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GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING Presentation to: Georgia WIC Program Staff Presented by: State WIC Staff Date: November 8, 2013 November.

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Presentation on theme: "GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING Presentation to: Georgia WIC Program Staff Presented by: State WIC Staff Date: November 8, 2013 November."— Presentation transcript:

1 GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING Presentation to: Georgia WIC Program Staff Presented by: State WIC Staff Date: November 8, 2013 November 15, 2013

2 Certification 2

3 Income – Income in WIC means all gross cash income before deduction. Current income refer to all income received by the household during the month (30 days) prior to the date the application for WIC benefit is made. If the income assessment is being done prospectively (i.e. the sole support of that family has just been laid off but has been authorized to receive unemployment benefits for the next six months), current refers to income that will be available to the family in the next 30 days. Certification: CT - 4 3

4 Certification: CT - 5 Note: New proofs must be obtained at each initial and subsequent certification. Proof of identification must be obtained for transfers and thirty (30)-day adjustments. No proofs should be over two months old, such as, electric bills, et c. All proof must be date-stamped up to the date proof was obtained. 4

5 Certification: CT - 6 An income eligibility assessment should be made either prior to rendering WIC nutrition assessment services or as the first step in the clinic visit process. If the applicant is income eligible, he/she will be screened for nutritional risk eligibility or a clinic appointment will be given for a nutritional risk assessment. If the client is not eligible on the basis of income, the ineligibility procedures will be followed (see Ineligibility Procedures CT-XVI). If the applicants income changes for any reason, the applicant may reapply for WIC services at any time. Income eligibility is valid for in-stream migrant farm workers and their families for a period of twelve (12) months. The income determination can occur either in the migrants home base area before the migrant has entered the stream or in an in-stream area during the agricultural season. 5

6 Certification: CT - 6 The Disclosure Statement (see Attachment CT-30) must be completed annually by all clinic employees who perform WIC services to inform District staff of their family participation on the Georgia WIC Program. This form must be updated if any information changes. This form must be completed by the local agency and returned to the Nutrition Services Director by September 30th of each year. A copy of this form must also remain in the county health department / WIC clinic site for audit purposes (i.e., one copy at the clinic plus one copy at the District). 6

7 Certification: CT - 8 D.Covert (Surprise) Telephone Calls In an effort to monitor processing standards, District staff must make covert telephone calls to their local agencies quarterly. The results of those calls must be sent to the State WIC office quarterly, also. 7

8 Certification: CT - 8 E. Patient Flow Analysis If a clinic fails to meet processing standards for a period of over three (3) months, the state recommends that District staff should conduct a Patient Flow Analysis (PFA) to determine the cause of not meeting those standards. If a PFA is conducted, a copy of that report must be sent to the State WIC Office. 8

9 Certification: CT - 11 B.Participant Instructions Participant/parent/guardian/caregiver/spouse/alternate parent must be instructed on the purpose and use of the WIC ID card. The following is a guide to the information that should be given to the participant regarding the WIC ID card. Whenever possible, the participants proxy (ies) should be present during the explanation. 1.This WIC ID card is to identify you as an authorized WIC participant when picking up and/or redeeming vouchers. You should keep vouchers with the WIC ID card. You must have your WIC ID card in your possession when picking up vouchers, at certifications and when redeeming vouchers at the grocery store. A proxy must have the WIC ID card and additional IDs in order to pickup or redeem vouchers. Refer to the section below for more information regarding proxies. 2.Notify the clinic if the WIC ID card is lost or stolen. 3.Explain the Expiration Date and when the participant will be due for eligibility screening. 4.Explain shopping procedures (e.g., review allowable items, importance of separating foods, etc.). 5. Explain the purpose of the next scheduled appointment (i.e. Nutrition education, certification). 9

10 Certification: CT – Proxies –General 6.If a proxy picks up vouchers or brings a child in for subsequent certification or half certification, WIC clinic staff must ensure that adequate measures are taken for the provision of nutrition education and health services to the participant. 7.Documentation of proxies must be recorded on the following: Georgia WIC Program ID Card Certification Form Computer 8. Explain the purpose of the next schedule appointment (i.e. Nutrition education certification) 10

11 Certification: CT – 14 Grandparents as Guardians – There are many situations where the grandparents serve as temporary or even become permanent guardians for children on the Georgia WIC Program. If the grandparent has the proper documentation with regards to certification, (ID, residency, income proofs) he/she may have the right to act on behalf of the WIC participant. These situations may arise due to an applicant/participant/guardian/caregiver/spouse/ alternate parent not being able to come for WIC services for a short period of time. In these cases, the grandparent may serve as the guardian. 11

12 Certification: CT – 14 Joint Custody In joint legal custody, both parents share the ability to have access to educational, health, and other records and have equal decision- making status where the welfare of the child is concerned. Each parents information must be documented in the medical record along with all legal documentation from court. 12

13 Certification: CT – 14 Other Legal Custody – The Georgia WIC Program could never list all of the possible guardianship situations or persons who may have temporary and permanent custody of a child. As long as the proper documentation with regards to certification is presented, (ID, residency, and income proofs) the participant may be placed on the program. 13

14 Certification: CT – 18 Look for the total income line item on the income tax return. Use the dollar amount on this line and divide by twelve (12). This is found on the following forms: Form 1040EZ: Line 4, Form 1040A: Line 15 and Form 1040: Line

15 Certification: CT – 21 Procedures for Completing the Verification of Residency and/or Income: (1)Write in the name(s) of the WIC applicant(s) along with the address that is given. (2)Sign your name at the bottom portion of this form along with date given to the WIC participant. (3)Complete or fill in the date that the form must be delivered back to the clinic. (4)Once the form is received, write in the date received and have the person who received it sign the letter. (5)Form should be completed when the applicant/participant does not have proof of residency in their name 15

16 Certification: CT – 24 Procedures when applicant/participant fails to bring back proof: It is the responsibility of the clinic to terminate participants who fail to bring back proof to the clinic within thirty (30) days of certification. Under no circumstances should a second, subsequent 30-day certification period be used if an applicant fails to provide the required documentation of income before the temporary certification period expires. 16

17 Certification: CT – 25 Income Inclusions n.Student Grant, Scholarship (does not include Pell Grant). 17

18 Certification: CT – Income Exclusions u. Self-Employment – Both farm and non-farm, self-employed persons are assessed for WIC income eligibility using net income rather than gross income. In families where adult members are self employed, they may not know their net income. To calculate net income, use the most current Internal Revenue Service (IRS) tax return as a basis for calculating net income for both farm and non-farm self-employed income. 18

19 Certification: CT – 29 Documented Proof of Income 2.A statement from employers for all employed persons in your household. Attach non-letterhead statements from employers to the No Proof Form and file in the health record. 3.Current tax return (W-2 or 1040) from previous year up until April 15 th of the current year (e.g., 2009 W-2 can be accepted up until April 15, 2011). 4.On-going financial records (for self-employed only). 5.Unemployment notice. 6.Other (see List of Income Inclusions). All proof of income should not be more than thirty(30) - days old with the exception of the most recent tax return. 19

20 Medical Data 2. The Hematological Data Date… Blood work should not be performed on infants younger than nine (9) months of age, unless there is a medical reason. In most cases, infants will have their first blood work performed around twelve (12) months of age. All children are required to have blood work at each certification. If the hemoglobin is low at certification, repeat at half-certification. Children less than two years must have blood work at half- certification. For children 2 and over, blood work does not have to be performed at the half-certification if normal at certification. Use the one of following procedures to follow-up for abnormal blood work: 20 Certification: CT – 32

21 Use the one of following procedures to follow-up for abnormal blood work: a.For infants and children receiving their health care through the health department, follow the protocol for treatment of low hemoglobin. b.For infants and children receiving health care from a private provider, refer the participants with low hemoglobin values to their providers. At the next certification (subsequent or half) visit repeat the hemoglobin test or enter a referral value from the private provider. Blood work within the normal range at certification is valid for children for twelve (12) months beginning at twenty-four (24) months of age. Postpartum, breastfeeding women who have breastfed for six (6) months are not required to have to have blood work performed at their mid-assessment visit unless there is a medical reason. 21 Certification: CT – 33

22 Certification: CT – 37 CERTIFICATION PERIODS Certification periods are: Breastfeeding Women: for one (1) year from the date of initial and/or subsequent certification as a postpartum, breastfeeding woman. Eligibility ends when the certification period is over, when the breastfed infant turns one (1) year old or when breastfeeding is discontinued, whichever comes first. Note: The certification period for the breastfeeding woman is one (1) year; however, she must receive a mid-assessment between 5-7 months of her delivery date as a breastfeeding postpartum woman if she is still breastfeeding an infant less than one (1) year of age. 22

