healthcare system recovery guide hurricane harvey (dr-4332-tx) · healthcare system recovery guide...

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Health and Social Services Recovery Support Functions

Healthcare System Recovery Guide Hurricane Harvey (DR-4332-TX)

Healthcare Recovery Guide (Hurricane Harvey)

Table of Contents

Introduction............................................................................................................................................ 1

Financial and Legal Recovery Issues .............................................................................................. 3CommonIssues.....................................................................................................................................................3PotentialCoursesofAction(COA)................................................................................................................3COA1–Int egrateCost RecoveryintoHealthcareFacility EmergencyPlanning .................3COA2–PreparetoUtilizeAllFinancialAssistanceAvenuesAvailable.................................. 4 COA3‐EngageHealthcareCoalit ionLeadsand Partnersin SolvingFinancialandLegalIssues........................................................ ............................................................................................................4COA4–Researchand UnderstandState/Local Rules..................................................................... 5

Resources..................................................... ...........................................................................................................5Contacts.................................................................................................................................................................... 6

Operational Planning Issues ............................................................................................................. 7CommonIssues.....................................................................................................................................................7PotentialCoursesofAction(COA)................................................................................................................7COA1–IdentifyRiskandDevelopanEmergencyPlan ..................................................................7 COA2–DevelopHealthcareFacilityCOOPPlanswiththeGoalof PlanningforandEnsuringC ontinuation ofEssentialServicesduringaDisaster..................................................8

Evacuation......................................................................................................................................................9Shelter‐in‐Place.........................................................................................................................................10

COA4–ImplementCo mprehensiveCommunicationStrategies...... ......................................10 COA5–Engagethe WaiverandRegulatoryFlexibilitiesProcess...........................................11 PublicHealthEmergency......................................................................................................................11 CMSWaiversandRegulatoryFlexibilities...................... ..............................................................11

COA6–Increaseknowledgeoft heH ealthInsurancePorta bilityandAccountabilityAct(HIPAA)PrivacyRuleandWaivers.............................. ........................................................................12 COA7–Int egrateHealthcareFacilityRecovery intoComprehensi veCommunityPlanning............................................................................................................................................................12

Resources..................................................... ........................................................................................................13 Contacts.................................................................................................................................................................15

Workforce Issues.................................................................................................................................16CommonIssues..................................................................................................................................................16 PotentialCoursesofAction(COA).............................................................................................................16 COA1–Inc reasePost‐DisasterWorkforceResilience.................................................................16 COA2–Pro videPost‐Disast erBehavioralHealthResourcestoStaff...................................16 COA3–PlantoUse Volunteers/Donatio ns...................... ................................................................17

Resources..................................................... ........................................................................................................17

i

COOP.................................................................................................................................................................8EssentialHealthServices.........................................................................................................................8SupplyChain..................................................................................................................................................8

COA3–DevelopPlansforFacilityEvacuation o rSheltering‐in‐Place.................................... 9


Contacts.................................................................................................................................................................18

Training and Testing Issues ............................................................................................................19CommonIssue....................................................................................................................................................19 PotentialCoursesofAction(COA).............................................................................................................19 COA–ImplementStrategiesandA ctionstoFullyDevelopandMaintainFacilityTrainingandTestingP rograms..............................................................................................................19

Resources..................................................... ........................................................................................................20 Contacts.................................................................................................................................................................20

Resource Directory.............................................................................................................................21PartnerResources............................................. ...............................................................................................23

ii

Impacted ClinicVisited– October2017


Introduction

Disastershaveadirectandimmediateimpactonhealthcaresystems.Theseimpactsaffectnotonlythefacilities andtheiroperations,butalsothedemandforthe criticalservicesprovidedbythosefacilities.TheimpactsofHurricaneHarvey were far‐reaching, affectingover1MTexans.Someofthoseimpactspersist,toincludedislocation,jobloss,lackoftransportation,anddiminishedaccesstomedicalcare.Bymost accounts,thehealthcaresystemsin Texasperformedwith afocusand determinationtosupportsurvivorneeds.Manyofthem,inparticularthelargersystems,consider themselvestobefullyrecoveredfromtheimpactsofHurricaneHarvey.

However,healthcaresystemscompriseawiderangeoffacilitytypesandsizes,rangingfrom thesmallnetworksofproviderstothe largehospitals,theinsurancescompanies,emergencymedicalservices,andothermedicalfacilities.SomesmalltomediumhealthcarefacilitiesinTexasremainclosedfollowingHurricaneHarvey,creatingcaredeliverygapsinsomeofthemostimpactedareas.Manyfacilitieshaveongoingconcernswithprovidingservices,includingrecoveringfromstructuralandequipmentloss,futurefinancialviability,long‐termstaff issues,andpreparingforthe nextdisaster while recovering.

InsupportofTexasrecoveryoperations, the Healthand Social Services(HSS)RecoverySupportFunction(RSF)reviewedhealthcarefacilityconcernsrealizedthroughthelandscapeassessment andengagedinonsiterecoveryworktoinformdevelopmentofthisguidetoassistsmalltomedium facilitieswithlong‐termrecovery.ThisHealthcareRecoveryGuideisintendedto:

Identifycommonpost‐disasterrecoveryplanningissuesforsmalltomediumsizedfacilities.

Proposecoursesofactiontoassistshortthroughlong‐termrecoveryandimprovefuturepreparedness/response.

Identifyrelevantsupportresources.

Recentcommonandrecurringdisaster recoveryissuesarethe focalpointofthisguide,whichareorganizedbythe followingtopicareas:

FinancialandLegal:Issuesaffectingahealthcarefacility’sabilitytogeneraterevenue,maintainorreducecosts,mitigatelegalimpediments, and ultimatelystayeconomicallyviableduringrecovery.

Overview 1


OperationalPlanning: Comprehensivebusiness contingencyplanningfortheentire facilityanditscomponentsinordertomaintainoperationsduringrecovery.

Workforce: Postdisasterimpactsto afacility’s clinicaland non‐clinical staffaffecting theirwell‐being andsubsequently,businesscontinuityduringrecovery.

Trainingand Testing:Theprocessofensuring healthcarefacilityplansmatch assessedandotherhazards,havingtrainedstaff available toperformjobdutiesand otherfunctionsduringrecovery, andmaximizinglessons learned fromexercises/real‐eventsthatleadto correctiveactions.

Overview 2


Healthcare Facility Financial and Legal Recovery Issues 3

Financial and Legal Recovery Issues

COMMON ISSUES

Issue 1: Manyhealthcarefacilities conductemergencyplanning,butthoseplansmaylacksufficientdetailtoguideshortandlong‐termrecoveryfinancialandcashflowissues.

