Vendors Must Come to the Rescue of SLED Health Authorities in Early Response to Coronavirus

Published: March 16, 2020

SLED Market AnalysisCoronavirus (COVID-19) PandemicForecasts and SpendingHealth Care

On March 6th President Trump signed into law "H.R.6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020." This act appropriates more than $2 billion with significant impact on the SLED market.

KEY TAKEAWAYS

  • $950 million is immediately available to all of the states, locals, and territories to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.
  • States, locals, and territories are operating under the “Key Components of Pandemic Influenza Operational Readiness” as part of the 2019-2024 Public Health Emergency Preparedness (PHEP) performance period.
  • The state, city, and county health officials' associations have made public extensive lists of the supplies and support they will need to procure during the emergecy and that can be reimbursed by the federal supplemental funding.

FEDERAL SUPPLEMENTAL FUNDING

The act put into place the following items:

  • $2.2 billion, to remain available until September 30, 2022, for “CDC–Wide Activities and Program Support.”
    • Not less than $950,000,000 of the amount provided shall be for grants to or cooperative agreements with States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.
    • $475,000,000 of the funds made available in the preceding proviso shall be allocated within 30 days of the date of enactment.
    • Every grantee that received a Public Health Emergency Preparedness grant for fiscal year 2019 shall receive not less than 90 percent of that grant level from funds provided.
    • Not less than $40,000,000 of such funds shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.
    • The Director of the Centers for Disease Control and Prevention (“CDC”) may satisfy the funding thresholds outlined in the preceding two provisos by making awards through other grant or cooperative agreement mechanisms.
    • Each grantee described in the third proviso under this heading in this Act shall submit a spend plan to the CDC not later than 45 days after the date of enactment (April 20, 2020).

In the data set attached to this article, the CDC's Public Health Emergency Preparedness (PHEP) grant funding for all states, localities, and territories for federal fiscal year (FFY) 2019, 2020, and this supplemental have been compiled.  Deltek's estimates, based upon the legislation, find that only $560.6 million of the $910 million available to states, locals, and territories would be appropriated by formula (i.e., using the minimum 90% of FFY 2019 grant awards).  That leaves another $349.4 million to be allocated on a reimbursement basis.

PANDEMIC INFLUENZA OPERATIONAL READINESS

State, local, and territorial jurisdictions were intended to be complying with the March 2019 funding guidance document “Key Components of Pandemic Influenza Operational Readiness” as part of the 2019-2024 PHEP performance period.  A jurisdiction is considered likely to be operationally ready for a pandemic influenza event when they can demonstrate the performance of 15 activities.

These requirements are similar to those of the 2018 “Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health.”

Readiness is determined by the CDC’s "Operational Readiness Review" (ORR), which is described as “a rigorous, evidence-based assessment that evaluates state, local, and territorial planning and operational functions. Currently, the ORR primarily focuses on evaluating a jurisdiction’s ability to execute a large response requiring medical countermeasure (MCM) distribution and dispensing.”

As this is written, the latest publicly available report on operational readiness is the “2015-2016 National Report of Medical Countermeasure Readiness.” It provides national percentages of readiness but no jurisdiction-by-jurisdiction findings.

STATE, LOCAL, AND TERRITORIAL EMERGENCY REQUIREMENTS

While extensive planning and preparation for all-hazards in general and pandemic outbreaks (such as H1N1) have boosted the operational capabilities of states, locals, and territories to their highlest levels ever, the nature of the coronavirus disease 2019 (COVID-19) outbreak appears to exceed the severity of scenarios under previous consideration.

On February 24th the leaders of national public health organizations, including the Association of State and Territorial Health Officials (ASTHO), National Association of County and City Health Officials (NACCHO), Council of State and Territorial Epidemiologists (CSTE), and Association of Public Health Laboratories (APHL) joined together to declare their support the supplemental appropriation in order to meet immediate needs for the following:

  • Purchasing of new equipment to provide rapid diagnosis in state public health laboratories
  • Additional staffing support to conduct disease investigations, including clinic visits or mobile home testing teams for uninsured/underinsured persons meeting case definition who need testing to confirm infection
  • Obtaining and maintaining quarantine isolation housing capacity
  • Expanding CDC capacity to respond globally to outbreaks
  • Data analytics and surveillance systems for rapid case detection and response
  • Transport for uninsured/underinsured persons with symptoms for medical evaluation

NACCHO expanded upon this with a list in its own release as follows:

  • Isolation/quarantine related activities, including securing and standing up facilities, transportation and lodging and wrap around services like behavioral health services/support, counseling, or even necessities like food, toiletries, etc.
  • Testing and monitoring patients that are currently under investigation (PUIs), rapidly investigating cases, and obtaining information on their close contacts.
  • Outreach to the general public, including media buys for public communication, collaboration with community organizations, printing, phone banks, updating web information, and translating materials into appropriate languages.
  • Engagement with hospital, healthcare system, and health plan leaders to monitor healthcare staffing and supplies; implement plans to reduce demands on the healthcare system; increase surge capacity in our systems and implement alternate standards of care to conserve limited supplies.
  • Acquisition of personal protective equipment (PPE) including N95 masks, face shields, gowns, and secure fit testing resources by third party vendors for respiratory protection.
  • Other equipment, such as infection control supplies, digital thermometers, and other equipment costs associated with quarantine and isolation.
  • Funds to cover the clinic visits or mobile home testing teams for uninsured/underinsured persons meeting case definition who need testing to confirm infection.
  • Funds to cover medical transport and hospitalization for uninsured/underinsured persons with symptoms for medical evaluation.
  • Specimen tracking and transport.
  • Laboratory testing reagents, supplies, and consumables.
  • Laboratory equipment for sample extraction.
  • Laboratory packing, shipping materials, and supplies.
  • Clerical assistance and/or laboratory assistance to support laboratory testing and other related functions.
  • Additional staffing to eliminate uneven response.
  • Connecting the laboratory test data from the new CDC COVID-19 Real-Time Reverse Transcriptase PCT Diagnostic Panel with the public health disease surveillance systems where disease information case investigations will occur.
  • Data analytics and epidemiological surveillance system capacity.
  • Implementing seamless, interoperable data sharing across the public health infrastructure (from local/state/tribal/territorial to or from the federal level).
  • Improved data collection and sharing of and transmission of data for persons under quarantine and persons under investigation.

With President Trump telling states that they can move faster on their own in procuring medical equipment, such as N95 masks, the green light has been given for vendors to move forward on offering any and all of the items above and not wait for federal guidance or intervention.  The federal supplemental funding detailed above serves as a backstop for emergency purchases of this sort.