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Open Enrollment Vendor Assessment Form
Solicitation # OEV26006424 MPA 613 OE Vaccine Administration Services Instructions: Please complete and upload the following form to the attachment section of your bid submission. Upload any additional documentation as required.
· For further information review the Agency Solicitation Specification form under Section C: Proposal Business Information Business Name
Questions Responses
General Criteria
| 1. |
| Vendor is enrolled in Rhode Island’s State-Supplied Vaccine (SSV) Program and agrees to follow all SSV, Vaccine for Children (VFC) as applicable, and Rhode Island Child & Adult Immunization Registry (RICAIR) Terms & Conditions. |
| 2. |
| Vendor has a Medical Lead/Prescriber licensed in Rhode Island and has a local presence with physical offices to store vaccines within the state of Rhode Island. |
| 3. |
| Vendor agrees to follow all state and federal guidelines and agreements required to be an authorized vaccine provider (e.g., COVIDReadi, COVID-19 Provider Agreement, etc.). |
| 4. |
| Vendor follows all applicable state insurance requirements, including, but not necessarily limited to, Liability, Workers Compensation, Professional Liability, Technology, Cyber, Health Information, Automobile, Elderly, Children, etc. |
Open Enrollment Vendor Assessment Form
| 5. |
| Vendor agrees to the State’s Confidentiality of Health Care Communications and Information and to sign confidentiality agreements. |
| 6. |
| Vendor follows all applicable FDA requirements for vaccines, including but not limited to Emergency Use Authorization (EUA) and Investigational New Drug (IND) guidelines. |
| 7. |
| Vendor follows all Public Readiness and Emergency Preparedness Act (PREP Act) declarations if there is one for the event. |
| 8. |
| Vendor agrees to follow all guidance and best practices related to the storage, handling, preparing, and administration of vaccines according to manufacturer’s recommendations, CDC and the Advisory Committee on Immunization Practices (ACIP) guidelines, Occupational Safety and Health Administration (OSHA) regulations, and in a manner that is consistent with accepted medical practices. All vaccinators and administrative staff handling vaccine must agree to take all required CDC vaccine trainings. |
| 9. |
| Vendor can transport all necessary supplies and ancillary items to safely administer vaccine and dispose of all medical waste (expired vaccine, diluent, used doses, etc.) per CDC instructions, and state and federal regulations. |
Open Enrollment Vendor Assessment Form
| 10. |
| Vendor agrees to adhere to National Standards on Culturally and Linguistically Appropriate Services (CLAS-http://minorityhealth.hhs.gov/) and Americans with Disabilities Act (ADA). |
| 11. |
| Vendor can provide a multilingual staff, proportionally representative of the state’s top five (5) languages. |
| 12. |
| Vendor designates a Project Leader to be the primary contact person, provide project oversight and manage project team. Project Leader must be physically located in Rhode Island. |
| 13. |
| Vendor certifies their healthcare providers, healthcare workers, and support staff are up to date on all RIDOH recommended vaccinations. |
| 14. |
| Vendor uses the federal online Vaccine Adverse Event Reporting System (VAERS) to report all adverse events and errors in administration. |
| 15. |
| Vendor has a data infrastructure that meets or exceeds state requirements for data security and transfer. |
| 16. |
| Vendor must be prepared to account for and report on all wasted doses/vials/vaccine. |
| 17. |
| Vendor shall provide a completed rate card. |
Open Enrollment Vendor Assessment Form
Component A Criteria
| 1. |
| Vendor can appropriately staff and operate a Mass Vaccination Site, and provide a comprehensive suite of supporting services, such as on-site registration, patient check-in/checkout (including additional dosage registration), vaccination administration, pharmacy (drawing/mixing of vaccine), vaccine storage and handling, greeting, guiding, screening, eligibility verification, scheduling, observation, queue, and traffic control, emergency adverse events treatment, and others as needed. Vendor can also set-up and operate private area(s) for vaccination administration for special situations (e.g., including but not limited too – needing to remove clothing for a thigh injection, need to be administered vaccine while in a prone position, etc.). |
Component B Criteria
| 1. |
| Ability to appropriately staff and operate Pop-Up Clinics, including on-site registration, check-in, vaccination administration, observation, checkout/additional dose registration. Pharmacy, private area for vaccination administration for special situations (including but not limited too – needing to remove clothing for a thigh injection, need to be administered vaccine while in a prone position, etc.), and an emergency adverse events treatment area. |
Open Enrollment Vendor Assessment Form
| 2. |
| Vendor has secured a Community Immunizer Agreement through RIDOH’s Office of Immunization. |
| 3. |
| Vendor can transport all necessary supplies and ancillary items following all CDC and RIDOH pack-out guidelines to safely administer vaccine at Pop-Up Clinics. |
Component C Criteria
| 1. |
| Vendor has secured a Community Immunizer Agreement through RIDOH’s Office of Immunization |
| 2. |
| Vendor can transport all necessary supplies and ancillary items following all CDC and RIDOH pack-out guidelines to safely administer vaccine at LTCF-based clinics. |
| 3. |
| Vendor has a system to directly receive requests for service from LTC facilities and work with them to schedule clinics and register patients who are unable to register themselves but wish to receive a vaccine. |
| 4. |
| Vendor can achieve vaccination capacity of >5 facility clinics (50 administrations per facility) per week. |
Component D Criteria
| 1. |
| Vendor has secured a Community Immunizer Agreement through RIDOH’s Office of Immunization |
Open Enrollment Vendor Assessment Form
| 2. |
| Vendor has a system to directly receive requests for service from the public and/or healthcare providers, including homecare providers. |
| 3. |
| Vendor’s staff can safely enter individuals’ homes. |
| 4. |
| Vendor can transport all necessary supplies and ancillary items following all CDC and RIDOH pack-out guidelines to safely administer vaccine at individual homes. |
| 5. |
| Vendor can achieve vaccination capacity of >50 in-home vaccination visits per week. |
Signature
Name
Signature of the Person Submitting this Form
Name of the Person Submitting this Form (print)
Date of Signature
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