed COVID-19-positive patients, and/or non-COVID-19 patients in a mixed setting.

2 Intended Audience: State, Local, Tribal, and Territorial Entities FEMA Regional Administrators HHS Regional Administrators Health care Systems 06/30/2020 ii Federal ACS Toolkit Third Edition KEY UPDATES IN THE Third Edition The Third Edition of the ACS Toolkit provides augmented guidance based on feedback from and experience with the national ACS mission. The Third Edition builds upon, but does not change, basic tenets from the original guidance provided in the Second Edition . Key updates in the Third Edition based on lessons learned include: Inclusion of a Key Takeaways section (page iii); Updated language surrounding How to Use This Toolkit for clearer ease of navigation (page iv); Renamed the Hospital care ACS Model to the Hybrid care ACS Model to deconflict the term hospital care with the concept of a traditional hospital, but the guidance surrounding this model remains unchanged (page 2).

3 Inclusion of information that hospitalized patients may require dialysis support either due to a pre-existing condition or due to COVID-19 as a planning factor for the Hybrid care Model and the Acute care Model (page 4); Expanded information on funding sources (page 8) , including an updated Appendix D, which now links to the ASPR TRACIE ACS Funding Summary: Establishment and Operationalization tip sheet (page 28); Inclusion of Appendix N: Sample Temperature Screening Protocol (page 60 ); Inclusion of information on retaining an ACS as a warm site and information on eligible costs to maintain an ACS warm site (page 27); Inclusion of a Glossary of Terms (page 29); and Streamlined and updated previously existing cache lists to include currently available products (page 76).

4 06/30/2020 iii Federal ACS Toolkit Third Edition KEY TAKEAWAYS The following bullets represent the Key Takeaways for the ACS Toolkit. One of Many Options for Medical Surge: An ACS is one of many options to address medical surge. The decision to establish an ACS should be considered in conjunction with the suite of other options available to meet medical surge needs such as telemedicine options and local and regional coordination mechanisms ( , targeted patient transfer, select workforce strategies). Local Decision: Decisions about the need for and type of ACS should be made by SLTT entities, and HHS and FEMA regional personnel can provide consultation on the approach.

5 Medical Operations Guidance: This ACS Toolkit is medical operations guidance. It details the establishment, operations, and closure of an ACS. There are three ACS care Models described in this document: Non-Acute care , Hybrid care , and Acute care . Importantly, this guidance focuses on the delivery of health care for all patients impacted by this health care emergency ( , both pediatric and adult patients). Medical Support Essential: Given the potential for patient decompensation even at the non-acute care level, it is recommended there be medical support available at any ACS.

6 One Good Approach: This Toolkit provides one good approach to configure Alternate care Sites. All SLTTs are encouraged to adapt these principles to meet the specific needs of their community. Fully Functional ACS: To be considered fully functional, an ACS must include not only the facility (the space ), but also the appropriate personnel (the staff) and medical equipment and supplies (the stuff) for health care delivery (the service). A key component of a functional ACS is a robust network of communication and coordination that ensures smooth transfer of patients within a community, as needed, for delivery of care .

7 Health care Partnership: An ACS should be established in partnership with existing and traditional health care organizations (the system) for both operational and funding reasons. Warm site Status: Alternate care Sites that remain operationally ready but unused (warm sites) will provide an available surge capacity for COVID-19 readiness and response. It is recommended that SLTT entities retain their existing ACS locations for future COVID-19 outbreaks as warm sites. 06/30/2020 iv Federal ACS Toolkit Third Edition HOW TO USE THIS TOOLKIT This ACS Toolkit is structured around a Base Document, Appendices, Supplements, and a Checklist.

8 The Base Document describes the foundational ACS framework to include the establishment, operations, and closure of an ACS. The Appendices are supporting documents, tools, templates, and web links to support implementation of the foundational ACS framework. The Supplements describe detailed guidance pertaining to staffing and equipping the three different ACS care Models based on level of care . The Checklist is a helpful quick reference for establishing, operating, and closing an ACS. BASE DOCUMENTF oundational Alternate care site FrameworkAPPENDICESS upporting Documents, Tools, and TemplatesSUPPLEMENT 1 Additional Guidance for Non-Acute care ACS ModelSTAFFINGEQUIPMENT & SUPPLIESSUPPLEMENT 2 Additional Guidance for Hybrid care ACS ModelSUPPLEMENT 3 Additional Guidance for Acute care ACS ModelSTAFFINGEQUIPMENT & SUPPLIESSTAFFINGEQUIPMENT & SUPPLIESTEAR SHEET: Alternate care site CHECKLIST 06/30/2020 v Federal ACS Toolkit Third Edition TABLE OF CONTENTS Key Updates in the Third Edition .

9 Ii Key Takeaways .. iii How to Use This Toolkit .. iv 1. Purpose and Scope .. 1 Concept .. 2 ACS Decision Framework .. 3 Can your community benefit from an ACS? .. 3 Which ACS model would best meet the needs of your community? .. 3 ACS Process Flowchart .. 5 2. Procedures .. 5 Identify Potential Sites .. 5 Conduct site Assessment .. 5 Physical Considerations .. 5 Logistical Considerations .. 6 Operational Considerations .. 7 Infection Prevention and Control Considerations .. 8 Pharmaceutical Considerations .. 8 Secure Funding .. 8 ASPR Hospital Preparedness Program COVID-19 Emergency Supplemental Funding.

10 9 CDC Crisis Response Cooperative Agreement: COVID-19 .. 9 Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response .. 9 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) .. 9 CMS Payment for Health care Services .. 10 06/30/2020 vi Federal ACS Toolkit Third Edition COVID-19 Claims Reimbursement to Health care Providers and Facilities for Testing and Treatment of the Uninsured Program .. 11 FEMA Public Assistance Program .. 11 Secure Property .. 11 Convert site for Health care Use.