23 Certification: CT – 37 CERTIFICATION PERIODS Certification periods are: –Infants: certified at age greater than six (6) months: for one (1) year from date of certification. –Children: for one (1) year from the date of each certification may continue eligibility until they reach their fifth birthday, if assessed at nutritional risk. 23

24 Certification: CT – 45 Staff Signature(s)/Printed Name - The local WIC official signature, print name and date confirms that income, residency and family size are correct as stated by the applicant/participant. The signature, print name and date also verifies/witnesses the participants signature. An appropriate signature consists of first and last name and title of person verifying income and witnessing the participants signature. 24

25 Certification: CT – 45 f.Applicant/Participant Signature/Printed Name The participant/parent/spouse/guardian/ caregiver/ alternate parent or proxy must be asked to read, sign, print name and date the following statement each time they are certified (if unable to read, must have it read to them) 25

26 Certification: CT – 56 Transferring a Foster Child: –When transferring a foster child from one WIC clinic to another WIC clinic, intra-state policy also applies. If a foster child is placed in a different home during the valid certification period, the foster parent must present all legal documentation. The new foster parents should sign a Release of Information Form in order to receive entire WIC record of the child (see Attachment AD-4). 26

27 Certification: CT – 57 F.Migrant Transfer When a migrant visits your clinic, automatically issue an EVOC card. In-stream migrant farm workers (and their families) with expired verification of certification (VOC) card must be considered income-eligible, provided that their income is redetermined once every twelve (12) months. 27

28 Certification: CT – 58 g.Required Data on the EVOC and Paper VOC cards Required data on the EVOC and Paper VOC cards is as follows: 25. The Thirty(30)-Day return date and the missing proof information, if applicable, (hand write on paper card) 28

29 Certification: CT – 59 VOC Card Inventory (Paper) Issuance 6.Name/City/State participant is moving to or if issued to a migrant. Print migrant in space for City and State. 29

30 Certification: CT – 68 Certification for Home Visits Procedures 3.Vouchers must be created prior to leaving the WIC clinic. The client must sign the voucher receipt or voucher register. If blank manual vouchers are used, a copy must be turned into the clinic. The signed receipt or register or voucher copy must be filed and maintained according to standard operating procedures 30

31 Certification: CT – 74 A transit clinic is a site where WIC staff does not have an office in the hospital but make rounds to determine eligibility for the Georgia WIC Program. Transit clinic staff must bring documents, vouchers, etc., to the hospital. These clinics do not store records on site. 31

32 Certification: CT – 46 Certification: CT – 46 Pending USDA final review and approval Physical Presence (Certification Form) (D) – Disabilities – The local agency must grant an exception to applicants who are qualified individuals with disabilities and are unable to be physically present at the WIC clinic because of their disabilities, or applicants whose parents or caregivers are individuals that meet this standard. Examples of such situations include: a.A medical condition that necessitates the use of medical equipment that is not easily transported. b.A medical condition that requires confinement to bed rest; and c. A serious illness that may be exacerbated by coming into the WIC clinic. d.Mother/baby breastfeeding dyad: Hospitalized breastfed infant(s). The Mother/baby breastfeeding dyad applies to breastfeeding mothers whose infant has not been released from the hospital. 32

33 Rights and Obligation 33

34 Rights and Obligation: RO Conduct of the Hearing and the Appellants Rights –The claimant/designated representative shall be provided with an opportunity to: 1.Bring and call witnesses to provide testimony. 2.Advance arguments without undue interference. 3.Question or refute any testimony or evidence, including an opportunity to confront and cross examine adverse witnesses. 4.Submit evidence to establish all pertinent facts and circumstances in the case. –The local agency shall have the same opportunities listed above. 34

35 Rights and Obligation: RO VOUCHER INFORMATION Failure to keep appointments will reduce the number of vouchers you receive The fruit and vegetable/cash value voucher can not be prorated. It must always be issued and must be issued in full value (e.g., $6, $7, $8 and $10) Food packages will be prorated based on the total number of vouchers in the package 35

36 Administrative 36

37 The allocation of Nutrition Service and Administration (NSA) Grant funds is based on methodology developed by the Georgia WIC Program and the WIC Allocation Advisory Committee, with final approval from the Commissioner of the Department of Public Health. Administrative -AD 3 37

38 Administrative: AD-6 District level administrative costs are collected through the Uniform Accounting System (UAS) subsystem of DPHs general ledger system, Peoplesoft. Rebates are collected from the Peoplesoft general ledger system. This amount is posted in Peoplesoft and recognized the month it is received. Rebate invoices to the infant formula contractor are developed from reports generated by Georgia WICs banking and data contractor based on monthly product redemptions. Rebate rates are reconciled to the appropriate contract rates. Rebates collected from the rebate contractor are reconciled to rebates invoiced. 38

39 Administrative: AD-12 Ensure that no WIC funds are expended toward a computer system unless the computer system has prior written approval by the State WIC Program and USDA. 39

40 Administrative: AD Comply with the Georgia DPH Administrative Policy and Procedures and DPH Grants-to Counties Policies for administration of funds. Acquire approval from the State (and USDA) for the purchase of equipment with a base unit cost of $25,000 or more such as a vehicle or telephone system. Acquire approval from the State (and USDA) for the purchase of IT equipment procurement totaling $100,000 and more (regardless of cost per individual units or components)

41 Administrative: AD-13 Acquire approval from the State for all purchases over $5,000 or more (including purchase from WIC local agency sub contractors). State WIC approval must be obtained before procurement expensed can be invoiced. Approval to purchase supplies under $5,000 does not require approval from the State. However, capital expenditures (major equipment or furniture will require approval (if over $5,000). 41

42 Administrative: AD-14 Updates to the Georgia WIC Program Inventory Database are required whenever new non-ADP equipment over $1,000 (one thousand dollars) or any computer related equipment or new ADP equipment for any dollar amount has been acquired. Acquisition : Use the county asset form (See Attachment AD- 28) to log all purchased items over $1, and computer related equipment. This form should be sent to the WIC property and equipment specialist twice a year (December and May) along with supporting documents. 42

43 Administrative: AD-15 Equipment that is no longer valuable and/or usable and is scheduled for destruction must be noted on Attachment AD-2. Also attach a Destruction of Surplus Property Affidavit (See Attachment AD-29) Districts are to complete the Missing or Stolen Property Report (See Attachment AD-30) Disposed electronic items must be done using a separate Property Transfer Form. Computers, laptops or any item with a hard drive would need to have a computer Tech wipe clean the hard drive and fill out the Information Assets Eradication and Software Removal form (See Attachment AD-31). (This should be done before items are approved and picked up). Property Removal Form Property Removal Form (See Attachment AD-32) is to be used when equipment is taken out of the building. 43

44 Administrative: AD-20 These are the additions to the program management activities for the NSA costs: Visual Collaboration Individual Nutrition Education Group Nutrition Education Individual Breastfeeding Education Group Breastfeeding Education Individual Nutrition Education Certification Individual Nutrition Education Re-Certification Half-Certification (Children) Mid-Assessment/Breastfeeding Administration District Services Trainings/Meetings Tele health Tele Medicine Paid Time Off Mid-Certification (Infant) 44

45 Administrative: AD-30 All history to be maintained for each employee regardless of employees status changes from WIC District to Non-WIC Direct and back. 45

46 Administrative: AD-51 This is a new report available in PARs – Individual Employee Activity Report 46

47 Administrative: AD-62 This is an addition to the Retention Schedule for five (5) years plus current Federal Fiscal Year Fair Hearing and Civil Rights complaints and all related documentation 47

48 Administrative: AD XIX.LOCAL AGENCY STAFF The Nutrition Services Directors position is an administrative position. Attached is a copy of the current job description, which describes the responsibilities (see Attachment AD-10). 1. Nutrition Service Director Each of the WIC districts or contract agency (Grady) must be staffed with a District Nutrition Services Director who must be at minimum a (1) full-time equivalent (FTE) public health nutritionist, (2) a Licensed Dietitian (LD) in the state of Georgia and (3) be employed in either the class of Nutrition Services Director, Nutrition Program Manager, or Nutrition Manager. Preferred qualifications are a Registered Dietitian and a Masters Degree in dietetics, human nutrition, food and nutrition, nutrition education, food systems management or a closely related field from an Academy of Nutrition and Dietetics accredited program or a closely related field. Duties include: planning, organizing, implementing, and evaluating the nutrition service component of WIC. This encompasses leadership in the development and approval of nutrition education materials, development of the nutrition education plan, and implementation of nutrition risk criteria and food package delivery. 48