Issue 2: Delaysordisruptionsinbillingandreimbursementforpatient careafteradisastercancreatecashflowchallenges for healthcare facilities.

Issue 3: Costsforrepairandreplacementofstructuraldamage,equipment,and inventoryafteradisastermay exceedhealthcarefacility insurance coverage.

Issue 4: Healthcarefacilitiesmay notfullyleveragecoalitionpartnerstoassist financialrecoveryandincreasedelays.

Issue 5: Healthcarefacilitiesmay notunderstandstate/localrulesand regulations regardingpost-disaster recovery.

POTENTIAL COURSES OF ACTION (COA)

1. Community primary care facilitiesimplemented pre‐planned paper billing strategies post‐Hurricane Maria, that included staff training, use of proper forms, and required essential elements of information to advance Medicaid payments. 2. During Hurricane Maria, communityprimary care facilities had a pre‐established rainy‐day fund created in part through a program to reduce supply chain waste. This fund was helpful to pay staff salaries and have cash on hand for critical supplies, such as generator fuel, during the immediate recovery. 3. To handle a surge in claims, healthcarefacilities may consider developing a preplanned disaster protocol with private insurance companies to include a streamlined claims process, pre-established information requirements, and triggers.

COA 1 – Integrate Cost Recovery into Healthcare Facility Emergency PlanningToexpeditepost‐disasterrecovery, emergencyplansshouldincludelossmanagementconsiderations.

Developplansforhowtodocumentbillablepracticeswhileunderreducedpowerandcommunicationcapability.

Identifycontingencyarrangements,contracts,andrelationshipswithfinancialinstitutions toextendlinesofcreditforlongerperiodspost‐disasterandtosustainhealthcareservicedelivery.

Forecastandplanforpost‐disasteroperatingcostsincludinguncompensatedcare.

Planforcashreservestoassiststaffretentionandinventoryre‐supply.

COA 2 – Prepare to Utilize All Financial Assistance Avenues Available


In Puerto Rico, a level 1 acute care hospital critical to community recovery in an urban area engaged regional FEMA Public Assistance (PA) contacts early during recovery. This helped to ensure properly completed packages, including an itemized assessment of facility structural and equipment damage, documented losses, and pictures. This thorough documentation led to receipt of FEMA PA funds within approximately three months to advance facility and community recovery.

Healthcare facilitiesshouldpreparedamage/lossassessments,fileinsuranceclaims,andbeready tosubmitapplications tofederalprogramsthatmayoffer post‐disasterassistance.

Planforacomprehensivedamageassessmentafteradisaster.

Identifyprotocolsandmethodstotrackoperations anddisasterexpenses.

Gatherdetaileddocumentationforallclinical/nonclinicalpost‐disasterissuesandcosts.

Developabudgetandprocessbywhichthesurvivingorreplacementhealthcarefacilityandstaffwouldresumeoperations.

Reviewinsurancepoliciesin advanceandunderstandcoverages,terms,conditions, deductibles,limits,exclusions, andtheprocessforfiling claims.

EvaluateandplanforSmallBusinessAdministration (SBA)loan opportunities.

Ifapublicorprivate nonprofithealthcare facility,anticipateusingFederalEmergency ManagementAgency(FEMA)PublicAssistance programs forstructural,equipment, andinventorydamage assistance.

COA 3 ‐Engage Healthcare Coalition Leads and Partners in Solving Financial and Legal Issues

Early during TX recovery, healthcare facilities and their leadership learned from other coalition organizations with prior disaster experience about SBA and its Economic Injury program. This facilitated interest and connection to the SBA, resulting in long‐term recovery loans to assist with business operations, continuity, and financial viability for improved facility and community recovery.


Healthcare coalitions andpartnerscanbeavaluableresourceforfacilitieswithoutexperiencedstaffdedicatedtoadvancingfinancialandlegalissues.

Understandthesupportingroleofeachcoalitionpartner(hospitals,emergencymanagement,EmergencyMedicalServices(EMS),andpublichealth).

Workwithcoalitionpartnerstohelpsolveanticipatedfinancialrecoveryissuesthat interfacewithmultiplelevels ofgovernment.

Utilizelessonslearned fromhealthcarefacilities withexperiencereceivingFEMAPublicAssistance,SBAloans,andinsurancepayouts.


COA 4 – Research and Understand State/Local Rules and Regulations

TX authorities worked to grant provisional waivers during Hurricane Harvey recovery to reduce Medicaid and CHIP enrollee administrative burdens, including those impacting out‐of‐state evacuees, and to ensure continuity of care.

Toexpeditepost‐disasterrecoveryandtocomplywithstateand localrulesandregulationsthatinfluenceemergencycare,facilitiesshouldensuretheirleadershipunderstandsthoseregulatory policies.

Reviewregulationsforhealthcarepractitionerlicensure,practicestandards,reciprocity,scopeofpracticelimitations,a ndstaff‐to‐patientratios.

Addresslegalauthorizationtoallocatepersonnel,resources,equipment,andsuppliesamonghealthcarefacilities.

Understand emergency decision‐makingprocessesforstate and/orlocallegislature.

Assessavailablestateliability protectionsforresponders.

RESOURCES

AQuickGuide–FEMAReimbursementforAcuteCareHospitals:https://www.ynhh.org/~/media/files/emergency/aquickguide_femareimbursement.pdf

ASPR2017‐2022:HealthCare PreparednessandResponse Capabilitieshttp://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017‐2022‐healthcare‐pr‐capablities.pdf

CMSApprovesTexasCHIPprovisionstoassistwithHurricaneHarveydisasterrelief:https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press‐releases/2017‐Press‐releases‐items/2017‐09‐01.html

Healthcare SystemRecovery:FinancialSustainability afteraDisaster:https://www.youtube.com/watch?v=Z9IfH‐s_sOE&feature=youtu.be

EssentialFunctionsandConsiderationsforHospitalRecoveryVersion2:https://cdn1.sph.harvard.edu/wp‐content/uploads/sites/1608/2014/09/HSPH‐Emergency‐Preparedness‐Response‐Exercise‐Program_Hospital‐Recovery.pdf

FEMAPublicAssistance:PublicandNonprofitPolicyandGuidance:https://www.fema.gov/public‐assistance‐policy‐and‐guidance

SmallBusinessAdministration DisasterLoan Assistance:https://disasterloan.sba.gov/ela/

USDepartmentofHousingandUrbanDevelopment–CommunityDevelopmentBlockGrant(CDBG)Disaster RecoveryProgram:https://www.hudexchange.info/programs/cdbg‐dr/


https://www.ynhh.org/~/media/files/emergency/aquickguide_femareimbursement.pdf

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare%E2%80%90pr%E2%80%90capablities.pdf

