2010 Round 1 meeting - Region 3 - Louisiana Hospital Association

FY 09-10
HHS ROUND 1 MEETING
THIBODAUX OPH OFFICE
Houma, LA
Region 3
February 2, 2010
9:00 AM to 12:00 NOON
Attendees: 12 of 16 hospitals attended: Assumption Community Hospital; Franklin
Foundation Hospital; Lady of the Sea General Hospital; Leonard J. Chabert Medical Center;
Ochsner-St. Anne General Hospital; Physicians Medical Center; River Parishes Hospital; St.
Charles Parish Hospital; St. James Parish Hospital; Teche Regional Medical Center;
Terrebonne General Medical Center; Thibodaux Regional Medical Center; 75% of the
hospitals were present.
Non-Attendees: 4 of 16 hospitals failed to attend: Physicians’ Alliance Hospital of Houma;
Specialty Rehabilitation Hospital of LaPlace; Specialty Rehabilitation Hospital of Luling; St.
Charles Specialty Rehabilitation Hospital; 25% of the hospitals were not present.
Guests:
Kim Beetz, Region 3 ADRC; Asha Smith, HHS/LHA; Alicia Prevost, Robin Williams,
DHH/OPH; Ann Bruno, Lafourche OPH; Deborah Gautreaux, Lafourche Ambulance; Chad
Davis, Acadian Ambulance; Brady Daigle, Lafourche Ambulance; Chris Boudreaux,
Lafourche OEP
Announcements:
Region 3 has a regional Strategic National Stockpile (SNS) plan that is being updated.
Welcome and Introductions:
Kim Beetz, Region 3’s Administrative Designated Regional Coordinator, welcomed everyone
and then called the meeting to order at 9:00am.
HHS Emergency Preparedness Associate, from the Louisiana Hospital Association, Asha G.
Smith, presented a Power Point on the Health and Human Services (HHS) Hospital
Preparedness Grant program. She reminded the group that the 2008-2009 traditional grant
funds were released back in June of 2009. Documentation for this grant period is due Friday,
February 5, 2010. Hospitals are encouraged to get their documentation in to the grant staff as
soon as possible.
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2009-2010 Grant:
For the 2009-2010 grant year, Louisiana received $5,188.408, a decrease of $507,786 from the
previous year, in traditional grant funds. Louisiana also received $1,267,023 in Pandemic
Flu/H1N1 Grant Funds. These funds were given to one hospital in each region to spend on
behalf of the region in November 2009. Regions were directed to spend funds on personal
protection equipment, ventilators, Points of Dispensing (POD) planning, rapid flu aid tests,
and/or education and training.
2009-2010 Grant Changes:
Mrs. Smith indicated that there are several changes in the grant process for the 2009-2010
grant year. The changes are:
(1) Project Period - The project period is normally a 12 month grant cycle. In Louisiana,
the first 3 to 4 months are used for planning. The allocation model determines how
much each hospital will receive. This year, the 2009-2010 grant year, the budget period
is only for 9 months. The budget period runs from August 9, 2009 – June 30, 2010.
This means that hospitals will have less than time to spend funds.
(2) Distribution of Fund – The grant specifies that 75% or more of the funds be
distributed to the hospitals and emergency medical services. This is not really a change
as Louisiana has always done this in the past, but wanted to point this out to the
hospitals. The remaining 25% is used for administrative cost, which includes grant
staff salaries and benefits, software programs including the ESAR-VHP system and
EMSystem, maintenance of equipment and continuing education units for our training
programs.
(3) Maintenance of Funding – The grant indicates that a State’s general funds must have
a budget not less than the average of FY07 and FY08 HHS grants dedicated toward
emergency preparedness. Louisiana has been using the Louisiana Emergency Response
Network (LERN) to meet this requirement.
(4) Continuation of funds in FY10, FY11 based on availability of the funds – HHS has
indicated that we can expect funding to continue for the next 3 years, including the
2009-2010 grant. The funds may however decrease.
(5) Match Requirement – The HHS grant is now requiring that States match 5% of their
grant funds. For future years, we anticipate that the match will increase to 10%.
Looking back, hospitals have already been spending an average of 9% over the amount
awarded. Hospitals are not asked to spend additional funds (unless needed), but are
now asked to start documenting the emergency preparedness and response purchases
they make every year.