49 Administrative: AD Staffing Standards Each WIC local agency must be staffed with a minimum of one (1) full-time equivalent (FTE) Competent Professional Authority (CPA) for every one thousand (1,000) participants, and one (1) full-time equivalent (FTE) Registered and Licensed Dietitian (RD, LD) or Licensed Dietitian (LD) for every five thousand (5,000) participants. District staff time providing direct services can be counted towards these requirements; for example District staff can perform both participant services and district responsibilities. Job Classifications and Compensation Nutrition positions should be appropriately classified according to the policies, procedures, and guidelines of the Department of Public Health and the Human Resources Administration Division of the Department of Administrative Services. The Nutrition class specifications should be used for nutritionists providing direct client nutrition services, and these nutritionists should receive supervision from a higher level public health nutritionist. The class specifications, qualifications and compensation levels are to be according to the Department of Public Health and the Human Resources Administration Division of the Department of Administrative Services policies, procedures, and guidelines. The Breastfeeding Coordinator position may be a qualified nutritionist, nurse, health educator, Certified Lactation Counselor (CLC), or International Board Certified Lactation Consultant (IBCLC). A job description for Health Educator Senior/Lactation Consultant, which may be used to assure an individual is qualified to fill this position can be found in Attachment AD

50 Administrative: AD A Georgia Gain job classification sample job description entitled District Breastfeeding Coordinator can be found in Attachment AD-27 2.Breastfeeding Coordinator a.Each local agency must designate a staff person to coordinate breastfeeding promotion, education and support activities. b.It is recommended that this position be designated as a full-time position in order to facilitate coordinating services throughout the local agency and across program lines and to adequately meet Federal requirements. c.It is recommended that the breastfeeding coordinator work across program lines to provide breastfeeding services, thus increasing opportunities for all current and potential WIC participants to be reached. This will also serve to integrate services, and assure that all clinic staff receive appropriate training and deliver consistent information on breastfeeding. 50

51 Administrative: AD XXVII. STATE PLAN The State Plan consists of Goals and Objective for the State.

52 Administrative: AD-93 XXXIII. RECONCILIATION RATES FOR GEORGIA The State of Georgia Reconciliation of voucher rates from FFY2009 – present is listed below: First four months of manual reconciliation (through January, 2013) 52 FFYTotal Vouchers Produced Unmatched Original CUR 1 & 2 Unmatched Final Manually Reconciled Total Unreconciled Total Reconciliation Rate Total Unreconciled Rate ,414,21650,97513,7807,1046, %0.0538% ,463,15127,7453,0121,7371, %0.0077% ,285,22233,7606,9376, %0.0017% ,799,77984,80129,10927,5821, %0.0091% 2013*5,427,47218,6155,2134, %0.0078%

53 Administrative: AD-93 XXXIV. PUBLIC COMMENT SURVEY RESULTS 2012 Public Comment Survey Results Georgia WIC received 15,947 surveys for FFY 2012 from WIC participants, advocates and vendors. Participant surveys (English and Spanish) were available in the WIC clinic sites throughout the state and the Public Health Website. A total of 15,703 surveys were completed. Advocate surveys were mailed and placed on the Public Health Website with a total of 230 surveys being completed. Vendor surveys were also placed on the Public Health Website with 14 surveys being completed. The summary of the analysis is currently underway and is not completed to date Public Comment Survey Plans The 2013 Public Comment survey for participants, vendors, and advocates will be available for completion online from August 5 – September 6, The public service announcement will be released prior to this date by the Office of Communications to increase awareness and responses to the survey. Hard copies of the participant survey will be placed at all clinics in the District/local agency so that participants can complete them onsite. Vendor surveys will be electronically ed to at all vendors. 53

54 Administrative: AD-94 XXXV. INFORMATION SYSTEMS Information Systems Georgia WIC has four front end data collection systems (AEGIS, Mitchell and McCormick, Netsmart, and HealthNet2) and a contract with Computer Services Corporation (CSC) for all back end data processing, banking and reports. Georgia WIC is currently working to complete a Planning Advanced Planning Document (PAPD) that will research, assess and define alternatives for a new WIC clinical system. The goal of Georgia WIC in conjunction with the DPH Information Technology staff is to coordinate the planning activities that will ultimately provide the state of Georgia with a modern clinical information system that is: Cost effective Flexible Client and case centric Standardized for financial management Compliant with Functional Requirements Document (FReD) Standards Adaptable to Electronic Benefits Transfer (EBT) implementation Able to integrate with current clinical systems Electronic Benefit Transfer (EBT) – Current plan complete conversion to EBT by April 1, Milestones and plans during these next several years are located in the State Plan. 54

55 Administrative: AD Voucher Management and Reconciliation System (VMARS) During FFY 2014, the state of Georgia plans to implement VMARS state- wide The systems will validate all WIC client transactions and information in real time and notify the clinic user of any unresolved critical errors Upon completion of the validation process, the clinic user will transmit the command to print vouchers, the system will assign voucher serial numbers and send the command to the local printer The system will eliminate the need for daily batching, as well as Dual Participation, Bank Exceptions, Cumulative Unmatched Redemptions (CUR), Unmatched Redemption, Critical Errors, duplicate vouchers, and duplicate voucher numbers.

56 Administrative: AD Data Processing Request for Proposals (RFP) Georgia WIC is in the final year of its contract with CSC An RFP is in the final stages of preparation. The contract was awarded to CSC. This will be a business as usual contract to give the state time to prepare for upcoming changes, including EBT and VMARS.

57 Administrative: AD-95 XXXVI. Infant Formula Rebate Invoicing Infant Formula Rebate Contract Effective July 1, 2013, Georgia WIC has entered into contract with Nestle Infant Nutrition for infant formula cost containment in the form of rebates for formula redeemed by Georgia WIC vendors per 7 CFR a. The initial term of the contract is for three (3) calendar years from the execution date of the contract. Georgia WIC has two (2) one (1) year options to renew, which options shall be exercisable at the sole discretion of Georgia WIC. 57

58 Administrative: AD-95 Infant Formula Rebate Invoicing Process To insure proper rebate invoicing, Georgia WIC has developed four (4) standard operating procedures (SOPs) to manage changes in rebate rate changes, product name changes, package size changes and rebate invoicing. These will be maintained as attachments to the Administrative Section of the procedures manual. See Attachments AD-33 58

59 Administrative: Attachment 1 59 PROGRAM NAME: Georgia WIC, WIC Farmers Market Nutrition Program, WIC Breastfeeding This attachment discusses the Georgia Farmers Market and WIC Breastfeeding

60 Administrative: Attachment 2 60 PROGRAM NAME: Using Loving Support to Manage Peer Counseling Program The purpose of this attachment is to discuss Peer Counseling to promote breastfeeding

61 Administrative: Attachment 25 This is a new attachment regarding standard operating procedures for returned food instruments. 61

62 Administrative: Attachment 26 This attachment is for the job description for the Lactation Consultant. 62

63 Administrative: Attachment 27 This attachment is for the job description of the District Breastfeeding Coordinator. 63

64 Administrative: Attachment 33 This attachment is for the standard operating procedures for Infant Formula Rebate Changes (Product Name Changes) 64

65 Administrative: Attachment 33 This attachment is for the Standard Operating Procedures for Infant Formula Rebate Changes. 65

66 Vendor Management 66

67 Application Acceptance Periods Vendor Management 67 VENDOR APPLICATION PERIODS – VM 1 Applications for WIC vendor authorization will only be accepted during the following periods of each calendar year: March 1 st - June 30 th October 1 st - December 31 st

68 If an application for authorization is denied, the applicant will be barred from reapplication for a period of one year with the exception of the Denial Reasons listed below. 1.Accepting WIC vouchers prior to Authorization. The denial period is three (3) years. 2.Business Integrity and Related Denials. For Business Integrity or Integrity-related reasons, the denial period will be two (2) years. 3.All Other Reasons for Denial. The denial period is one (1) year. Vendor Management 68 Re-application Limitations after Application Denial – VM 1

69 Selection Criteria and Continuing Compliance with Selection Criteria The selection criteria represent the requirements to be considered for authorization as a Georgia WIC vendor. All applicants and vendors must meet the selection criteria at the time of authorization and maintain them throughout the agreement period unless there is inadequate participant access in that area. Vendor Management 69 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2)