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press%E2%80%90releases/2017%E2%80%90Press%E2%80%90releases%E2%80%90items/2017%E2%80%9009%E2%80%9001.html

https://www.youtube.com/watch?v=Z9IfH%E2%80%90s_sOE&feature=youtu.be

https://cdn1.sph.harvard.edu/wp%E2%80%90content/uploads/sites/1608/2014/09/HSPH%E2%80%90Emergency%E2%80%90Preparedness%E2%80%90Response%E2%80%90Exercise%E2%80%90Program_Hospital%E2%80%90Recovery.pdf

https://www.fema.gov/public%E2%80%90assistance%E2%80%90policy%E2%80%90and%E2%80%90guidance

https://disasterloan.sba.gov/ela/

https://www.hudexchange.info/programs/cdbg%E2%80%90dr/

https://www.hudexchange.info/programs/cdbg%E2%80%90dr/


USDepartmentofLabor:Employment&WagesunderFederalLawduringNaturalDisasters& Recovery:https://www.dol.gov/whd/regs/compliance/whdfs72English.htm

CONTACTS

Centers for Medicare and Medicaid Services – Region VI1301YoungStreet,Room714,Dallas,TX75202Phone:(214)767‐6423Email: [email protected]

Federal Emergency Management Agency – Region VIFRC800NorthLoop288,Denton,T X76209‐3698Phone:(940)898‐5399Website: https://www.fema.gov/region‐vi‐arkansas‐louisiana‐new‐mexico‐oklahoma‐texas

Small Business Administration ‐Region VI4300AmonCarterBoulevard,Suite108,FortW orth,TX76155 Phone:(817)684‐5581Website: https://www.sba.gov/offices/regional/vi


mailto:[email protected]

https://www.dol.gov/whd/regs/compliance/whdfs72English.htm

https://www.dol.gov/whd/regs/compliance/whdfs72English.htm

https://www.fema.gov/region-vi-arkansas-louisiana-new-mexico-oklahoma-texas

https://www.sba.gov/offices/regional/vi


Operational Planning Issues

COMMON ISSUES

Issue 1: Healthcarefacilitiesmayhavee mergencyplans,butcriticalactionsfor staffmay

notbedefined,trainedto,andt ested,resultinginoperationalandpost‐disasterrecover y

challenges.

Issue 2: Healthcarefacilitiesmaybecha llengedtodevelopandtestcontinuityof

operationsplans(COOP)toensuretheavailabilityofessential serviceswhenneeded duringrecovery.

Issue 3: Manyhealthcarefacilitiesl ack welldevelopedplansforevacuationorsheltering‐

in‐place,whichmayimpactdecision‐makinga ndpatientsduring recovery.

Issue 4: Healthcarefacilitiesmaybecha llengedwithinternalcommunication and

informationsharingduringr ecovery.

Issue 5: Healthcarefacilitiesmaynoten gagei ntheCentersforMed icareandMedicaid

(CMS)waiverprocessearlyandde laypossibleregulatoryflexibilitiesthatcouldimpactpost‐disasterrecoveryoperatio nsa ndfinances.

Issue 6: Healthcarefacilitiesareoftenchallen gedduringadisas terby whattypesofpatient

informationcanbereleased,towhom,andunderwhatcircumstances.

Issue 7: Post‐disasterrecoverycanbech allengingforhealthcarefac ilitiestointegrateinto

community‐wideplanningefforts.


Healthcare facilities

and staff across

the

Southwest Texas

Regional

Advisory

Council (STRAC)

executed

core functions

established in their

Emergency

Operations Plans,

leading

to efficient

medical surge

management

of patients

and sustained

operations

into early

recovery.

COA 1 – Identify Risk and Develop an Emergency PlanTominimizeloss,continueessential operations,andexpeditepost‐disaster recovery,emergencyplanningshouldaddressdisruptionstoday‐to‐dayoperations including:

Lossofutilitiesincludingwaterandpower;

Relianceongeneratorpower;

Degradedorlostcommunicationability;

Operational Planning 7

Loss of the use of the facility or portion thereof


Supplychaininterruptionsincludingcritical medicalsupplies (e.g.,oxygen,saline,pharmaceuticals,etc.)andotherinventories;

Increasesinvulnerable andat‐riskpopulations; Non‐acutepatientsrequiringshelter,food,water,prescriptions; Needforstaffresiliency strategies;and

Needforpracticalactions(e.g.,covercomputers,securingfiles,etc.).

COA 2 – Develop Healthcare Facility COOP Plans with the Goal of Planning for and Ensuring Continuation of Essential Services During and After a Disaster

Many TX healthcare facilities in the Coastal Bend Regional Advisory Council (CBRAC) executed pre and post Hurricane Harvey continuity of operations by performing pre‐storm discharge planning, arranging to have additional staff report to work early and complete rotations. Ultimately, sustaining essential health and wrap around services through recovery.

Healthcare facilityCOOPensures organizationalfunctionsandessentialhealthcareservicescontinue.Adjustmentsmaybeneededtomeetthemission,handlepatientsurges,addresscompromisedutilities, aswellasanticipatedstaffand inventory shortages resultingfroma disaster.

COOP

Utilizefacilitycontinuityresources andchecklists.

Planforvariousself‐sustainmentperiods.

Includeabusinessimpactanalysis.

Recognizebroadercommunityplanninganddependencies.

Addresscoreelementssuchas leadership,fin ance,a lternatecaresites, humanresources,communications,legal/ethics,facilities,records,operations,supplies,s taff,logistics,etc.

EssentialHealthServices

Listandr ankallservicesinthehealthcarefacility.

Identifythoseserv icesdeemede ssentialinanycircumstance.

Anticipate andplanfor neededresources.

SupplyChain

Ensurethatadministrative,supplymanagers, emergency planners, andclinicalstaffcoordinateasateamonassessing integrityofthesupplychain (e.g.,thelease,purchase,deliveryofmedical/othergoodsandservicesforpatients/staff).

Assessvulnerabilities forprovidingcriticalsuppliesandservices (e.g.,pharmaceuticals,medicaldevices,PPE,bloodproducts,oxygen, saline,food,fuel,etc.).



EnsuresupplychainissueswithinCOOP arere viewedbyt heteam.

Anticipatepost‐disasterfinancialresourcesandmarket(manufacturers/distributors)supplyavailabilityissues.

Planforsupplyneedsbasedonriskassessmentsandotherevents(e.g.,radiological/nuclearevent,etc.).

Ensurecontracts/agreementswith vendorsareupdatedto m aintaininvento ryandconsiderscenariosthatimpactvendorsabilitytoprovidesupplies.

Engage the healthcare coalitionto leverageequitieswith supplychainassessmentandplanning.

