Covid-19 Community Vaccination Program (CCVP)

Monkeypox is a component of CCVP, Monkeypox vaccine may be offered alongside of COVID-19 vaccine at community events. MSDH was recently awarded funding from the Center for Disease Control and Prevention(CDC) to ensure greater equity and access to Coronavirus Disease 2019 (Covid-19) vaccine by those disproportionately affected by Covid-19.MSDH needs the assistance of enrolled immunization providers to administer COVID-19 vaccination within your local communities. CCVP providers will be reimbursed for costs associated with vaccination services at a rate of $75. This fee for service (FFS) rate is structured to encompass expenses incurred in setting up and conducting community-based vaccination clinics to include, but not limited to: staffing, printing, mileage, signage, tenting, internet access, electrical, vaccine storage, air/heat, medical waste disposal, etc. The number of individuals vaccinated will determine the reimbursement per event. Conditions in the places where people live, learn, work, play, and worship affect a wide range of health risks and outcomes, such as COVID-19 disease, severe illness, and death. As evidenced by the available data to date, populations that have been disproportionately affected by COVID-19 include, but are not limited to: • People in racial and ethnic minority groups • People living in communities with high social vulnerability index • People living in rural communities • People with disabilities • People with who are homebound or isolated • People who are underinsured or uninsured • People who are immigrants and/or refugees • People with transportation limitations ELIGIBILITY: Providers interested in applying must: 1) be an actively enrolled Covid-19 Vaccination Provider 2) complete the CCVP Provider application information Once the application is approved, the Office of Immunizations will contact the provider to enroll as a Covid-19 Community Vaccination Program provider. If you have any questions about the CCVP, please call 601-576-7751.

Are you a current Monkeypox Provider?

IF No - Click here to complete the Monkeypox Enrollment Information

Yes - I have completed the Monkeypox Enrollment Information to provide Monkeypox vaccine in the clinic setting and I want to participate in CCVP to provide vaccinations off-site.

No - I have not completed Monkeypox enrollment. Click link above to complete the Monkeypox enrollment before completing this application.

Monkeypox Vaccination Provider PIN Number

COVID-19 Vaccination Provider PIN Number

If you are not a current COVID-19 Vaccination Provider please complete the COVID-19 Vaccination Provider Agreement before moving forward with this application. COVID-19 Vaccination Provider Agreement

Are you a current CCVP provider that wants to administer Monkeypox vaccine in the community (not in your clinic)?

If yes - Click here to complete the COVID-19 Community Vaccination Program Add-On

Yes, I am a current CCVP provider and want to administer Monkeypox in the community. Click link above and complete CCVP Monkeypox Add-On

No- I am not a current CCVP provider. - Please complete the remainder of this application.

Provider Organization

Date of Application

mm/dd/yyyy

Organization Street Address (e.g. 123 Main St)

Address Field (e.g. Suite 123)

City

State

Zip Code

Organization Contact Person (Firstname Lastname)

Email for Contact Person

Phone Number of Contact Person

Enrolled COVID19 Provider Pin

Required Activity #1

ACTIVITY: CCVP providers are required to focus their vaccination efforts on communities with high vulnerability, high COVID-19 case burden, and/or disproportionately low COVID-19 vaccination rates. Applicants should use the following resources to define their vaccination plan: - the CDC"s Social Vulnerability Index ( https://www.atsdr.cdc.gov/placeandhealth/svi/index.html ) - the NIH's Pandemic Vulnerability Index ( https://covid19pvi.niehs.nih.gov/ ) - MSDH Covid-19 vaccination rates by county ( https://msdh.ms.gov/msdhsite/_static/resources/12130.pdf ) Using the above resources, identify the communities of focus in your Covid-19 Community Vaccination Program (CCVP) plan.

Required Activity #2

ACTIVITY: CCVP Providers are required to partner with community organizations (COs) to identify community members in need. Community Organizations include social service organizations, faith-based organizations, YMCAs/YWCAs, fraternities, school organizations (e.g., PTAs/PTOs), meal delivery services, senior centers, and others. Providers should consider: 1. the geographic location (encourage partnering with COs located in a variety of areas throughout the coverage area); 2. the CO's rapport within the community of focus; 3. the CO's experience working with communities most affected by COVID-19, including experience addressing social determinants that influence populations most severely affected by COVID-19; 4. CO's ability to act as a "trusted messenger" with the community of focus; 5. and the CO's capacity to expand it's services where other COs do not exist or do not have the capacity to support implementation of vaccination services Identify community organizations (COs) you plan to partner with:

ADOPT A SCHOOL

Please select yes if you would like to adopt a school. By adopting a school(s)/school system(s) your facility would coordinate with school officials on consents, dates and times of vaccination clinics.

Yes

No

Required Activity #3

ACTIVITY: CCVP providers are required to support strategies that ensure greater equity and access to COVID-19 vaccine by those disproportionately affected by COVID-19. Check all populations you plan to target your vaccination efforts (one or more):

Required Activity #4

ACTIVITY: Immunization clinics must be conducted outside of normal clinic operations. The CCVP clinic must be external to your facility. Vaccination sites must include, but not limited to mobile sites, community-based sites, pop-up sites, etc. Please describe the types of community-based vaccination clinics you intend to conduct along with the estimated number to vaccinate. Vaccination sites should include, but not be limited to community-based sites, mobile sites, and both large-scale vaccination sites and small or on-site pop-up vaccination sites.

Required Activity #5

ACTIVITY: Providers participating in the CCVP program are responsible for reporting all COVID-19 vaccination data to the state's Immunization Registry (MIIX) within 24 hours. The approved methods of reporting are 1. Using your EHR or 2. Manually entering the information into the MIIX web portal. (NOTE: Faxes, CSV files, or phone calls are not approved methods of reporting.) I understand that providers are required to report all COVID-19 vaccination data within 24 hours using the State's immunization registry (MIIX).

Yes

No

Required Activity #6

ACTIVITY:

CCVP Monkeypox providers are required to focus their vaccination efforts on individuals 18 years or older may who

Have been notified or are aware of close intimate or sexual contact with someone diagnosed with monkeypox, OR
Identify as gay, bisexual, transgender, or other men who have sex with men, who report

a. having had multiple or anonymous sex partners, OR

b. having attended an event or venue where monkeypox may have been transmitted (for example, by skin-to-skin contact or sex on-site).

Using the above resources, describe you ability to reach the population at highest risk for monkeypox, with a focus on health equity:

Required Activity #7

ACTIVITY:

CCVP Monkeypox Providers are required to partner with LGBTQ+ Community any other appropriate community partners to reach the target population following guidance of MSDH on the appropriate eligible populations.

Describe how you will engage attendees at highest risk and implement efforts to maximize health equity.

Required Activity#8

ACTIVITY:

Detail your plans to educate participants about the need and importance to receive a 2nd dose for full vaccination, and detail your plan to coordinate the 2nd dose with those same participants.

Required Activity #9

ACTIVITY:

Monkeypox vaccine must be administered intradermally.

I understand that MPX-CVP providers must administer monkeypox vaccine intradermally.

MSDH Referrals

On occasion, would your organization accept homebound referrals from MSDH?

Yes

No

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