70 Selection Criteria and Continuing Compliance with Selection Criteria Summary of changes/additions: Complete, Accurate and Truthful Information and Documents Provide supporting documents during the process. Previous Sanction or Violation History with SNAP or WIC Program Applicants who have pending or current Terminations or Disqualifications that have not expired will not be authorized. Previous Applicant History Review for inconsistencies, fraudulent conduct or misrepresentation. Vendor Management 70 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2)

71 Selection Criteria and Continuing Compliance with Selection Criteria Summary of changes/additions: Competitive Prices All applicants and vendors are required to submit and maintain prices that are at, or lower than other vendors currently participating in the program. Length of time as a SNAP retailer and Previous Grocery Industry Experience All applicants must demonstrate a minimum of twelve months experience as a retail grocer. Vendor Management 71 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2)

72 Selection Criteria and Continuing Compliance with Selection Criteria Summary of changes/additions: Business Integrity & Background Checks Business integrity and sound reputation of: Owners, officers, partners or the immediate family of owners, officers and partners. Minimum Inventory of WIC-Approved Foods & Pre-Approval Visit At least one pre-approval visit is required for each applicant to verify the items listed on the application. Vendors can provide a written request for a second visit if minimum inventory is not met after pre-approval visit has been conducted. Georgia WIC reserves the right to revisit at any time. Vendor Management 72 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2 & VM-3)

73 Selection Criteria and Continuing Compliance with Selection Criteria Summary of changes/additions: Suitable Store Location 5,000 square feet - minimum square footage requirement after Oct 1, 2013 for new vendors coming on the program. 3,000 square feet – vendors participating in program prior to October 1, New and existing vendors - 20% of location can be used for administrative or storage space. Store Acquisition Georgia WIC will not approve or continue the authorization of a store location or entity that was sold or assigned to circumvent an unexpired sanction, claim or civil money penalty. Vendor Management 73 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2)

74 Selection Criteria and Continuing Compliance with Selection Criteria Summary of changes/additions: Infant Formula Suppliers The program will no longer permit vendors to purchase infant formula from other program vendors. Only purchases from the manufacturers, distributors and wholesalers will be permitted. Pharmacies All Pharmacy peer group vendors must be licensed and remain in good-standing with the Georgia State Board of Pharmacies to provide prescription drugs and special medical foods in Georgia. Vendor Management 74 SELECTION CRITERIA FOR VENDOR AUTHORIZATION (Attachment VM-2)

75 Authorized vendors are classified into seven different peer groups depending on square footage of the store (including administrative and storage space), number of stores in the chain, and potential or actual above 50% status. Peer Group TypeDescription A Small5,000 to 10,000 Square Feet. Vendors in operation prior to October 1, 2013 may remain at 3,000 square feet. Vendor Management 75 PEER GROUPS – VM 2 Stores in Peer Groups A, B, and G will no longer be permitted to redeem vouchers for Special Infant Formula and Medical Foods. Stores in Peer Groups C, D, Military Commissaries (E), and Pharmacies (F) are the only vendors permitted to redeem these types of vouchers.

76 High risk vendors will be prioritized based on high risk scores and volume of WIC redemption. Those with the highest scores and the highest volume of WIC redemption will be investigated/audited first. Vendor Management 76 HIGH RISK IDENTIFICATION SYSTEMS – VM 3

77 The Georgia WIC Program implemented a cost containment plan to identify and manage vendors who derive more than fifty (50) percent of their annual food revenue from WIC food instruments. All vendors will be assessed at application, within six months after authorization, and annually thereafter to determine whether they derive more than fifty (50) percent of their SNAP eligible food sales from WIC redemptions. Conduct an initial food sales assessment based on programmatic reports. Request a detailed Food Sales assessment. Terminate any vendor who fails to provide documentation upon request. Vendor Management 77 VENDOR COST CONTAINMENT – VM 5

78 Georgia WIC may conduct record or inventory audits on any vendor at any time. Inventory audits will include: Examination of food invoices or other proofs of purchase. Invoices should reflect the name and address of the wholesaler or supplier, date of the purchase, list of the items purchased, size, stock number, quantity, unit price and total dollar amount for the quantity purchased. Itemized cash receipts with name and address of store. During an audit, the vendor must supply Georgia WIC or its representative with documentation of pertinent records upon request and retain copies of all invoices relating to the purchase of WIC food items for the three previous years plus the current year. Vendor Management 78 INVENTORY AUDITS – VM 6

79 VENDOR APPLICATION (attachment VM-1) Detailed, operations, sales and ownership history Prior WIC Application information Bank information (including routing and account numbers) Inventory and price list update Vendor Management 79 SUMMARY OF ADDITIONAL CHANGES

80 GEORGIA WIC PROGRAM VENDOR HANDBOOK (attachment VM-3) Effective October 1, 2013 Updated to include all new and revised changes. Vendor Management 80 SUMMARY OF ADDITIONAL CHANGES

81 VENDOR AGREEMENT (attachment VM-4) 3 year Agreement for Corporate Vendors 2 year Agreement for Non-Corporate Vendors CORPORATE ATTACHMENT FORM (attachment VM-5) Prior WIC History Medical formula and special medical foods CORPORATE NON-CORPORATE VENDOR TRAINING CHECKLIST (attachment VM-6&7) The types of valid WIC food instruments, the procedures for transacting Georgia WIC food instruments and the types of Infant Formula vouchers that vendors in different Peer Groups may transact. NON-CORPORATE VENDOR TRAINING CHECKLIST (attachment VM-6) The right to challenge the Agencys initial determination as an above fifty percent vendor and the responsibility to provide all documentation and information requested by Georgia WIC in connection with a full Food Sales Assessment. Vendor Management 81 SUMMARY OF ADDITIONAL CHANGES

82 Food Package 82

83 Formula Names updated throughout section –Gerber Graduates (Gentle, Soy) –Enfagrow Toddler Transitions (Regular, Soy, Gentlease) –Enfagrow Toddler Next Step Vanilla –PurAmino Formula examples may have changed Food Package 83

84 Contract Versus Non-Contract Formula –Updated contract date –July 1, 2013 through June 30, 2016 Food Package FP-1 84

85 Rice Added Formula (Medical Documentation Required) –The following two conditions must exist prior to issuance of a Non-Contract Rice Added Formula: Diagnosis of Gastroesophageal reflux disease (GERD) And one of the following conditions: Pneumonia, Tube feed, GERD Surgery (Fundoplication), Poor weight gain; Drop of at least one weight channel on growth chart. (Note: If weight is not provided, issuance will be based on weight obtained at WIC clinic.) Food Package FP-3 85

86 Feeding Type Assignment 3. Some Breastfed (SBF) infants receive formula in excess of the amount allowed for mostly breastfed infants in the federal regulations but is receiving breastmilk at least once per day. 4. Fully Formula Fed (FFF) infants receive the full formula package and breastfed less than an average of once every 24 hours. Food Package FP-9 86

87 Food Package Assignment – Mostly Breastfed - First Month For example, entering F17 in the second box would provide the maximum formula amount of four (4) cans allowed for ages one (1) to three (3) months. This option is only available at the initial certification. Food Package FP-11 87

88 Food Package Assignment – Some Breastfed Some Breastfed (SBF) infants are infants who receive formula from WIC in amounts that exceed the maximum allowed for mostly breastfed infants (approximately half [50%] of the full formula package issued to FFF infants). a. Some Breastfed Packages SBF infant packages contain approximately 75% of the full package and begin with a P. The computer will issue food packages beginning with a P to SBF infants ages 0 through three (3) months old, a Q package to SBF infants ages four (4) through five (5) months old, and an I package to SBF infants ages six (6) through 11 (eleven) months old. The WIC computer system will automatically add the cereal and baby food to the food packages when the infant is six (6) months old. Food Package FP-11 88

89 Food Package Assignment – Some Breastfed b. Maximum Formula Packages The SBF may also receive the full formula package which starts with an A. The computer will issue internal system food packages beginning with an A to SBF infants ages 0 through three (3) months old, a B package to SBF infants ages four (4) through five (5) months old, and a D package to SBF infants ages six (6) through 11 (eleven) months old. The WIC computer system will automatically sequence the formula quantities and add the cereal and baby food to the food packages Food Package FP-11 89