COA 3 – Develop Plans for Facility Evacuation or Sheltering‐in‐Place

TX has procedures in place to move patients when a healthcare facility requires evacuation assistance. During Harvey response and recovery, many in the impacted area utilized a healthcare coalition‐based medical operations center in Houston (e.g., SETRAC) to match patients to other facilities able to accept them and to facilitate coordination of ambulance and emergency crews. This coalition coordinated over 20 hospital and nursing home evacuations as well as over 1,000 patient movements.

Toimprovedecision‐makingandoperationsduringdisasterrecovery, healthcare facilitiesshoulddevelopevacuationor sheltering‐in‐place plans.

EvacuationEvacuation planning shouldincorporate emergencymanagement and otherhealthcarecoalitionpartners.

EstablishMOUswithhospitalsand otherhealthcarecoalitionpartners that identify roles and responsibilities for transferof patientsandmutualaid duringadisaster and when returning patients to the originating facility.

Evaluatepossibilitiestoutilizeanyinternalnetworkforpatientmovementifpartofahospitalsystemwithtransportationandstaffassets,andsupportresources.

Coordinatewithstate public health, regional, or National DisasterMedicalSystem(NDMS) patientmovementplans.

Establishdecision‐makingcriteria,triggers,andauthorities.

Dischargepatients early,ifappropriate.

Identifyfac ilitystaginga reas

anddestination facilities.

Matchpatientswithtransportationresources,trackandnotify families.

Anticipateallpatientmedical,transport,andsupportneedswhenthe communityandfacility reopenandcitiz ensandpatientsr eturn.

Includefacilityclosureandsecurityprocedures.



Shelter‐in‐PlaceShelter‐in‐placeplanningshouldi ncludeconsiderationsforpatientsa ndstaff(andpotentialfamilymembers).

Establishdecision‐makingcriteria,triggers,andauthorities. Planforshelteringinprotecteda reaswithinthefacility. Forecastpatientandstaff medicalandotherneeds, to include staff work rotations

and sleeping areas.

Anticipate sustainmentn eedssuchasfoodandwater.

Evaluatefacilitymaintenanceandotherissues(e.g.,turnoffHVAC,access control/lock‐down,etc.).

Establishtriggersforliftingshelter‐in‐placerequirements.

Healthcare

facilities

across

three

healthcare

coalitions

in

the

Hurricane

Harvey

impact

zone

utilized

established

redundant

communication

platforms

and

processes

to

ensure

connections

across

facilities

and

with

other

key

disciplines

for

medical

surge

management.

This

helped

to

maintain

situational

awareness

and

track

patient

movements.

COA 4 – Implement Comprehensive Long-Term Communication Strategies Poorcommunicationstrategiesmaynegatively impacthealthcare facilityoperationalplanningandexecution.

Ensurethatinternalcommunicationisaccurate,timely,andclear.

Extendinformation sharingacrosshealthcarecoalitionpartners.

Performariskassessmentofcommunicationstrategies.

Consideruseofsocialmediatoenhancecommunications.

Establishsimpleinformationexchange mechanismsinternallyamongallstaff and maintain scheduled situational awareness updates for staff.

Ensureallinternalpatientprioritizationstrategies(e.g., triage,admission,discharge,etc.)arecommunicated routinelyandunderstood.

Ensureabilitytoeasilyaccess andcollecttimely,releva nt,a ndactionablefacilityinformationsharingwithhealthcarecoalitio ns.

Planforcommunicatingessential elementsofinformation(e.g.,bed a vailability,

resourceneeds,patients,illnesses/injuries,etc .)asneededo noperatingstatus.

Identifytr iggersthatactivatealerta ndnotificationprocessestohealthcarecoalitionpartners.

Addressdataprotectionmeasuresandproced uresforinformation technologysystems.

Identifyandutilizeint eroperable,redundantcommunicationsystems andplatformsamonghealthcarecoalitionpartners(e.g.,satellite,HAMradio,bedandresourcetrackingsystems).



COA 5 – Engage the Waiver and Regulatory Flexibilities ProcessItiscriticalthathealthcarefacilitiesunderstandSection1135oftheSocialSecurityAct,andthefullcomplementofregulatory flexibilities, includingrequestandapproval,thatmayallowthemimprovedbusinesscontinuityandfinancialrecovery.

PublicHealthEmergencyFollowingaPresidentialdeclarationofadisasterandwhenasection 319declarationhasbeenmadebytheSecretaryofHealthandHumanServices(HHS), itisimportanttounderstand that:

CertainMedicare,Medicaid,Childr en'sHealthInsurance Program (CHIP),andHIPAArequirementscan bewaivedormodifiedand

Grantsmaybeextended,orsanctionswaivedrelatingtosubmissionofdataorreports.

CMSWaiversandRegulatoryFlexibilities

In the months following Hurricane Harvey, healthcare facilities in impacted counties utilized CMS blanket waivers to successfully prevent gaps in access to care, including those providing emergency coverage of skilled nursing facility services without a qualifying hospital stay, adjusted data transmission requirements for home health agencies, critical access hospital bed and length of stay parameters, and for medical equipment suppliers in order to ease replacement burden.

Healthcare facilitiesshouldbe preparedtowritejustificationsand formallyrequestthroughtheirregionalCMSoffice, waiversfor regulatory flexibilityincludingthefollowing: Conditions of Participation – Facilities

mustmeetinordertoparticipateintheMedicareandMedicaidprogramsincludinghealthandsafetystandardspre‐approvalrequirement flexibility.

Licensure Requirements –Applicabletophysiciansandotherhealthcare staffthat requirelicensureinthe stateinwhichtheyprovideservices.

Survey and Certification –Coordinatingwithstatesurveyagenciesand accreditingorganizationsregardingflexibility tobalancepatientprotectionswithadisaster’scircumstances.

EMTALA–Sanctionsunderthe Emergency Medical Treatment and ActiveLaborAct(EMTALA)relating topatienttransfer and redirection flexibility.

Physician Self-referrals –Waiverofsanctionsregardinglimitations on physicianreferralsforarrangements that didnotmeet thecriteria forexceptions.

Out-of-Network Payments–Paymentstoout‐of‐networkhealthcareprovidersforitemsandservicesfurnishedto certainpatients.

Inpatient Beds –Modificationstoexpandthenumberofavailablebeds. Medicare Billing and Accelerated Payments– Relaxingof Medicarerequirements

includingthefee‐for‐servicepolicyandbilling,offeringacceleratedpaymentoptionstohealthcareproviders whosupplycareduringadisaster.



EMTALA Sanctions–WaivingEMTALAsanctionsfortransferringpatients tootherfacilitiesforassessment.

End Stage Renal Disease–Providingreimbursementto non‐traditionaldialysisfacilities.

Nursing Homes and Skilled Nursing Facilities –Modificationsaddressingthethree‐daypriorstayandminimumdatasetrequirements.