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Hospitals can document the 5% match in two ways for the FY09-10 grant:
•
Direct in-kind cash-Hospitals can submit receipts that document the 5% match
amount. Examples of direct in-kind match include costs incurred by the facility
that are more than the reimbursable amount. These costs could be vents,
circuits, oxygen, generators, and communication equipment that
directly/indirectly support the Emergency Preparedness plan for the hospital or
for the region; and/or
•
In-kind staff time-Hospitals can show the match with in-kind staff time for
attending emergency preparedness meetings. If the facility chooses to
demonstrate the match in staff time, then required documentation such as signin sheets, meeting agenda and a cost summary showing a reasonable dollar
value must be submitted so as to support the dollar amount of the in-kind staff
time.
By reporting this match in either direct in-kind cash and/or in kind staff time, the
facility is attesting that the matching claim will also not be used as a claim for other
federal or state reimbursements.
(6) Reimbursement Method - This year, no up-front funds will be provided to hospitals.
All funds plus the 5% match must be spent before reimbursement will be given. To be
reimbursed, your facility must submit Acceptable Documentation with Proof of
Payment or your facility will not be reimbursed. Acceptable Documentation with Proof
of Payment includes:
• Receipts stamped “Paid” along with the “check number” and “date paid”.
• Copies of the corresponding check(s) used to pay invoice/receipt.
• Invoice(s) indicating items have been paid with a credit card. Credit card
payments must be accompanied by the credit card statement and proof of
payment of the credit card statement.
• If claiming sales taxes that are not listed on the invoice/receipt, documentation
supporting your tax percentage should also be submitted.
The Louisiana Hospital Association will cut reimbursement checks within 15 days of
receipt of funds from the Department of Health and Hospitals. This process should be
completed within 60 days from the documentation deadlines.
(7) Submittal of Receipts - In the past facilities were required to mail in a copy of their
documentation along with an expenditure form. Now, hospitals will be required to use
an electronic expenditure tracking system for submittal of grant documentation. The
electronic expenditure tracking system can be found on the LHA homepage at
www.lhaonline.org or at http://lagrantmanagement.com. Hospitals will be required to
upload as well as mail in all copies of Acceptable Documentation with Proof of
Payment. Training on the use of the electronic expenditure tracking system will begin
in February 2010.
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2009-2010 Spending Process and Participation Agreements:
Mrs. Smith indicated that participation agreements will be sent out by the end of January and
hospitals must agree to participate and follow the rules of the agreement. Hospitals must
include the 5% match in their budget proposals. The HHS staff is strongly encouraging the
hospitals to submit all documentation at the one time. Hospitals will not have to obtain
purchase orders by a certain deadline this year. There will only be a receipt deadline, in which
hospitals must obtain final invoices and pay for grant expenditures.
Acceptable
receipts/invoices and proof payments for the 2009-2010 grant year must be dated from
September 10, 2009 - June 1, 2010. Any expenditures or proof of payments dated before are
after this time period will be not be accepted. Mrs. Smith provided the hospitals a copy of their
participation agreement and asked them to let the HHS staff know as soon as possible if they
are not planning to participate. If not, hospitals need to complete a declination form, which
will be included in the participation agreement packets.
Mrs. Smith also indicated that HHS grant funds cannot be used for new construction or to pay
for subscription charges for blackberries and cell phones for hospital employees. Vaccines and
antivirals are allowable this year, but hospitals are being strongly encouraged to spend their
funds in other areas. Hospitals will need to get pre-approval if they are planning to do any
retrofitting or planning to purchase security equipment and/or storage trailers or lease
warehouse space. Hospitals that have received approval for leasing storage space in the past
do not need to request approval again this year.
Mrs. Smith stressed that hospitals that signed up for the Telecommunication Services Priority
(TSP) must submit documentation for the installation and monthly subscription costs or a letter
stating they have the service, if it was free of charge.
Regional Goals and 2009 Needs Assessment Data:
Mrs. Smith informed the group that funds were initially pushed out for bioterrorism in 2004.
In 2004, hospitals developed 3 year planning goals to purchase surge beds, isolation beds,
redundant communications, pharmaceuticals, decontamination and PPE equipment. The focus
shifted towards all-hazards planning in 2007, with an emphasis on pandemic flu, and 5 year
planning goals were developed. Hospitals are currently in Year 2. Year 3 begins with the
2009-2010 HHS grant.

Surge Bed, Ventilator, PPE and Mass Fatality Goal - A hospital needs assessment
survey was sent out to the hospitals back in October 2009. The purpose of the survey
was to assess the hospitals’ capabilities and to ensure hospitals are meeting their grant
goals. The grant goals and responses for surge bed, ventilators, PPE, and mass fatality
from the HHS needs assessment survey were reviewed with the hospitals. Mrs. Smith
indicated that most hospitals have met their 2 week supply of PPE goal for the year, but
the hospitals will need to reevaluate their PPE inventory as some hospitals used some
of their stockpile for the H1N1 event. Most hospitals have also met their surge bed and
ventilator goals, but hospitals need to work on meeting their mass fatality goals.