90 Child – WIC Foods Milk: Children greater than 23 months 15 days of age will have a choice between two standard food packages – C21 (with 1 pound of cheese substituted for part of the milk) or C28 (with all milk and no cheese). Food package C28 with no cheese should be considered the standard package and C21 an alternative package. Food Package FP-20 90

91 Women– WIC Foods Only low-fat milk is allowed for women. Women in Food Package V or VII have a choice of two standard packages – one with cheese and one without cheese. Food packages without cheese (all milk) should be considered the standard package and the package with cheese an alternative. Food Package FP-24 91

92 Medical Documentation – Frequency & Records 1. Current medical documentation is required, at a minimum, every six (6) months, with any change in the order, and at every recertification/sub-certification/mid-certification* and at WIC type changes when a certification is not completed, for the prescription of special formulas and medical foods on Form #1. 2. Current medical documentation is required, at a minimum, every six (6) months, with any change in the order, and at every recertification/sub-certification/mid-certification* and at WIC type changes when a certification is not completed, for the prescription of special milk substitutions on Form #2. Food Package FP-33 92

93 Emory Genetics– Provision of Formula and WIC Foods When an Emory Genetics client is on a standard infant formula the Nutrition Unit may coordinate the issuance of the formula by the clinic. Food Package FP-41 93

94 Creating 999 Food Packages State created voucher codes must be used for all food categories (i.e., milk and whole grains). If a participant needs a WIC approved formula or medical food when no state created vouchers are available, the product must be ordered through the state office. Food Package FP-42 94

95 Some Breastfeeding Packages added Infant Food vouchers updated Food Package Attachment FP-1 to FP-8, FP-18, FP-27 95

96 Voucher Codes for Special Formula Packages for Some Breastfeeding Infants – Recommended Amounts – Tables added - Some Breastfeeding Special Formula Vouchers Food Package Attachment FP-27 96

97 Supplemental Formula Table – Modulars Displacement conversions added for –Human Milk Fortifier - liquid –Microlipid –Complete Amino Acid Mix Food Package Attachment FP-28 97

98 D. Matching Mother/Baby Packages Mother/baby breastfeeding dyad refers to the process of thinking of a mother and her infant as a unit or pair rather than as two individuals. The mother/baby breastfeeding dyad food packages must agree. For instance, the infant of an Exclusively Breastfeeding Woman (EBF) must be issued an Exclusively Breastfed food package. The table below matches the appropriate infants food package to their mothers food package. Food Package FP-11 Food Package FP-11 Pending USDA final review and approval 98

99 Food Package FP-12 Food Package FP-12 Pending USDA final review and approval 99 D.Matching Mother/Baby Packages Note: The Mother/baby breastfeeding dyad still applies to breastfeeding mothers whose infant has not been released from the hospital. An infant that has not been released from the hospital, but qualifies as a breastfeeding infant must be certified as part of the Mother/baby breastfeeding dyad. The breastfeeding mother should be certified as Exclusively Breastfeeding as no food benefits will be issued to the infant. Issue the infant CPA Food Package 190 Infant in Hospital: Mother/baby breastfeeding dyad. Food package 190 contains a tracking voucher with no formula or food benefits. Formula or food benefits can not be issued to the infant until they have been released from the hospital. The tracking voucher message will encourage the participant to contact the local WIC clinic when the infant is released from the hospital. Upon release WIC staff should evaluate the Mother/baby breastfeeding dyad feeding staus and update the Mother/baby breastfeeding dyad food package as needed. Physical presence for the breastfed infant(s) will be documented as reason (D) Disabilities. For more information on Physical Presence See section XV. 19 Certification Section of the Procedures Manual. If the mother discontinues breastfeeding prior to the infant being discharged from the hospital, continue issuing food package 190 to the infant and update the mothers food package to reflect her new feeding status.

100 100 Food Package FP-12 Pending USDA final review and approval Food Package CodeRankVCVoucher Message 1909 This voucher has no cash value Grocers should not accept this voucher Your infant is enrolled in WIC and is not receiving a food benefit from WIC. Contact your WIC clinic when your baby is released from the hospital or a food package change is needed. Hospitalized Breastfed Infant / Not receiving formula or food from WIC

101 Nutrition Education 101

102 Totally reorganized –Major sections Introduction Definitions State Agency Responsibilities Nutrition Education Plan Participant Nutrition Education Documentation of Nutrition Education Local Agency Staff/CPA Participant Referral to Other Agencies Nutrition Education/Resources - Job descriptions/duties were moved to administrative section Nutrition Education 102

103 Introduction –Nutrition Education is a major component of the WIC program. Nutrition Education NE-1 103

104 State Plan 1. Develop, implement, and evaluate the State Nutrition Education Plan. Periodically review, evaluate, and make appropriate revisions as necessary. 2. Develop guidelines for local agency Nutrition Education Plan development. Review each plan and provide feedback. 3.Monitor the progress of local agency Nutrition Education Plans on a periodic basis through on site visits and annual reporting Nutrition Education NE-3 104

105 Participant Nutrition Education Plan 1. Local agencies must provide breastfeeding women and caregivers of infant and child participants with four (4) nutrition education contacts (must receive nutrition education on four different occasions) during each twelve (12) month certification period, but not within the same day/clinic visit. For prenatal and post-partum women nutrition education contacts shall be made available at a quarterly rate, but not necessarily taking place within each quarter Nutrition Education NE-3 105

106 Methods for Providing Nutrition Education 1. The nutrition education contacts can be provided by individual or group sessions on topics appropriate to the individual participant's nutritional needs. On-line nutrition education is an additional option. Nutrition Education NE-4 106

107 Exit Counseling 1. All women participants must receive exit counseling by the final nutrition education contact of the postpartum period (i.e., counseling at least one (1) time on each of the below topics between the initial prenatal certification and when the postpartum woman is terminated as a participant for the current pregnancy). It is recommended that Exit Counseling be discussed at the first contact. Nutrition Education NE-5 107

108 Exit Counseling 2. Parents or caregivers of WIC infants and children must also be provided with exit counseling. ). It is recommended that Exit Counseling be discussed at the first contact. Exit counseling is defined as counseling which includes the following topics which are to be discussed within an infants certification period (birth to one year) and childs certification period (one to five years): Nutrition Education NE-6 108

109 Proxy Nutrition education may be provided to the proxy at the time of voucher issuance and count as a contact for the participant. Nutrition Education NE-6 109

110 Primary Nutrition Education 1. Primary nutrition education can be documented on the staff side of the client nutrition questionnaire or directly into the electronic medical record. 2. Documentation must include date, topics covered, and provider. Nutrition Education NE-6 110

111 Secondary Nutrition Education 6. In addition to the date, topic(s), the title of the person providing the nutrition education and method by which the nutrition education contact was provided high risk follow-up must include a nutrition care plan using the Nutrition Care Process. 7. Approved formats for high risk documentation include; ADIME (Assessment, Diagnosis, Intervention, Monitoring and Evaluation), and SOAP (Subjective, Objective, Assessment, Plan) A flow sheet may be used as long as it contains all components of the Nutrition Care Process. ADIME format is the preferred method of documentation for Registered Dietitians. Nutrition Education NE-6 111

112 Secondary Nutrition Education 6. In addition to the date, topic(s), the title of the person providing the nutrition education and method by which the nutrition education contact was provided high risk follow-up must include a nutrition care plan using the Nutrition Care Process. 7. Approved formats for high risk documentation include; ADIME (Assessment, Diagnosis, Intervention, Monitoring and Evaluation), and SOAP (Subjective, Objective, Assessment, Plan) A flow sheet may be used as long as it contains all components of the Nutrition Care Process. ADIME format is the preferred method of documentation for Registered Dietitians. Nutrition Education NE-7 112

113 Continuing Education 2. CPAs require WIC programmatic in-service training (e.g., risk criteria, food package/approved foods, etc.). These trainings do not count towards the required twelve (12) hours unless approved by the state. Nutrition Education NE-8 113

114 Nutrition Education NE-9 & 10 Referrals Children with the following nutritional risks should be automatically be referred to the District Children 1 st coordinator using the Children 1 st Screening and Referral Form: Risk 134: Failure to Thrive Risk 211: Elevated Blood Lead Level Risk 348: Central nervous System Disorders Risk 349: Genetic and Congenital Disorders (i.e., inborn Errors of Metabolism) 114 Risk 362: Developmental, Sensory or Motor Delays Interfering with Ability to Eat Ri sk 382: Fetal Alcohol Syndrome Risk 703: Infant Born to Mother with Mental Retardation, or Alcohol or Drug Abuse during Most Recent Pregnancy Risk 801: Homeless Risk 901: Recipient of Abuse Children 1 st is Public Healths single point of entry for children birth to age five. Parents whose infants and children are at risk for poor health and developmental outcomes are linked to prevention-based programs and services.

