The general steps for implementing an ACS are outlined below.
1. Identify potential sites
Review real estate assets. Use epidemiological and hospital data to determine where ACSs will be needed. Determine the State’s intended strategy for use of ACSs.
2. Conduct site assessments
Potential sites should be assessed for suitability as ACSs. State will need to prioritize which ones should be selected for use as an ACS. USACE and HHS may provide technical assistance with Site Assessments if tasked by FEMA.
3. Secure funding
The establishment and operation of Alternate Care Sites by state, local, tribal and territorial entities and certain private non-profit organizations (eligible applicants) to expand capacity for COVID-19 are eligible emergency protective measures under FEMA's Public Assistance (PA) Program. Eligible applicants may perform or contract for the work directly and seek reimbursement through PA or submit a resource request for Direct Federal Assistance (DFA) to FEMA through the state, tribe (if direct recipient) or territory. Both options are cost shared.
States are responsible for securing the Real Estate, and often identify Real Estate they already own. If they will be receiving Federal Assistance, they must provide the lands, easements, and rights of way necessary to accomplish the approved work to the construction agent.
5. Convert site for healthcare use
If any construction will be required to convert the facility for medical use, prepare a design and issue a contract for this work. A State or municipality could use the materials below as a starting point to issue the construction contracts. Alternately, FEMA could assign the mission to USACE, who could issue the contract and manage the work.
The General Scope of Work below will support a broad range of contracting mechanisms and is intended to be combined with one of the performance work statements and supplemented with State or Federal contract clauses as applicable. The performance work statements are based on Department of Defense Unified Facilities Guide Standards, and any discrepancies with Local/ State medical standards should be resolved between the State/ local governments and the construction agent. They cover conversion of the bare rooms with no furnishings or equipment.
General Scope of Work
Design and Construction Submittals
NFPA Temporary Compliance Options for ACSs
NFPA Safe Health Care Facilities in Extraordinary Times
Hotel to Healthcare Concept H2HC
H2HC COVID Trifold
Arena to Healthcare Concept A2HC
A2HC COVID Trifold
A2HC COVID Containerized Tri-fold
Closed Hospital to Healthcare Concept CH2HC
C2HC COVID Trifold
6. Secure wraparound services
Wraparound services generally include meals and beverages, transportation, ambulance service, custodial service, biomedical waste removal, laundry, and fencing. Wraparound service contracts could be administered by the State or municipality.
For the latest materials on wraparound services, please see HHS’s revised alternate care sites toolkit.
7. Staff, equip, and supply site
Procure staff, equipment, and supplies to operate the facility. Staff will need to provide 24 hour care. Furnishings and medically-unique equipment will need to be procured, installed, and configured. Staff, equipment and supply contracts could be administered by the State or municipality.
For the latest materials on staffing, equipping and supplying the site, please see HHS’s revised alternate care sites toolkit.
8. Operate site
Manage operational contracts and ensure robust supply chain for expendables over life of the facility. For the latest materials on operating the site, please see HHS’s revised alternate care sites toolkit.