Coronavirus-Related Supplemental Funding Allowable Uses Technical Assistance Resource

Background

The Health Resources & Services Administration (HRSA) awarded nearly $2 billion to health centers in fiscal year (FY) 2020 to address COVID-19, including testing and related services, through the following supplemental funding opportunities:

• Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Award Name: COVID-19, Activity Code: H8C) to prevent, prepare for, and respond to COVID-19,
• Coronavirus Aid, Relief, and Economic Security (CARES) Act (Award Name: CARES, Activity Code: H8D) to detect coronavirus, prevent, diagnose, and treat COVID-19, and maintain current health center capacity and staffing levels, for the duration of the national emergency,
• Paycheck Protection Program and Health Care Enhancement Act (Award Name: Expanding Capacity for Coronavirus Testing (ECT), Activity Code: H8E) to support purchasing, administering, and expanding the organizations’ capacity for testing to monitor and suppress COVID-19, and
• Paycheck Protection Program and Health Care Enhancement Act (Award Name: FY 2020 Health Center Program Look-Alikes: Expanding Capacity for Coronavirus Testing (LAL ECT), Activity Code: L1C) to support purchasing, administering, and expanding the organizations’ capacity for testing to monitor and suppress COVID-19.

Purpose

Health center award recipients are required to submit quarterly progress reports to report on and demonstrate the impact of activities funded under HRSA’s coronavirus-related supplemental funding. This document is a technical assistance resource designed to support health center award recipients and provide suggested guidance to best categorize each allowable use activity with the five major categories that health centers will respond to in the quarterly progress report:

1. Staff and Patient Safety
2. Testing
3. Maintaining or Increasing Health Center Capacity and Staffing Levels
4. Telehealth
5. Minor A/R

** Please note, this document serves as suggested guidance only and does not establish requirements for how to report. This list is not all-inclusive and is meant to assist health centers in determining what category to document activities. Health centers should enter each activity into the most relevant category.

Coronavirus-Related Funding Activities

Please note, the first four sections, Reporting Categories 1 to 4, only apply to LAL ECT, Activity Code: L1C.

Reporting Category 1: Staff and Patient Safety

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Award Name: COVID-19, Activity Code: H8C)

• Perform outreach and provide patient and community-wide education on hand hygiene, cough etiquette, and COVID-19 transmission, using existing materials where available.
• Disseminate educational materials on precautions to prevent, contain, or mitigate COVID-19 and other respiratory illnesses.
• Refresh training for all staff on standard, contact, and airborne precautions, and infection control procedures, including administrative rules and engineering controls, environmental hygiene, and appropriate use of personal protective equipment. Health centers may consider using the Centers for Disease Control and Prevention’s (CDC) pre-pandemic training HRSA BPHC exit disclaimer for influenza, which is recommended for COVID-19.
• Review your infection control plan and make necessary adjustments to align with CDC Guidelines for Environmental Infection Control in Health-Care Facilities.
• Train staff, establish workflows, and designate separate space to screen patients prior to entering communal areas of the health center so that those who may be infected with COVID-19 can be isolated.
• Train staff, establish workflows, and designate separate space for clinical and administrative services for persons under investigation and those testing positive, including temporary and non-fixed barriers.
• Purchase supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer that contains 60-95% alcohol, tissues, and no-touch receptacles for disposal.
• Purchase personal protective equipment (PPE) for health center personnel and infected patients, including National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators for health center personnel.

CARES Act (Award Name: CARES, Activity Code: H8D)

• Refresh training for all staff on standard and contact precautions, respiratory hygiene, and infection control procedures, including administrative rules and engineering controls, environmental hygiene, and appropriate use of personal protective equipment (PPE). Health centers may consider using the Centers for Disease Control and Prevention’s (CDC) pre-pandemic training for influenza, which is also recommended for COVID-19.
• Review your infection control plan and make necessary adjustments to align with CDC Guidelines for Environmental Infection Control in Health-Care Facilities.
• Ensure and enhance as needed to align with evolving recommendations, implementation of infection control plans and procedures, particularly regarding surface, space, clothing, and instrument cleaning/sanitization.
• Train staff, establish workflows, and designate separate space for clinical and administrative services for persons under investigation and those testing positive for coronavirus.
• Purchase and post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette.
• Purchase supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer that contains at least 60% alcohol, tissues, and no-touch receptacles for disposal.
• Purchase PPE or supplies to fashion protection for health center personnel and suspected or known-infected patients, including National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators for health center personnel.
• Perform outreach and provide patient and community-wide education on hand hygiene, cough etiquette, and COVID-19 transmission, using existing materials where available.
• Disseminate educational materials on precautions to prevent, contain, or mitigate COVID-19 and other respiratory illnesses.