115 New Nutrition Assistant Observation Form Nutrition Education Attachment NE-1 115

116 Outreach 116

117 An Outreach Plan is required to be submitted to the State WIC office on a quarterly basis. General Changes Outreach: OR-1 117

118 16.Department of Family and Children Services 20.Department of Labor Outreach: OR

119 Income Eligibility Guidelines effective July 1, 2013 to June 30, 2014 Outreach: OR Family SizeYearly Income 1$21, , , , , , , ,316 Each Additional Member Add +$7,437

120 Food Delivery 120

121 A.Vouchers Printed On Demand (VPOD) Voucher Management and Reporting System (VMARS) vouchers will be used in the same manner as VPOD vouchers with the exception of receiving serial numbers from the ADP contractor. The ADP contractor will be responsible for printing the vouchers and maintaining the serial numbers for each clinic. There will not be an inventory log used with VMARS vouchers. Food Delivery: FD-2 121

122 Food Delivery: FD C. Preprinted Standard Manual Vouchers Clinics must keep an adequate supply of all Manual voucher sets. Hospital sites must maintain a one-month supply of blank manual voucher sets.

123 Food Delivery: FD-3 (contd) E. WIC Farmers Market Nutrition Program (FMNP) FMNP coupons are printed in the WIC clinic and issued to participants to allow them to purchase fresh fruit and vegetables from participating Farmers Markets. Coupons Printed On Demand (CPOD) differs from Vegetable and Fruit Vouchers in appearance, value and redemption process (see Attachment FD-4). CPOD coupons may only be redeemed during the FMNP season which runs from approximately May to October of each year. They may not be used in grocery stores. 123

124 Food Delivery: FD-4 F. Senior Farmers Market Nutrition Program (SFMNP) SFMNP coupons are either printed at the WIC clinic or may be preprinted depending on the clinics situation (see Attachment FD-5). SFMNP coupons are issued to Senior Citizens over the age of 60 years. This Program is run jointly with the Georgia Department of Aging. 124

125 Food Delivery: FD-5 III. Voucher Issuance- General Postpartum women who are due for recertification must not be over issued vouchers. Over Issuance occurs when women are issued vouchers during the prenatal period for one month plus forty-five day increments beyond their date of delivery. When participants are subsequently recertified as a postpartum woman, vouchers must not be issued for the postpartum period without first checking the last voucher issuance date. Retrieved vouchers must be voided in the system, stamped void, and returned to CSC for processing. Women must not be issued two sets of vouchers for the same month. This will prevent the woman from being over issued vouchers during the postpartum period. 125

126 Food Delivery: FD-6 E. Categorically Ineligible When a participant becomes categorically ineligible before the end of the month, they will only receive vouchers up to the categorical term date. For example, if a participants category term date is January 15 and his/her pick-up is January 2, the participant will only receive two vouchers plus the produce/fruit vegetable voucher. If the participants pick-up date is after the categorical term date, the participant will receive no vouchers. Vouchers must not be issued past the date of Categorical eligibility. The categorical ineligible message will appear on the voucher receipt for the last set of vouchers one month prior to the termination date. 126

127 Food Delivery: FD-7 E. Categorically Ineligible Vouchers cannot be issued if the pickup code is after the birthdate. If the childs birthdate is in the first week of the month, he/she will only receive one voucher plus the produce/fruit and vegetable voucher. 127

128 Food Delivery: FD-11 V.MANUAL VOUCHERS (Blank and Standard) 4. All manual vouchers must be entered into the computer for electronic submission. Log all serial numbers for each type of manual vouchers on the Manual Voucher Inventory Log, and a screen shot of the computer entry must be attached to the inventory log. Manual voucher cannot be mailed to the ADP contractor for processing. 128

129 Food Delivery: FD-12 E.Inventory Control of Manual Vouchers Each clinic must log all manual vouchers in the computer the same day that they are received but, in any event, no more than three (3) days after receipt. A computer screen must be printed and stapled to the corresponding packing slip to show date of entrance. 129

130 Food Delivery: FD-12 (contd) 1.Perpetual Inventory (Weekly) (Manual Vouchers) All columns of the log must be completed accurately, legibly, and initialed, by a responsible staff member. Always record the voucher numbers immediately after receiving them from the ADP contractor on the Log Sheet and enter them in the computer. 130

131 Food Delivery: FD-13 Manual Voucher Inventory Logs must be retained for five (5) years plus the current Federal Fiscal Year. Inventories must be completed in black or blue ink. 131

132 Food Delivery: FD-14 H. Voided Manual Vouchers Vouchers marked VOID must be submitted electronically. Void the vouchers in the computer and transmit to the ADP contractor. Attach the voided vouchers to receipt. 132

133 Food Delivery: FD-14 (contd) 1.Voided Manual Vouchers that were reported to the ADP contractor as Issued - The system contains an issuance record that must be voided. To accomplish this, the clinic must void the voucher in the computer and submit it to the ADP contractor. 2.VoidedManual Vouchers that were not reported to the ADP contractor as Issued. These voids are due to errors made while completing the voucher, which prevent the voucher from being issued. All three (3) manual voucher copies must be marked "VOID". Void these vouchers in the computer system and transmit to the ADP contractor. Although there are no issuance records on these vouchers, the ADP contractor will input this voided information into the system to identify the disposition of the vouchers. All Voided and Destroyed vouchers must be reported to the ADP contractors Bank. Do not send any manual vouchers back To the bank. 133

134 Food Delivery: FD-15 All receipts must be reconciled with the Daily Activity Report. The receipts must be filed in numerical order. Each clinic must maintain a file for the activity reports and keep it in the clinic. If vouchers are voided, they must be stamped VOID before filing them with the receipts. Clinic staff must staple or paperclip the voided vouchers to the back of the receipt. If the voucher does not print or the receipt is lost, use a blank voucher receipt to write those numbers, the date, the participants name, the participants WIC ID number and the clerks initials on the receipt. Skipped Serial Numbers must be entered into the system as void and reconciled with the Daily Activity Report. The Daily Activity Report must be signed and dated to verify reconciliation each day. 134

135 Food Delivery: FD-16 H. Corrective Actions for VPOD is required for the following: 1.Missing receipts 2.Incomplete log sheets 3.More than one percent Fail to Sign on receipts 4.Vouchers issued during an invalid certification period 5.Missing and/or any incomplete Daily Activity reports 6.Any vouchers filed with receipts that do not have VOID stamped or written on them 7.Voucher printing problems that are not documented properly 8.Voucher numbers that did not print, and are not voided in the computer 9. Missing participant signatures 135

136 Food Delivery: FD-17 VII. VMARS PROCEDURES A.General The Voucher Management and Reporting System (VMARS) will centrally manage WIC data and voucher printing independent of the various MIS systems. This web service client will accept securely communicated front end system WIC data. The data will be validated in real time by the ADP contractor for use by the VMARS print queue system. The VMARS print queue system will print the Georgia WIC vouchers with a uniform appearance statewide. A complete and valid certification will be required to be on file with the ADP contractor before a voucher will be issued to a participant. 136

137 Food Delivery: FD-17 (contd) B.Validating A Certification Record The front end system will send certification and voucher information through the web service to the ADP contractor; the ADP contractor will break the string into the 131 current data elements and validate the record based on the current edits manual. The VMARS client will validate and cross edit the submission and respond with a pass/ fail message. A detailed message will be returned to explain any failed submissions, listing the data element(s) and reason(s) for the rejection. All required information must be corrected and submitted prior to vouchers being allowed to print. 137

138 Food Delivery: FD-17 (contd) C.Voucher Printing VMARS_Q The clinic will submit a voucher request to the ADP contractor who will verify the participant is in a valid certification period. The vouchers will be printed by the ADP contractor managed print queue system VMAR_Q. All the vouchers will have an identical appearance due to a single system producing them. This will reduce the possibility of duplicate voucher numbers. The ADP Contractor managed VMARS server will track and control the voucher numbers assigned to the clinics and coordinate with the backend system the voucher ranges used. Using this system will eliminate the use of an inventory log. The print queue system will be installed on a dedicated computer/server that will allow all printers used to print the vouchers. The clerks will retrieve the vouchers from their assigned printer and ensure that all vouchers were printed accurately. When the vouchers print a receipt will be printed with the vouchers and the participant will need to sign acknowledging the receipt of the vouchers. 138

