July 2013
Vol 5 Issue 1
The Mission of the National Center for Health in Public Housing (NCHPH) is to strengthen the capacity of federally funded Public Housing Primary Care (PHPC) health centers and other health center grantees by providing training and a range of technical assistance.
NCHPH, a project of North American Management, receives funding through a cooperative agreement grant awarded by the U.S. Department of Health and Human Services Administration.
In This Issue
Countdown to Health Insurance Enrollment
Program Requirements Review
Emergency Preparedness
Preparing for Emergencies
Coping with Disaster
Emergency Plans and Policies
Grantee Corner
2013 Health Center and Public Housing National Symposium
"Keys to Health Center Success"

2013 National Symposium Synopsis:

The National Center for Health and Public Housing and Community Health Partners for Sustainability hosted the national training symposium, "Keys to Health Center Success", June 4-6, 2013 at the Downtown Sheraton in Denver, Colorado. The symposium was designed to increase Health Resources and Services Administration (HRSA) health center program grantees' awareness of issues public housing residents face. Symposium attendees included health care professionals, HRSA grantees, public housing authority staff members, public housing resident advocates, and public housing residents. 

Daily keynote speakers included: 

Joe Garcia, Colorado Lieutenant Governor
Darlene Barnes, Regional Administration Food & Nutrition Services Mountain Plains Regional VIII
Percy Devine, Bi-Regional Administration of the Administration for Colorado Region VI & VIII
Susan Niner, Housing Choice Voucher Program Manager at Colorado Department of Local Affairs Division of Housing

Dan Gomez, Deputy Regional Administration for U.S. Department HUD Region VIII
Lynnzy McIntosh, Consortium for Older Wellness
Kristen Pieper, Colorado Community Health Network
Heather Powers, HUD Veteran's Affairs Support Housing

Shawn Frick, Associate Vice President, PCA & Network Relations for the National Association of Community Health Centers
Patrick Gillies, Regional Administrator for the Health Resources & Services Administration
Velveta Golightly-Howell, U.S. Department of Health and Human Services (OCR/HHS) Region VIII

The symposium lasted two and a half days and consisted of over 30 workshops presented by a diverse group of health professionals and advocates. Workshop topics included resident advocacy, increasing access to oral health, health care policy, innovative outreach strategies and much more. 

The NCHPH would like to thank everyone who helped make this training symposium an exceptional event. A special thanks goes to our exhibitors and keynote speakers. We look forward to seeing everyone again in 2014. For more information or assistance please contact us directly: info@nchph.org.

To view footage and access workshop sessions, please click here.

Keynote speakers and Staff Members (Left to Right): Nancy de Leon Link, Alex Lehr O'Connell, Susan Niner, Percy Devine, Darlene Barnes, Astril Webb, Bob Burns

Presenters, Lynn and Stephanie Wachman.

Conference attendees during a workshop session.
Countdown to Health Insurance Enrollment

Health Insurance Marketplaces will begin open enrollment October 1, 2013. The U.S. Department of Health and Human Services, as well as other government agencies are preparing resources, tools, and technology to give patients and providers adequate information. October is a few short months away and NCHATA wants to ensure that health care providers and senior patients understand key provisions of the Affordable Care Act (ACA) and available resources. 


Things You Need to Know

  1. The websites: Healthcare.gov or Cuidadodesalud.gov have been launched to provide information on the Health Insurance Marketplaces
  2. A 24/7 Help Center is available by calling: 1-800-318-2596 
  3. Health centers may choose to partner with enrollment groups or organizations (brokers or navigators) to assist them during this time
  4. Most health centers have funds specifically allotted to assist during enrollment
  5. Patients with insurance can search for alternative plans through the Marketplaces
  6. Some preventive services, such as routine screenings are now available at no cost 
  7. Small businesses can use the Marketplaces to provide insurance to their employees
  8. Insurance coverage will begin in January 2014 


Factsheets with information related to Medicaid or Medicare are available. 
Program Requirements Review

 Program requirements 10 and 11 have been included in this newsletter to facilitate a better understanding of collaborations with other health care providers and written agreements between providers. Although collaborations are encouraged, health center programs, affiliates, and contractors must adhere to HRSA regulations outlined in the sections below. 


Program Requirement #10: Contractual/Affiliation Agreements


(Section 330(k)(3)(I)(ii), 42 CFR Part 51c.303(n), (t)), Section 1861(aa)(4) and Section 1905(l)(2)(B) of the Social Security Act, and 45 CFR Part 74.1(a) (2))) Contractural/Affiliation Agreements: Health center exercises appropriate oversight and authority over all contracted services, including assuring that any subrecipient(s) meets Health Center program requirements. 