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Hospitals should work with community partners to identity storage space or purchase
equipment to increase internal storage capacity.

Critical Care Goal – Hospitals postponed working on the critical care bed goal for the
first two years as hospitals felt it would be difficult to obtain a critical care bed with the
amount of grant funds they receive. The goal was to develop an alternative definition
of a critical care bed for a pandemic influenza event. This was taken to the Pandemic
Influenza Clinical Forum for recommendations. The committee indicated that a
standard critical care bed includes 1 electrical outlet, 1 50 PSI oxygen outlet, 1 50 PSI
air outlet; 1 Suction outlet; 1 Pulse oximetry (non-portable), 1 Ventilator; 1 Cardiac
Monitor and appropriate staff members, depending on the hospital. They recommended
that each region adopted an altered definition of a critical care bed, which includes: 1
electrical outlet, 1 50 PSI oxygen outlet, 1 50 PSI air outlet, 1 suction outlet or portable
suction outlet and 1 portable pulse oximetry. This altered definition will help hospitals
meet their critical care bed goal. This altered definition is basically a standard medical
surge bed with added outlets.
Each region needs to decide if they will begin this year meeting the critical care bed
goal (33% of the 2012 goal) or next year (50% of the 2012 goal) so it can be added to
Attachment A.
Hospital Site Visits:
The Office of Inspector General recommended that Louisiana conduct site visits in their 2008
audit findings. Site visits were conducted at 10 hospitals across the state in 2009. One hospital
in every region was chosen, with two hospitals in region 4. Overall hospitals did an excellent
job in tracking grant expenditures.
Objectives included ensuring the hospitals have purchased the equipment they reported to the
HHS grant staff by comparing grant documentation to actual equipment. It was also
recommended to physically view the hospital’s grant purchases and ensure equipment is being
maintained and rotated.
Some of the recommendations from the site visits included: tagging HHS grant purchases;
placing equipment along with the property tag information on an inventory sheet and keeping
copies of the HHS grant documentation in both the accounting department and in the
coordinator’s grant files. A form has been created and is located in the packet to assist
hospitals in tracking their HHS equipment. Hospitals should add a column to indicate on the
spreadsheet what grant year these purchases were purchased in. All grant records should be
kept in a fire proof filing cabinet.
Pandemic Flu Planning Update:
Pandemic Clinical Forum subcommittees were developed to help address surge and staffing
issues within hospitals. Within the Pandemic Flu Clinical Forum, a hotline subcommittee was
established to develop a hotline to assist in minimizing the surge on hospitals. A ventilator
subcommittee was also developed and is helping to identify the most cost effective types of
ventilators that would be helpful in treating pan flu patients.
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The Altered Standards of Care subcommittee is working on identifying standards that may
need to be altered or relaxed during a pandemic. The Institute of Medicine (IOM) released a
report, which identified three (3) levels of care:
• Conventional - routine “business as usual”
• Contingency - functionally equivalent but adapts space, staff, and supplies in response
to a surge demand-State Hospital Pan Flu Plan
• Crisis (Altered Standard) - substantial change in level of care; usual safeguards are no
longer possible and available resources are insufficient to meet usual care standards.
Executive order will be needed for crisis standards of care.
Each region is asked to develop a regional crisis of care plan. Region 2 has taken the initiative
and is the first region to develop their plan. The plan is being shared with the other regions to
help jump start their planning.
EMSTAT:
Due to the data reporting limitation of EMSystem, EMSTAT was created to ensure facility
status reports could be delivered to the Secretary and Governor in a timely fashion. Hospitals
and Nursing Homes are required to report information via EMSTAT during a State Declared
Disaster.
Participation in EMSTAT is also a requirement of the HHS grant. Hospitals must complete the
census, Influenza Like Illness (ILI) and HHS sections of EMSTAT every Wednesday by 10
am. In response to the H1N1 event, hospitals must report the number of people presenting to
their hospital with influenza like illness (ILI). The purpose of the data is to gather a snapshot
of the number of ILI cases within hospitals and to gauge hospital surge capacity.
Once
hospitals have completed data entry into these three tabs on EMSTAT, their HHS reporting
obligation is complete.
Adjournment:
The meeting ended at 12:00 noon.
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