139 Food Delivery: FD-17 (contd) D.Issuing VMARS Vouchers The following procedures must be followed when issuing VMARS Vouchers: 1.Identification - Verify the identity of the person picking up the vouchers 2.Issuance- The ADP contractor will validate all certification and voucher information before any vouchers will be printed. The clerk may ensure their assigned printer or the default printer print the vouchers. 3.The name of the participant will be compared to the participants name on the WIC ID card and as it appears on the vouchers. 4.The participant must sign the receipt before receiving the vouchers. Vouchers must not be issued until after the participant/proxy/guardian signs the receipt. The receipt must be reconciled with the daily activity report. 139

140 Food Delivery: FD-17 (contd) E.Daily Reconciliation Vouchers numbers will be controlled by the ADP contractor, unlike VPOD, a specific number range will not be assigned to each clinic. The serial numbers on the vouchers will be based on the next available number in the queue. The voucher number will be in sequential order by participant but not by clinic, for example: Participant A vouchers will be numbers 1-5, Participant B vouchers may be 10-15, therefore voucher receipts must be reconciled with the Daily Activity Report to ensure all receipts and vouchers are accounted for. Each clinic must maintain a file for the Daily Activity Reports and keep it in the clinic. If vouchers are voided, they must be stamped VOID before being filed with the receipts. Clinic staff must staple the voided vouchers to the back of the receipt. The Daily Activity Report must be signed and dated to verify reconciliation. At the end of each day, the WIC clinic staff must print a Daily Activity Report that includes: 1.Voucher Numbers 2.Participants Name 3.Issue Date 4.Initials of issuing clerk 5.Status of voucher(Issued or Void) 140

141 Food Delivery: FD-17 (contd) F.Voiding VMARS Vouchers If it becomes necessary to void VMARS vouchers, the vouchers in question must be voided in the computer system. The voided vouchers must be submitted to the ADP contractor before replacement vouchers can be requested for the participant. The system will send a message stating this participant has received vouchers for this period. This will also alert the clerk if the participant has received vouchers from another WIC clinic to detect dual participation. 141

142 Food Delivery: FD-17 (contd) G. Benefits of VMARS As a real time system with immediate pass/fail of certification information at the front end, this should eliminate errors on the backend and virtually eliminate the CUR report. Real time means all data submitted to the ADP contractor will be accepted or rejected as soon as it is received by CSC. All required certification information will have to be corrected prior to vouchers being allowed to print. The VMARS system will communicate with the ADP contractor via a web service over the internet. Changing to a real time system will eliminate the daily batching process. The data will be captured during the validation and cross editing process and stored by the backend systems for the reconciliation process. With the elimination of the daily batching process, participant information will be added to the GWISnet system as it is received, and the twenty-four (24) hour delay will be eliminated. A reduction in the Previously redeemed bank exception report will occur because VMARS will not allow the front-end system to send the same voucher information repeatedly. The Previously Void will be reduced by requiring the front end systems to send voided, lost, stolen, and destroyed voucher information via the internet web service system and not mailing them to the ADP contractor for manual entry into the system. This system will also reduce dual participation by verifying whether a participant has already been issued a voucher for a specific timeframe. It will also cross edit participant information with the current dual participation edits to ensure the participant is not enrolled in another WIC clinic. Voucher information will be displayed in GWISnet with the participant and voucher issuance information allowing clinics to review transferring participants history and reduce dual participation. The system allows for multiple transactions to be completed in the same day so long as the previously sent information was accepted by CSC. An example of this is a participant who is transferring and need a certification; both transactions can be completed in the same day without receiving a critical error. 142

143 Food Delivery: FD-17 (contd) H.System Failure The VMARS system will require internet connectivity. Should the system lose connectivity, the current policy and procedures for issuing manual vouchers will apply (VPOD will not be operable once VMARS is in place; only manual vouchers can be issued). These vouchers will be submitted by inputting the information into the front end system when the system is available. This will allow a site to continue voucher issuance should a system or equipment failure occurs. In the event of a VMARS system failure, follow the manual certification and voucher issuance procedures currently in place. Once the system is functioning, all certification and voucher issuance information must be entered into the computer to be submitted via the web service system. 143

144 Food Delivery: FD-17 (contd) I.Manual Voucher Submission All manual vouchers must be transmitted to CSC via the web service system. Manual vouchers cannot be batched manually or sent to CSC for manual processing. The following procedures must be conducted when manual vouchers are received: Each set must be entered in the computer using the previous VPOD procedures. Each clinic must log all numbers on the Manual Voucher Inventory Log and in the computer the same day that they are received but no more than three (3) days after receipt. A computer screen must be printed and stapled to the corresponding packing slip to show date of entrance. The packing list must be signed and dated and a copy sent to the district office within five (5) days of receipt. The packing list must also be kept on file in the clinics. 144

145 Food Delivery: FD-25 B. Replacement Vouchers Due to a Declared Emergency Prior to reissuance of lost vouchers for those participants who live in a declared emergency area the clinic staff shall: 1. Determine if the participant resides in an area that has been designated as an area affected by a Declared Emergency 2. Determine which vouchers the participant has lost and need replacement. 3. Call the CSC Help Desk to determine which lost vouchers have been cashed and processed by the bank. Listed below is the information that staff will need to provide to CSC: Voucher numbers Participant ID number Name of participant Clinic, County and District number Name of staff member requesting the information a. Phone number is b. Hours of operation are from 7:30 am to 5:00 pm, Eastern Standard Time (EST). 145

146 Food Delivery: FD-25 (contd) 4.Document the voucher information for lost vouchers that have NOT BEEN CASHED on the Lost/Stolen/Destroyed Voided Voucher Report, per family/participant (see Attachment FD-18). After receiving the verification information of lost vouchers that have been cashed or not cashed from the CSC Help Desk, use as many pages as necessary to document information. 5.Issue Replacement vouchers only for vouchers that have NOT BEEN CASHED by the participant and document on all voucher receipts, Replacement Vouchers-Declared Emergency. 146

147 Food Delivery: FD-34 B.Monthly Verifications 1.Ensure that all vouchers are appropriately issued and/or voided. Did not print is not an acceptable voucher status. 2.Review Unmatched and CUR Reports and reasons indicated. 3.Assure voucher redemption reports are verified and resubmitted in the required time frame. 4.Review the override reports at each clinic location. 147

148 Food Delivery: FD-34 (contd) XVIII.VMARS Security General Monthly, the clinic supervisor or Nutrition Service Director (NSD) must review the monthly override report to determine why the overrides are being used in the clinic. In addition, if a pattern is established, the supervisor or NSD must train staff on the issue or meet with system staff to make the needed changes in the system. Each District Health Director must submit the names of staff that have permission for override to the state WIC Office. The names of these staff members shall remain on file at the SWO and have been sent to the ADP (CSC) for verification prior to an override. In the event staff leaves, retires, etc., the District Health Director must submit the new name of staff to the System Unit Manager. It will take the SWO staff up to five (5) days to make the change because CSC must be contacted. Clinics must remove the name of the staff no longer authorized to perform override within three (3) days of this change. 148

149 Compliance Analysis 149

150 OIG will forward substantiated fraud claims to the local agency for final disposition to include all supporting evidence and case findings. Local agency will be responsible for notifying the participant of the claim amount. All DPH employees shall cooperate and assist the Inspector General as requested with any type of investigation regarding alleged misconduct or criminal offenses. Employees shall be available for interviews as requested, truthfully answer questions related to the performance of their duties and DPH business, produce documents, and submit to polygraph examination, as requested (HR ). Compliance Analysis: CA-1 150

151 Dual Participation The current TAD field code # 54 allows the system to identify multiple births. This should reduce, if not eliminate, twins from appearing on the dual participation report. If participant is a twin, indicate this by putting twin # 1 or # 2 after the first name on the TAD and the certification form. Compliance Analysis: CA-3 151

152 Compliance Analysis: CA-3 C.VMARS Dual Participation Notification Participants flagged by VMARS as a potential Dual Participant at the time of assessment should be investigated further by the local agency until all alleged dual participation is resolved. The local agency should contact the agency of issuance to verify the most recent certification, last voucher issuance and supporting documentation. Identified matches should result in immediate participant notification that the certification cannot be processed, and no additional vouchers can be issued without a transfer or expiration of current Certification. Should the participant agree to the transfer, staff should adhere to the guidelines listed in Certification XVII.C. 152