COA 6 –Increase knowledge of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and Waivers.

Although

not

suspended

during

Hurricane

Harvey,

the

HIPAA

Privacy

Rule

allowed

for

release

of

information

necessary

for

communication

with

public

health

and

law

enforcement

officials.

HIPPAregulationflexibilityallowspatientinformationtobesharedduringrecovery,enablingcareprovisionand improvedhealthcarefacility operations.Facility leadership, emergency management, and coalition members should understand and ensure compliance with these regulations. TheSecretaryofHHSmaywaive certainprovisionsofthePrivacy RuleundertheProject BioshieldActof2004(PL108‐276)andsection1135(b)(7)oftheSocialSecurityAct.

HIPAASanctionsandpenaltiesfor noncompliancethatcouldbewaivedinclude failures to: Obtainapatient’sagreementtospeak

withfamily membersorfriends;

Honorarequesttooptoutofthefacilitydirectory;

Distributeanoticeofprivacypractices;and

Providepatientswitharighttorequest privacyrestrictionsorconfidentialcommunications.

Healthcare facilitiesshoulddevelopHIPPAguidelinesandprotocolsaspartofemergencymanagementactivities andprovide just‐in‐time trainingguidanceon properuseandsharingofprotectedinformation.

COA 7 – Integrate Healthcare Facility Recovery into Comprehensive Community PlanningHealthcare facilitiesmayneedtoplanfora“newnormal”after a disaster and fullyengageinbroadercommunityrecoveryplanning.Facilitiesshouldconsiderpopulationdisplacementand return,any new geographic, businessandhousinglandscape,and evaluate economicconsiderations.

Healthcarefacilitiesshouldconsiderthefollowingcommunityrecoveryactivities:



Lookforopportunitiestoaddress unmetneedsandleveragecommunity governmentandhealthcarecoalitionpartnerrecoveryefforts.Thisenablesashared vision forlong‐termcommunityrecoveryandplanning.

Across TX, healthcare facilities are now engaging with their local community and business leaders on long‐term recovery planning, to include evaluating post‐disaster health needs of their populations, engaging on capital improvement project discussions, and evaluating economic viability strategies.

ReviewthemostrecentHHSASPRemPOWERprogramdataoncurrentMedicare recipientsusingelectricitydependentmedicaleq uipmentint heircounty/servicearea,asacommunityplanning indicatorforlong‐termhealthcaredemand.

EvaluatecurrentMedicaidrecipientsbydisasterimpactedcounty/serviceareaa ndagegroupas wellasuninsuredrates,forlong‐termhealthcaredemandandfinancial planningindicators.

Reviewcurrentchronicmedicalconditiondatafordisasterimpactedcounties/servicea reawithstate officialsasalong‐termrecoveryplanningindicatorforhealthcaredelivery.

Communicatetorecoveryplannersmajorshiftsindemandforhealthcareservicestohelpinformfutureplanningefforts.

RESOURCES

AlternateCareSites: https://asprtracie.hhs.gov/technical‐resources/48/alternate‐care‐sites‐including‐shelter‐medical‐care/47

ASPR,2017‐2022HealthcarePreparednessandResponse Capabilities–PHE.govhttp://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017‐2022‐healthcare‐pr‐capablities.pdf

ASPR,HealthcareCOOPandRecoveryPlanning:Concepts,Principles,T emplatesa ndResources http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc‐coop2‐recovery.pdf

CaliforniaHospitalAssociation: HospitalContinuityPlanningToolkit(ASPRTRACIECOOP/FailurePlanTC)h ttps://www.calhospitalprepare.org/continuity

Connerton, P.(2013).E thical Guidelines for the Development of Emergency Plans.American HealthCare Association. HealthcareFacilityEvacuation:https://asprtracie.hhs.gov/technical‐resources/57/healthcare‐facility‐evacuation‐sheltering/56.

Continuityo fOperations(COOP)Multi‐YearS trategyandProgram Management PlanTemplateGuide:Thisguideprovidesinstructionsfordeveloping aCOOPprogramhttps://www.fema.gov/pdf/about/org/ncp/coop_multi_year_plan_guide.pdf


https://asprtracie.hhs.gov/technical-resources/48/alternate-care-sites-including-shelter-medical-care/47

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017%E2%80%902022%E2%80%90healthcare%E2%80%90pr%E2%80%90capablities.pdf

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc%E2%80%90coop2%E2%80%90recovery.pdf

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc%E2%80%90coop2%E2%80%90recovery.pdf

https://www.calhospitalprepare.org/continuity

https://www.calhospitalprepare.org/continuity

https://asprtracie.hhs.gov/technical%E2%80%90resources/57/healthcare%E2%80%90facility%E2%80%90evacuation%E2%80%90sheltering/56.

https://www.fema.gov/pdf/about/org/ncp/coop_multi_year_plan_guide.pdf

https://www.fema.gov/pdf/about/org/ncp/coop_multi_year_plan_guide.pdf


EthicalGuidelinesfortheDevelopmentofEmergencyPlanshttps://www.ahcancal.org/facility_operations/disaster_planning/Documents/EthicalGuidelines fortheDevelopmentofEmergency Plans.pdf

Exercisesin Emergency PreparednessforHealthProfessionalsin CommunityClinicshttp://link.springer.com/article/10.1007/s10900‐010‐9221‐1

GeorgiaHospitalAssociationResearchandEducationFoundation, Inc.(GHAREF):Regional PlanningGuideforMaintainingEssentialHealth Services inaScarceResource Environmenthttps://www.gha911.org/circuits/library/docs/PlanningGuide082510.doc

Healthcare SystemRecoveryTimeline: A White Paperfor Texas,2017https://asprtracie.s3.amazonaws.com/documents/aspr‐tracie‐ta‐healthcare‐facility‐recovery‐timeline‐white‐paper.pdf

HHSResponseandRecoveryResourcesCompendium:http://www.phe.gov/emergency/hhscapabilities/Pages/default.aspx

HHS,SupplyChainDisaster PreparednessManual:https://www.cdc.gov/phpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm

HIPAAand Emergency PreparednessandResponse:http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/index.htm l

Hurricane Resources: https://asprtracie.s3.amazonaws.com/documents/aspr‐tracie‐hurricane‐resources‐at‐your‐fingertips.pdf

Instituteof Medicine.2012.Post ‐Incident Recovery Considerations of the Health CareService Delivery Infrastructure: Workshop Summary.Washington,DC: TheNationalAcademies Press. https://doi.org/10.17226/13442.