Contractural/affliation agreements are important management and finance program requirements. Agreements between health centers are important to providing quality care. Providers who care for special populations such as public housing residents may need a formal written contract or memorandum of agreement/understanding (MOA/MOU). All agreements must be aligned with federal grant regulations and adhere to HRSA/BPHC policies and procedures.


When drafting agreements and contracts it is critical to ensure that all contractual agreements do not undermine the integrity of the health center program or assert more power over the program. Also, all subrecipients of any agreement must also adhere to all health center program requirements.


Contractors must also keep excellent records and manage data and information in accordance with federal regulation and all records should be made available to HHS and the U.S. Comptroller General if necessary.


Lastly, health centers' governing boards must also be informed of and able to review any contract or agreement.


Resources for Performance Improvement: UDS Mapper and HRSA's Emergency Management Program Expectations


Program Requirement #11: Collaborative Relationships


(Section 330(k)(3)(B) of the PHS Act and 42 CFR Part 51c.303(n)). Collaborative Relationships: Health center makes effort to establish and maintain collaborative relationships with other health care providers, including other health centers, in the service area of the center. The health center secures letter(s) of support from existing health centers (section 330 grantees and Look-Alikes) in the service area or provides an explanation for why such letter(s) of support cannot be obtained. 


Health center programs should build relationships and partnerships with other health center program grantees, as well as health providers throughout the community. Program Requirement 11 is helpful in providing additional care to patients which subsequently increases the service area of grantees. Partnerships with other providers, organizations and affiliates can improve continuity of care during staff shortages, emergencies, or other untimely events. 


Letters of support are instrumental in solidifying a relationship and strengthening the partnership. Relationships should not only be written or verbal arrangements, but active collaborations that are utilized strategically. 


To improve performance, health centers should seek different agencies and organizations to partner with. This may include local and regional partners such as hospitals and rural clinics. Health centers should not limit partnerships to safety net providers but should also reach out to private health networks.


For more information on Program Requirements, please visit: http://bphc.hrsa.gov/about/requirements/


Source: HRSA


 Emergency Preparedness

 In 2011, the U.S. had the 6th highest disaster mortality in the world. 


Emergency preparedness is the act of preparing for disasters and traumatic events prior to disaster occurrence to decrease response and recovery times. Terms often associated with emergency preparedness are emergency response or emergency management. These terms refer to handling a disaster once it has already occurred. An efficient emergency response plan involves partnerships and agreements with other organizations. Forming relationships with other agencies and response groups can speed up recovery and increase the likelihood of continuity of care for patients.


Health providers are critical members of the disaster response workforce. If health care facilities are not damaged during a disaster then health centers may be asked to assist with medical needs. Consequently, health centers should be prepared to handle an influx of patients with few resources and limited staff.


Even minor disasters may be a problem for health centers.  Therefore, emergency plans should include instructions for multiple events. The most common disastrous events are storms, hurricanes, floods, wildfires, and tornadoes. Additional emergency events may include disease outbreaks, auto accidents, terrorist attacks, mudslides, chemical or nuclear accidents, and other mass casualty events.  


View the Emergency Preparedness Factsheet.


Sources: Center for Research on the Epidemiology of Disasters (CRED), Centers for Disease Control and Prevention (CDC)

 Preparing for Emergencies

Natural disasters are costly events. Storms in the U.S. in May of 2011 totaled about $25 billion in damages. 


 Action Plan


In order to have an action plan available to execute, strategic plans have to be made to account for people, supplies, and the type of disaster. Preparedness programs should include:

  1. Program Management
  2. Planning
  3. Implementation
  4. Testing and Exercises
  5. Program Improvement
To learn more about the components of an effective preparedness program, please click here


Helping the Community Prepare


Health centers should encourage patients to have emergency plans in place. Patients with chronic conditions, pediatric patients and older adults should be cautioned and prepared to receive continued medical care or medications in the event of an emergency. Health care providers can assist with preparations by referring patients to other health care providers that can assist with health care needs during a disaster. Health centers should use their established relationships within the community to store supplies or to gain additional support should the need arise. Patients also should be aware of how to receive communications from the health center if services are interrupted. 


View the Health Center Emergency Management Programs Expectations.