Paycheck Protection Program and Health Care Enhancement Act* (Award Name: ECT, Activity Code: H8E)

Reporting Category 2: Testing

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Award Name: COVID-19, Activity Code: H8C)

• Enhance staffing and purchase equipment and supplies as necessary to deploy walk up testing and laboratory services locations and in-scope mobile units to provide testing and/or to deliver care.
• Support COVID-19 testing and laboratory costs, including purchasing COVID-19 tests, specimen handling and collection, storage, and processing equipment, as appropriate.

CARES Act (Award Name: CARES, Activity Code: H8D)

• Enhance staffing and purchase equipment and supplies (e.g., triage tents) as necessary to create separate temporary testing areas and deploy drive- or walk-up testing and laboratory services locations.
• Support COVID-19 testing and laboratory costs, including purchasing COVID-19 tests, specimen handling and collection, storage, and processing equipment, as appropriate.
• Purchase or lease radiological equipment to aid in testing and diagnosis, including the purchase of health information technologies to support remote reading.

Paycheck Protection Program and Health Care Enhancement Act (Award Name: ECT, Activity Code: H8E)

• Maintain and increase health center capacity and personnel levels to support COVID-19 testing and related clinical and operational needs, including hiring and contracting with providers and other personnel.
• Development of testing plans for both active infection and prior exposure
• Procurement and distribution of tests within the service area.
• Purchase of testing equipment and supplies.
• Temporary drive- or walk-up testing.
• Laboratory services.
• Patient and community education related to testing.
• Assessment of symptoms, delivering test results, and appropriate follow up assessment, including by telephone, text monitoring systems, or videoconference.
• Testing personnel to support a safe workplace and facilitate timely return to work.
• Personnel training related to testing.
• Outreach to patients who may be at high risk or who have access barriers.
• In coordination with federal, state and local public health activities, notifying identified contacts of infected health center patients of their exposure to COVID-19, consistent with applicable law (including laws relating to communicable disease reporting and privacy).
• Reporting information on COVID-19 infection to federal, state, and local public health agencies consistent with applicable law (including laws relating to communicable disease reporting and privacy).
• Personal protective equipment.
• Equipment (e.g., telehealth equipment, temporary and non-fixed barriers to separate patients, vehicles to transport patients or health center personnel).
• Health information technology and digital tools (e.g., technology to support patient engagement and remote monitoring, case management, health information exchange with state and local public health partners, enhanced reporting).
• Purchase or lease of mobile vans/units directly supporting testing capacity expansion.

Reporting Category 3: Maintaining or Increasing Health Center Capacity and Staffing Levels

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Award Name: COVID-19, Activity Code: H8C)

• Administer COVID-19 therapeutics and vaccines when available.
• Review, update, and/or implement your emergency operations plan, including plans to address surge capacity and potential provider and other health center staff absenteeism.
• Hire and/or contract with new providers and/or other personnel to support increased service demand due to COVID-19.
• Strengthen partnerships with local and state public health authorities, and clinical and community-based organizations.
• Create new and enhance existing preparedness and response workflows to embed CDC guidelines and recommendations, which may require role/task reassignment.
• Enhance partnerships with medical respite facilities and other organizations delivering services to unsheltered individuals and/or prepare for expansion of or increased need for reliance on health center-supported respite care.
• Embed CDC guidance into electronic health record (EHR) clinical decision support tools.
• Enhance health information exchange capacity to support communications with public health partners, centralized assessment locations, and other health care providers, and/or to support transitions in care (e.g., to and from hospitals).
• Support increased capacity for patient triage, testing (including drive- or walk-up testing) and laboratory services, and assessment of symptoms, including by telephone, text monitoring systems, or videoconference through extended operating hours, enhanced telephone triage capacity, digital applications, and additional providers and other personnel.
• Purchase a vehicle to transport patients to assessment and testing locations, and/or to transport health center personnel to deliver COVID-19 assessment and treatment.
• Provide or otherwise support enhanced medical respite/recuperative care services.
• Purchase and administer medical countermeasures that may be identified to lessen severity or length of COVID-19 illness.