Instituteof Medicine.2015. Healthy, Resilient, and Sustainable Communities AfterDisasters: Strategies, Opportunities, and Planning for Recovery.Washington,DC:TheNationalAcademies Press. https://doi.org/10.17226/18996

KansasDepartmentof Healthand Environment:ContinuityofOperationsPlanGuidanceDocumenthttp://www.kdheks.gov/cphp/download/Hospital_COOP_Guidance_Document.doc

Pre‐Storm Checklist:https://www.ynhh.org/~/media/files/emergency/prestormchecklist_ynhhscepdr.pdf

ProcessFlow:Disclosingprotectedhealthinformation:https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/emergency/emergencyprepdisclose.pdf

PublicHealthEmergency–MedicalAssistance:http://www.phe.gov/Preparedness/support/medicalassistance/Pages/default.aspx

U.S.DepartmentofHealthandHumanServices,Officeof theAssistantSecretary ofPreparednessandResponse(2015). HealthcareCOOPand Recovery Planning:


https://www.ahcancal.org/facility_operations/disaster_planning/Documents/Ethical Guidelines for the Development of Emergency Plans.pdf

http://link.springer.com/article/10.1007/s10900%E2%80%90010%E2%80%909221%E2%80%901

https://www.gha911.org/circuits/library/docs/PlanningGuide082510.doc

https://www.gha911.org/circuits/library/docs/PlanningGuide082510.doc

https://asprtracie.s3.amazonaws.com/documents/aspr%E2%80%90tracie%E2%80%90ta%E2%80%90healthcare%E2%80%90facility-recovery%E2%80%90timeline-white-paper.pdf

http://www.phe.gov/emergency/hhscapabilities/Pages/default.aspx

https://www.cdc.gov/phpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/index.html

ttps://asprtracie.s3.amazonaws.com/documents/aspr%E2%80%90tracie%E2%80%90hurricane%E2%80%90resources%E2%80%90at%E2%80%90your%E2%80%90fingertips.pdf

https://doi.org/10.17226/13442

https://doi.org/10.17226/13442

https://doi.org/10.17226/18996

https://doi.org/10.17226/18996

http://www.kdheks.gov/cphp/download/Hospital_COOP_Guidance_Document.doc

http://www.kdheks.gov/cphp/download/Hospital_COOP_Guidance_Document.doc

https://www.ynhh.org/~/media/files/emergency/prestormchecklist_ynhhscepdr.pdf

https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/e mergency/emergencyprepdisclose.pdf

http://www.phe.gov/Preparedness/support/medicalassistance/Pages/default.aspx

http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc%E2%80%90coop2%E2%80%90recovery.pdf%20


Concepts, Principles, TemplatesandResources.http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc‐coop2‐recovery.pdf

U.S.GovernmentAccountabilityOffice.(2015). HurricaneSandy:AnInvestmentStrategyCouldHelptheFederalGovernment EnhanceNationalResilience forFutureDisasters.

1135Waivers: https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/SurveyCertEmergPrep/1135‐Waivers.html

CONTACTS

Health and Human Services – Region VI1301YoungStreet,Suite1124Dallas,TX75202Phone:(214)767‐[email protected]

Office for Civil Rights, Southwest Region1301YoungStreet,Suite1169DallasTX75202Phone:(800)368‐1019Email: [email protected]





http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/hc%E2%80%90coop2%E2%80%90recovery.pdf%20

ttps://www.cms.gov/Medicare/Provider%E2%80%90Enrollment%E2%80%90and%E2%80%90Certification/SurveyCertEmergPrep/1135%E2%80%90Waivers.html


Workforce Issues

COMMON ISSUES

Issue 1: Afteradisaster,healthcare facilitystafffacemanybarriers impactingtheirability

toreportforwork.

Issue 2: Short‐andlong‐termpost‐disasterimpactstohealthcareworkersaffecttheirwell‐

beingandabilitytowork.

Issue 3: Insufficientstaffinglevelscanjeopardizesafetyandsustainabilityofthe care

provided.


During Hurricane

Maria

recovery

efforts,

healthcare facilities

in Puerto

Rico

provided staff a full range

of services,

including overnight

and multi‐day

stay accommodations,

laundry

facilities,

and childcare

to ensure

staff

resiliency

and

retention. This increased

staff readiness

and availability ‐enabling

staff

to see

patients in areas

where

road closures

had impacted

access

to care.

COA 1 – Increase Post‐Disaster Workforce ResilienceStaffinglevelsarecriticaltoprovidingcommunitycareandkeeping healthcarefacilitiesoperational post‐disaster,promptingconsiderationofanumber ofresiliencestrategies.

Encourage stafftocreatedisasterpreparednessplansaddressingindividualbarriers.

Providejust‐in‐timetrainingrelativetotheemergency,staying safe andperforming criticalduties.

Developstaffrotationplanstolimitfatigue.

Inadvance, identifystafftransportationandlodging alternatives.

Executeplanstoprovideonsitemealstostaff.

Developactionablechildcaresolutions.

Providelaundryserviceonsiteforstaff.

Equip,train,andprovideresourcestoprotectstaffandfamilies(personalprotectiveequipment, medical countermeasures, etc.).

Workforce 16

Consider pet care solutions.

COA 2 – Provide Post‐Disaster Behavioral Health Resources to StaffBehavioralhealthresourcesadministeredby trainedprofessionalscanhelpstaffmanagephysical,emotionalandfinancialstress impacting their well‐beingand healthcarefacilityoperations.

Encourage healthylifestyles.


Developfamilyemergencyplans.

Conductpsychologicalfirstaidincludingworkplaceviolencereduction.

Provideaccesstoemployeeassistanceprograms,includingprofessionalbehavioralhealthservices.

Anticipateongoingpost‐disaster behavioral healthneeds.

Workforce 17

Train staff to recognize signs and symptoms of psychological stress in their

cowork ers.

During Hurricane Maria recovery, healthcare facilities in Puerto Rico implemented workforce resiliency strategies to ensure trained behavioral health specialists were onsite at all times to help other staff manage physical emotional, and financial stress.

COA 3 – Plan to Use Volunteers/Donations

TX

healthcare

entities

across

coalitions

used

social

networks

during

Hurricane

Harvey

to

seek

volunteer

nurses

from

across

the

country,

in

addition

to

the

state’s

volunteer

registry

of

licensed

health

professionals.

Application

processes

were

also

developed

to

assist

licensing

of

out‐of‐state

providers.

Healthcare facilitiesshouldleveragestateand localvolunteer programstoestablishMemorandaofUnderstandings(MOUs)tosupportthevetting,intake,andcoordinationofmedicalvolunteers.

Estimatetheanticipatednumberofvolunteerhealthcarestaff needed basedonriskassessments.

Leverageexistinggovernmentand non‐governmentalvolunteerregistrationprograms(e.g.,EmergencySystem forAdvanceRegistrationofVolunteerHealthProfessionals[ESAR‐VHP]andMedicalReserveCorps[MRC])toverifylicensesandcredentials.