Sources: CDC, HRSA, National Civilian Community Corps (NCCC)
Coping with Disaster
Victims of disaster may experience mental health problems. It is important for health providers to know the signs and symptoms of the onset of disaster-related stress in order to prevent health issues such as suicide. Signs and symptoms include incoherent speech or thought patterns, insomnia, difficulty managing daily activities, limited patience, substance use, and expressions of fear or guilt. 
Health centers may need to find additional mental health specialists or case managers to deal with the various needs of patients during a disaster. Stress may be caused by the lack of food, shelter and clean water and it is essential to assist patients with this as soon as possible. Special care must be given to children and the elderly. 
Source: Federal Emergency Management Administration (FEMA)
Emergency Plans and Policies


Health Center Emergency Management Program Expectations


According to HRSA's Policy Information Notice 2007-15, health centers must have risk management policies and procedures in place. Plans and procedures for emergency management must be integrated into a health center's risk management policy to assure that suitable guidelines are established and followed in order to effectively and appropriately respond to an emergency. Each health center is required to have an emergency management approach that considers the center's size, location, resources, as well as current State, local, or community/regional plans.


The emergency management expectations for health centers: 

  • Emergency management planning-health centers should be engaged in an ongoing, continuous process to ensure that emergency management plans (EMP) are appropriate.
  • Linkages and collaborations-health centers should maximize their linkages and collaborations.
  • Communications and information sharing-health centers should have policies and procedures for communicating and sharing information with internal and external stakeholders.
  • Maintaining financial and operational stability-health centers' business plans should address financial viability in the event of an emergency.


The expectations are broad due to the diverse range of health centers.  In addition to developing, implementing, and maintaining an Emergency Management plan, health centers should continually look for opportunities to enhance awareness, educate and train boards and staff, evaluate and test procedures, and integrate emergency management into what the health center does on a daily basis. A well-developed and appropriate emergency management strategy which reflects the unique characteristics, circumstances, and environment of the health center, will ensure a quick recovery and continued essential services for the community. There are a wide range of resources available to assist health centers in support of emergency management activities. 


For more information, read Health Center Emergency Management Program Expectations .


Public Housing Disaster Preparedness Act of 2013


Introduced to the House in April, the Public Housing Disaster Preparedness Act requires the Secretary of Housing and Urban Development (HUD) to require each public housing agency (PHA) that owns, operates, or assists at least 500 dwelling units in public housing projects (covered PHA) to develop a disaster response and relief plan.  


The plan must: (1) be included in the annual and five-year PHA plans required to be submitted under the Act, and (2) be submitted for HUD approval before its implementation.  The Act would require the HUD Inspector General to evaluate the plan, after its implementation following a disaster, and if necessary to make recommendations for improving it within 180 days after the conclusion of the disaster. Under the bill, PHA's would develop disaster response and relief plans to guide and prepare staff and residents for disasters affecting public housing projects. PHAs would be required to disseminate information (accessible to individuals with limited English proficiency) about the emergency protocols established under the plan to each resident.


Read more about the: Public Housing Disaster Preparedness Act of 2013



National Preparedness Guidelines and Standards


The 2009 H1N1 influenza pandemic and Hurricane Katrina highlighted the importance of building and sustaining public health and health care preparedness.  The Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) play leading roles in ensuring the healthcare systems in the Nation are prepared for potential threats and avoid the consequences that occur when a community is ill-prepared.  ASPR's Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness (NGHSP) and CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning (NSSLP) establish standards for protecting human health and national health security.


Through separate cooperative agreements, ASPR and CDC provide funding and technical assistance to state, local and territorial public health departments to prepare healthcare systems for disasters. Both NGHSP and NSSLP provide guidance in identifying gaps in preparedness, determining specific priorities, and developing plans for building and sustaining healthcare specific competencies. These standards are designed to accelerate state and local preparedness planning, provide guidance and recommendations for preparedness planning, and, ultimately, ensure safer, more resilient, and better prepared communities.


Each of the preparedness standards help the Nation's healthcare system and public health infrastructure to prevent, respond to, and rapidly recover from threats. 

Grantee Corner
Click above to visit site.


Feature: Zufall Health Center

Zufall health center is located in Dover, NJ and serves about 15,000 patients each year. This Public Housing Primary Care (PHPC) grantee has been an established member of the community for over 20 years.

Zufall is in a location on the east coast which is faced with snow storms, superstorms, and hurricanes. Due to consistent natural disaster threats, Zufall has developed an emergency preparedness plan that was featured by Health Care Communities.  Most recently, in October of 2012, New Jersey was severely hit by Hurricane Sandy. The plan outlines the role of key staff members at the health center. 

To learn more about Zufall, please contact the health center directly:


Zufall Health Center

17 S Warren St.

Dover, NJ 07801


(973) 328-3344



Household Preparedness for Public Health Emergencies--14 States, 2006-2010


Regional Public Health Emergency Preparedness: The Experience of Massachusetts Region 4b


The National Center for Health in Public Housing (NCHPH), a project of North American Management, is supported in part by a cooperative agreement grant awarded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). 
This publication was made possible by grant number U30CS09734 from the Health Resources and Services Administration, Bureau of Primary Health Care and its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.
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