Alternate Care Sites (ACS)

USACEHealth and Human Services (HHS) Logo



An Alternate Care Site (ACS) is a facility that’s temporarily converted for healthcare use during a public health emergency to reduce the burden on hospitals and established medical facilities. The US Army Corps of Engineers (USACE) and the US Department of Health and Human Services (HHS) compiled the following materials to support States and municipalities in creating ACSs to support their medical requirements during the COVID-19 pandemic.

Implementation of Alternate Care Sites is a State-led and managed process. While there are some steps listed on this page in which the Federal Government may be able to provide assistance, States and Municipalities are encouraged to complete them on their own.  The fact that materials and activities are listed on this website does not imply that the Federal Government will be providing any assistance in executing them.  States should tailor all materials based on local requirements.

In general, the steps that USACE may support, if tasked by FEMA, are assessing the sites (Step 2) and converting sites for healthcare use (Step 5). For additional information related to all other steps, please see HHS’s revised alternate care sites toolkit.

General Info and Recommendations


Alternate Care Sites Implementation Process

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.

Assessment Guidance

Assessment Template

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.


4. Secure property

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                             

H2HC Non-Acute- Business Rules

H2HC Acute- Business Rules

H2HC COVID Non-Acute- Performance Work Statement

H2HC COVID Acute- Performance Work Statement







Arena to Healthcare Concept A2HC

A2HC COVID Trifold

A2HC COVID Containerized Tri-fold     

A2HC COVID Non-Acute- Conceptual Layout A2HC COVID Acute- Conceptual Layout
    A2HC COVID Acute Containerized- Conceptual Layout​

A2HC Non-Acute- Business Rules

A2HC Acute- Business Rules

A2HC COVID Non-Acute- Performance Work Statement

 A2HC COVID Acute  Performance Work Statement 
A2HC Non-COVID Non-Acute- Performance Work Statement  







Closed Hospital to Healthcare Concept CH2HC

C2HC COVID Trifold                                   


CH2HC Acute- Business Rules


CH2HC COVID Acute- Performance Work Statement


Tent Camp to Healthcare Concept​ T2HC                             

T2HC Non-Acute- Business Rules


T2HC Design Concept






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.