CARES Act (Award Name: CARES, Activity Code: H8D)

• Review, update, and/or implement your emergency operations plan, including plans to address surge capacity and potential provider and other health center staff absenteeism.
• Create new and enhance existing preparedness and response workflows to embed CDC guidelines and recommendations, which may require role/task reassignment.
• Embed CDC guidance into electronic health record (EHR) clinical decision support tools.
• Support increased capacity for patient triage, testing (including drive- or walk-up testing) and laboratory services, and assessment of symptoms, through extended operating hours, enhanced telephone triage capacity, digital applications, text monitoring systems, videoconference, and additional providers and other personnel.
• Purchase and administer COVID-19 therapeutics and vaccines when available, including other measures that may be identified to lessen severity or length of COVID-19 illness.
• Enhance workflows, health information exchange capacity, and data exchange to support communications with public health partners, centralized assessment locations, and other health care providers.
• Provide or otherwise support enhanced medical respite/recuperative care services.
• Purchase a mobile unit to provide testing and/or to deliver care.
• Purchase a vehicle to transport patients to assessment and testing locations, and/or to transport health center personnel to deliver COVID-19 assessment and treatment.
• Coordinate with public health entities to help develop and enact the local and state emergency response plans.
• Support transitions in care (e.g., to and from hospitals or other health care providers) and coordination with health care partners, including health departments and hospitals, by enhancing workflows, health information exchange capacity, and data exchange.
• Increase enabling services that address social risk factors amplified by the public health emergency (e.g., transportation, community health workers, home visits).
• Ensure the availability of comprehensive primary care to meet the ongoing needs of the patient population by supporting salaries and benefits for health center personnel providing in-scope services that are typically paid through non-grant funds during this emergency.
• Support the relocation of services from temporarily closed sites, such as school-based health centers, including transfer of moveable equipment and supplies essential to operations, updating marketing materials and websites, and direct communication to patients and community partners.
• Support personnel salaries in response to extended care hours.
• Repurpose office space and/or reassign personnel to maintain or increase capacity to continue primary care services in context of COVID-19 and ongoing needs of the patient population.
• Develop new and/or update existing patient registries to inform workflows that will support continuity of services to patients whose access has been limited by COVID-19 response.
• Provide paid leave to exposed or vulnerable health center staff, including those unable to work due to the public health emergency.
• Hire and/or contract with new providers and/or other personnel to support increased service demand due to COVID-19.
• Purchase equipment and supplies for use by remotely located staff to ensure continuity of health center services.
• Purchase equipment to enhance electronic tracking, data exchange, reporting, and billing.
• Purchase or upgrade of an electronic health record that is certified by the Office of the National Coordinator for Health Information Technology.

Paycheck Protection Program and Health Care Enhancement Act* (Award Name: ECT, Activity Code: H8E)

Reporting Category 4: Telemedicine

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Award Name: COVID-19, Activity Code: H8C)

• Enhance website and social media feeds to include patient self-assessment tools and facilitate access to telemedicine visits.
• Enhance telemedicine infrastructure to optimize virtual care, including increased capacity to assess persons with symptoms.
• Enhance telehealth infrastructure to perform triage, care, and follow-up via telehealth, including with patients in community settings, with unstable or no housing, in homes, public housing, and other locations.

CARES Act (Award Name: CARES, Activity Code: H8D)

• Enhance telehealth infrastructure to perform triage, care, and follow-up via telehealth, including with patients in their homes, community settings, public housing, and other locations, including patients with unstable or no housing.
• Enhance website and social media feeds to include patient self-assessment tools and facilitate access to telemedicine visits.
• Enhance telemedicine infrastructure to optimize virtual care, including the use of home monitoring devices and video to help triage need for emergency services.
• Support transitions as necessary to increase access to care through telehealth.

Paycheck Protection Program and Health Care Enhancement Act* (Award Name: ECT, Activity Code: H8E)

Reporting Category 5: Minor Alteration/Renovation

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020* (Award Name: COVID-19, Activity Code: H8C)

CARES Act (Award Name: CARES, Activity Code: H8D)

• Purchase and install temporary barriers and/or reconfigure space through minor alteration and renovation activities to support appropriate physical distancing of patients and/or maximize isolation precautions for persons under investigation and those testing positive for coronavirus.
• Renovate interior floor plan and/or purchase equipment to maximize the use of telehealth.
• Enhance or install heating, ventilation, and air conditioning (HVAC) systems to promote facility air quality and hygiene.

Paycheck Protection Program and Health Care Enhancement Act (Award Name: ECT, Activity Code: H8E)

• Minor alteration or renovation (A/R) projects directly supporting testing capacity expansion.

*For additional guidance on what activities are allowable under each supplemental funding opportunity, email the Grants Management Specialist stated on your notice of award.