Developprivilegingbylawsdefiningactivityscopeandotherconsiderations.

Identify andaddress volunteerliability,scopeofpractice,andthird‐partyreimbursementissues that maydetervolunteeruse.

Consideraddressinghowtohandle receiptofdonationsandmechanismstotrackandensure effectiveutilization infacilityemergencyplansby: Proactivelyworkingtocoordinate andmanageunsoliciteddonatedgoods,and

byengagingbusinessesincommunityplanningefforts; Preparingalistofprioritizedequipmentneeds indicating desiredspecifications; Utilizing nationaldonationnetworksthatoffersupporton‐line; and Ensuringpropercommunicationwithpartners duringresponseand recovery

operations.

RESOURCES

ASTHOEmergencyVolunteerT oolkit: KeyEmergencyResponseVolunteerConcepts:http://www.astho.org/Programs/Preparedness/Public‐Health‐Emergency‐Law/Emergency‐Volunteer‐Toolkit/Key‐Emergency‐Response‐Volunteer‐Concepts/

http://www.astho.org/Programs/Preparedness/Public%E2%80%90Health%E2%80%90Emergency%E2%80%90Law/Emergency-VolunteerToolkit/Key-Emergency-Response-Volunteer-Concepts/


CorporationofNational& CommunityService (2018):https://www.nationalservice.gov/resources/disaster‐services/managing‐unaffiliated‐volunteers‐times‐disaster

DisasterBehavioralHealth CapacityAssessmentTool:http://www.phe.gov/Preparedness/planning/abc/Documents/dbh‐capacity‐tool.pdf

SubstanceAbuseand MentalHealthService Administration(SAMHSA):https://www.samhsa.gov/disaster‐preparedness

TheTexas DisasterVolunteerRegistry:https://www.texasdisastervolunteerregistry.org/

USDHHS,PHE,EmergencySystemfor Advance RegistrationofVolunteerHealthProfessionals(ESAR‐VHP): https://www.phe.gov/esarvhp/Pages/about.aspx

CONTACTS

SAMHSA Region VI1301YoungStreetSuite1030Dallas,TX75202Website: https://www.samhsa.gov/about‐us/contact‐us

Texas Disaster Volunteer Registry for Medical, Public Health and Lay Volunteer RespondersPhone:(512)776‐2651Website: https://www.texasdisastervolunteerregistry.org/

Workforce 18

https://www.nationalservice.gov/resources/disaster%E2%80%90services/managing%E2%80%90unaffiliatedvolunteers%E2%80%90times-disaster

http://www.phe.gov/Preparedness/planning/abc/Documents/dbh%E2%80%90capacity%E2%80%90tool.pdf

https://www.samhsa.gov/disaster%E2%80%90preparedness

https://www.texasdisastervolunteerregistry.org/

https://www.phe.gov/esarvhp/Pages/about.aspx

https://www.phe.gov/esarvhp/Pages/about.aspx

https://www.samhsa.gov/about%E2%80%90us/contact%E2%80%90us%20




Training and Testing Issues

COMMON ISSUE

Issue: Healthcarefacilitiesmaybe challengedwithdevelopingandmaintainingtrainingandtesting programs,alignedto emergencyplansandriskassessments,topreparefacilitiesandstafffordisasterresponseandrecovery.


Healthcare facilities near Houston regularly participate in communication drills and regional exercises as part of the Southeast Texas Regional Advisory Council or SETRAC healthcare coalition. Testing and training programs provided the solid foundation for many lifesaving transfers that occurred during Hurricane Harvey.

COA – Implement Strategies and Actions to Fully Develop and Maintain Facility Training and Testing ProgramsHealthcare facilitiesmayconsider actions for developingimprovedtraining and testingprogramstoimprovestaffreadinessduringdisasteroperations andrecoverysuchas:

Ensuringhealthcarefa cilitieshaveexpertiseinperformin g riskassessmentsanddevelopingemergencyplansthatincludedetailedstaffrolesandrequiredactions.

Developing disastertrainingspecifictoallstafflevels,including clinical,non‐clinical,administrative,andseniorleadership(e.g.,knowledge, skills,andabilities(KSAs)).

Creatingandexecuti ngt estingprogramsthatchallengestaffKSAstohelpidentify gapsandneeds.

Integratingresponders afetyand healthintoemergencyplans,andt rainingandtesting.

Developinga ndreviewingaftera ctionreportsincludingfacility,component,andstaffcorrectiveactio nsandupdate e mergencyp lansbasedonle ssonsl earned.

Ensuring thatplansincluderedundant communicationplatformsandprotocols,seamlessstaff operational planninga ndfullseniorleadershipengagement.

Engaginghealthcarecoalition expertisetoprovideresponseand recoveryeducationandinstructiontostaff, contractors,andvolunteersandensurefacility trainingandtestinggoals.

Engagingwiththepreparednessandresponse community, includinghealthcare coalitionsandlocal/stateemergencymanagementagenciesafter adisasteror exercisetodebrief,plancorrectiveactions,andintegraterecovery.

Utilizing Incident Command Systemsandprinciples.

Training, Testing, and Exercise 19


RESOURCES

ASPR,2017‐2017HealthcarePreparednessandResponse Capabilities–PHE.gov:http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017‐2022‐healthcare‐pr‐capablities.pdf

Emergency PreparednessRequirementsfor MedicareandMedicaidParticipating

EmergencyP reparednessRule: https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/SurveyCertEmergPrep/Emergency‐Prep‐Rule.html

ProvidersandSuppliers: https://asprtracie.hhs.gov/cmsrule

Healthcare SystemRecoveryTimeline: A White Paperfor Texas,2017https://asprtracie.s3.amazonaws.com/documents/aspr‐tracie‐ta‐healthcare‐facility‐recovery‐timeline‐white‐paper.pdf

Instituteof Medicine.2012.P ost‐Incident Recovery Considerations of the Health CareService Delivery Infrastructure: Workshop Summary.Washington,DC: TheNationalAcademies Press. https://doi.org/10.17226/13442.

Instituteof Medicine.2015.H ealthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery.Washington,DC:The NationalAcademies Press. https://doi.org/10.17226/18996

U.S.GovernmentAccountabilityOffice.(2015). HurricaneSandy:AnInvestmentStrategyCouldHelptheFederalGovernment EnhanceNationalResilience forFutureDisasters.

CONTACTS


Training, Testing, and Exercise 20


http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/2017%E2%80%902022%E2%80%90healthcare-pr-capabilities.pdf

https://asprtracie.hhs.gov/cmsrule

https://asprtracie.hhs.gov/cmsrule

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html

https://asprtracie.s3.amazonaws.com/documents/aspr%E2%80%90tracie%E2%80%90ta%E2%80%90healthcare%E2%80%90facilityrecovery%E2%80%90timeline-white-paper.pdf

https://doi.org/10.17226/13442

https://doi.org/10.17226/13442

ttps://doi.org/10.17226/18996

ttps://doi.org/10.17226/18996


Resource Directory

ASPRTRACIE(https://asprtracie.hhs.gov/)isahealthcareemergencypreparednessinformationgatewaythatensuresthatallstakeholders‐at thefederal, state,local,tribal,andterritorialgovernmentlevels;innongovernmentalorganizations;andinthe private sector‐haveaccesstoinformationandresourcestoimprovepreparedness,response,recovery,andmitigationefforts.

Thefollowingtopiccollectionshighlightkeyresourcesunderspecifichealthandmedicalpreparednesstopics.Collectionsincludepeer‐reviewedas well asotherpublicandprivatelydevelopedmaterialssuchasfactsheets,reports,technicalbriefs,white papers, articles,bulletins, toolkits,webinars,plans,guidelines,bestpractices, lessonslearned,andtemplates.

TopicCollection:AccessandFunctionalNeeds. Thisresourcedescribesthenationalstandardfor shelteroperations thatintegrate peoplewith disabilitiesandotherwithaccessand functionalneedsinto generalpopulationshelters.

TopicCollection:Alternate CareSites(includingshelter medicalcare). Thisresourcecontainstoolsfordevelopingand activatingalternatecaresites(ACS).

TopicCollection: ContinuityofOperations. Thisresourcehasbeen designedtohighlightselectedplansandplanningguidance,lessonslearned,tools,andpromisingpractices forhealthcare facility COOP.

TopicCollection: Crisis Standards ofCare. Theprovision ofmedicalcareundercatastrophicdisasterconditions requiresconsiderablepre‐eventplanning,alongwiththerecognitionthat the deliveryof healthcareserviceswilllikelychangeduetothepotentialscarcityofrequiredresources.

TopicCollection:DisasterEthics. Thisresourceisdesignedtohelphealthcareprofessionals,planners, andcommunitiesidentify,planfor,andaddressethicalchallengestheymayface before, during,andafteradisaster.

TopicCollection:DisasterVeterinaryIssues. Thisresourceisdesignedtohelpveterinarians,emergencyplanners,thoseinthefarmingandwildlifepreservation

Resource Directory 21

https://asprtracie.hhs.gov/


industries, andresidentswithpets andserviceanimalsbetter planfor andrespondtodisasters.

TopicCollection:HealthcareFacilityEvacuation/Sheltering. Thisresourceisdesigned tohelphealthcarefacilitystaffdevelopevacuationandshelteringplansand facilitate theirtrainingand exercisedevelopment.

TopicCollection:Healthcare‐RelatedDisaster Legal/Regulatory/FederalPolicy. This collectionhighlightsselectlaws,keyissues,lessonslearned, tools,andpromising practices thatcanhelp healthcare professionalsbetterunderstandtheenvironment in whichtheywillbeaskedtorespondduringlarge‐scaleemergencies.

TopicCollection:InformationSharing. Thisresourceisdesignedto highlightguidance andlessons learnedon information sharing.

TopicCollection:Mental/BehavioralHealth(non‐responders). Articlesin thistopic collectionaddressspecificnatural disastersandhazardsandelementsoftheirplanning.

TopicCollection:NaturalDisasters. Articles in thistopiccollectionaddressspecific naturaldisastersandhazards and elementsoftheirplanning.

TopicCollection:PatientMovementand Tracking(forwardmovementofpatients, trackingandtrackingsystems). Thisresourceincludesinformation onpatient movementfromareahealthcare facilitiesand trackingthatcan helpemergency planners andresponderslearnmoreaboutvariouslevelsofassistance available,howto requestit,howitisactivated, andlessonslearnedfromrecentevents.

TopicCollection:Recovery Planning. Theresourcesinthiscollection highlightplanning guidance/guidelines,tools,lessonslearned,andpromisingpracticestoassisthealthcare emergency plannerswithrecovery planning.

TopicCollection:ResponderSafetyandHealth. Thiscollectioni sdesignedtohelp disasterresponderscreateasafeandhealthy workforce to betterprovidethe community withan effective,comprehensive responseandrecovery.

TopicCollection:VolunteerManagement. Theresources inthiscollectioninclude guidance andstrategies,targetedlegalinformation, andplanningtemplatestoassist healthcarefacilitieswithsuccessfullyincorporatingvolunteersintotheirdisaster managementplans.

CMSandDisasters:ResourcesatYourFingertips. Thisdocumentprovidesinformation andresourcesfor CMSdisasterandemergency relatedprograms, includinginformation ontheCMS Emergency PreparednessRule.

DisasterBehavioralHealth:ResourcesatYourFingertips. Thisdocumentprovides information onandlinks toselectdisasterbehavioralhealthprogramsandresources.

Emergency Prescription Assistance Program(EPAP):OverviewFact Sheet. The EPAP is fundedbytheStafford Actanddesignedtohelpdisastersurvivorsaccessprescription medicines.



FederalPatientMovementOverviewFactSheet. Whenastaterequestsfederalsupport tomovepatients,HHS,asthelead federalagency,willimplementthe patientmovement system.

HIPAAand Disasters: WhatEmergencyProfessionalsNeedtoKnow. Thisguide is designedto answerfrequentlyaskedquestionsregarding therelease ofinformation aboutpatientsfollowinganincident.

Hurricane ResourcesatYourFingertips. This documentprovides numeroushurricane‐relatedresourcesapplicableto avarietyofstakeholdersandaudiences.

PARTNER RESOURCES

CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning. State and local jurisdictions can use this guide to better organize their work, plan their priorities, and decide which capabilities they have the resources to build or sustain. The capabilities also help ensure that federalpreparednessfundsaredirected topriorityareaswithin individualjurisdictions.

USDepartmentofLaborWebsiteforFloodRecoveryAssistance. TheU.S.Departmentof Laborassistsinrecoveryefforts in thecommunitiesaffectedbyfloods.

Hurricane ResponseandRecovery. Thisresourcecanhelpindividuals,families, communities,andprofessionalsstayup‐to‐dateandrecoverfrom thestorms.

Hurricane ReadyBusinessToolkit. TheReadyBusiness Programallowsuserstotake actiontoprotectemployees,protectcustomers,andhelpensure businesscontinuityfor Hurricanes andtropicalstorms.

PublicHealthEmergency. TheHHSASPRprovidessupportfor emergenciesandpreparedness.

Presentation:1135Waivers andtheEmergencyPreparednessRule. CMSdiscussesregulations and1135 Waivers.


HealthcareRecoveryGuide(HurricaneHarvey)

ResourceDirectory 24