153 Compliance Analysis CA-4 Participants who knowingly deny being active at another location or intentionallyattempt to receive benefits in multiple locations must be notified in writing. The local agency must issue a Warning Notice (see Attachment CA-16) and notify the participant that WIC services cannot be assessed until all alleged dual participation is resolved. The local agency must make a referral to DPH OIG within 24 hours of discovery. The referral should include supporting documentation regarding the intent by the individual to be a dual participant. Referrals should be sent to the Deputy Inspector General or faxed to 153

154 Compliance Analysis: CA-5 Terminations The local agency may permit a participant to reapply for WIC before the end of a mandatory disqualification period if: 1.In the case of a participant who is an infant or child under age of eighteen (18) years, and the local agency approves the designation of a proxy. 154

155 Compliance Analysis: CA-13 XII.VOUCHER ISSUANCE SECURITY 1.Only authorized WIC personnel will be given access to WIC vouchers and/or VPOD stock paper. 2.All vouchers and VPOD stock paper must be stored in a locked cabinet, desk, or closet, with the key stored in a secure location (change location of keys occasionally). 3.When issuing vouchers from a computer, the authorized WIC representative must log out before leaving the workstation. 4.When more than one person is using the same terminal, each person must log out upon completion of their printing job. 5.Passwords must be changed every ninety (90) days at a minimum. 6.When a WIC representative resigns or is no longer authorized to issue vouchers, the following procedures should be implemented: a.Immediately delete employees name from the system. b.Change all passwords used by or accessed by the employee. c.Change key to voucher security door (when applicable). d.Change location of all security keys. 155

156 Compliance Analysis: CA-32 Attachment CA-16 Georgia WIC Program VMARS Dual Participation Sample Warning Letter (Date) Dear Participant: Records indicate you have intentionally misrepresented your information in an attempt to participate in two Georgia WIC Programs. You were certified and enrolled on (clinic) ___________________ Georgia WIC Program on (date) __________, and you were also certified and enrolled on (clinic) _________________Georgia WIC Program on (date) __________. As indicated on your Georgia WIC Program ID card, participating in more than one Georgia WIC Program violates programs regulations. Information concerning this action will be forwarded to the Office of Inspector General for further investigation to determine if you will be required to repay money back to the Georgia WIC Program. f you have any questions, contact me at _________________________________. Sincerely, District Nutrition Services Director 156

157 Monitoring 157

158 158 District Review Questions: (Revised wording to account for the one year Child and Woman Certifications) D. Participant Nutrition Education Contacts 1. Describe the system used to provide nutrition education quarterly for infants, children and breastfeeding women certified for > 6 month or to provide two (2) nutrition education contacts for non-breasting women and other participants certified for 6 months or less. Monitoring Tool Attachment MO-1

159 159 F. Orientation Checklist: (Revised points awarded and wording for this section to ensure critical points are evaluated) Monitoring Tool Attachment MO-1 A.Orientation Checklist: SSN UNA Possible Points Points Awarded NE (V) Orientation Checklist Overall Rating: 5 1.District CPA orientation includes all components of the State Orientation Checklist? 1 2. Checklists on file for all CPAs hired since last program review 2 3. All components completed, initialed and checklist signed 2

160 The State will continue to review based on the five (5) year plus current procedure. All records must remain on file for five (5) years plus current year for other audits (i.e., USDA, OIG, State,, etc.). Monitoring MO-3 Monitoring MO-3 Clinic and Health Record Selection 160

161 POLICY UNIT PRIOR TO FORM – ADMINISTRATIVE MANAGEMENT EVALUATION Were copies of the Self Review submitted to the Georgia WIC Program quarterly? Date____________________ Was a Processing Standards Non-compliance letter sent to the district? If Processing Standards were not met for three months, did the district perform a PFA or were secret phone calls made? Monitoring Tool : MO

162 RECORD REVIEW Was the Medicaid number and eligibility date recorded? Was No Proof accepted as source of income? If so, was the form completed in its entirety and filed in the record? Monitoring Tool: MO

163 Food Instrument Accountability: MO-44 E. DUAL PARTICIPATION/PARTICIPANT AND/OR EMPLOYEE ABUSE 4.Does the district distribute the monthly Dual Participation List to clinics to prevent certifications and/or voucher issuance to dual participants? 163

164 Food Instrument Accountability: MO-44 (contd) F. CUMULATIVE UNMATCHED REDEMPTION REPORT (CUR) 3.Does the District monitor the voucher override report on a monthly basis? 4.Are findings from the override Report kept on file in the District Office? 164

165 Food Instrument Accountability: MO-45 B. MANUAL VOUCHER INVENTOY LOG 1. Is the log completed in its entirety on all vouchers? 165

166 Food Instrument Accountability: MO-46 E. VPOD INVENTORY LOGS 1. Is the VPOD/VMARS Inventory Log completed in its entirety? 2. Are the beginning and ending numbers documented correctly on the log? 3. Are voucher override reports maintained in the clinic and a copy sent to the district? 4. Are voucher override request approved by an authorized manager? 166

167 Food Instrument Accountability: MO-47 F. VOUCHERS PRINTED ON DEMAND (VPOD VOUCHERS) RECEIPTS 3. Does the VPOD/VMARS receipts contain the entry Failed to Sign more than 1% for the entire month? 167

168 Food Instrument Accountability: MO-47 (contd) G. DAILY ACTIVITY REPORTS 2. Are skipped Serial Numbers entered into the system as void and reconciled with the Daily Activity Report? 168

169 Food Instrument Accountability: MO-47 (contd) H. VOUCHER SECURITY 2. Is the key properly secured at all times only with authorized WIC personnel? 3. Are vouchers and VPOD/VMARS stock paper securely stored separately from ID cards and voucher receipts? 169

170 Food Instrument Accountability: MO-48 I.PRORATING /VOUCHERS ISSUANCE 2.Were vouchers over issued to Prenatal women who are due for certification? (Vouchers issued in excess during the prenatal period for one month plus forty-five day increments beyond their date of delivery). 3.Were vouchers issued to participants past the certification due date without a current certification completed? 170

171 Food Instrument Accountability: MO-50 M. PARTICPANT ABUSE/DUAL PARTICIPATION 3.a. Does the clinic maintain the monthly Dual Participation List to prevent certifications and/or voucher issuance to dual participants? b. Did the staff send a copy of the paperwork to OIG for any client who tried to be placed on two programs? 171

172 Breastfeeding 172

173 173 Breastfeeding BF-2 & 3 STATE AGENCY A.Breastfeeding Coordinator The responsibility for coordination of Statewide WIC breastfeeding activities is vested within the Georgia Department of Public Health, Nutrition Unit. B.Breastfeeding Promotion, Education and Support Responsibilities 1. Develop, implement and evaluate the state breastfeeding promotion, education and support plan. Periodically monitor the local agencies progress through on- site visits and reports. 2. Develop and implement a plan for providing training and technical assistance for Competent Professional Authorities (CPAs), paraprofessional staff, and clerical staff at local clinics. Training and technical assistance provide CPAs with current information on the management of normal breastfeeding issues and special problems in lactation. It provides all staff with an understanding of the importance of promoting, and ways to promote, breastfeeding in a clinic setting. 3. Identify and develop resources and education materials for use by local agencies. Provide materials in languages other than English in areas where a substantial number of participants are non-English speaking.

174 174 Breastfeeding BF-2 & 3 STATE AGENCY B.Breastfeeding Promotion, Education and Support Responsibilities 4. Coordinate WIC breastfeeding promotion, education and support activities with related programs and professional groups such as hospitals, private medical organizations, the Cooperative Extension Service, professional organizations, advisory committees, La Leche League, and other breastfeeding support and advocacy groups, private lactation consultants, etc. 5. Develop and implement procedures to assure that encouragement to breastfeed is offered to all prenatal participants, unless medically contraindicated. 6. Perform and document evaluation of breastfeeding promotion, education and support activities for each local agency on an annual basis. The evaluations shall include an assessment of the participant's views concerning the effectiveness of the education they received.

175 175 Breastfeeding BF-3 STATE AGENCY B.Breastfeeding Promotion, Education and Support Responsibilities 7. Establish breastfeeding promotion, education and support standards that include, at a minimum, the following: a.A policy that creates a positive clinic environment which endorses breastfeeding as the preferred method of infant feeding. b.A requirement that each local agency designate a staff person to coordinate the breastfeeding promotion and support activities. c.A requirement that each local agency incorporate task- appropriate breastfeeding promotion and support training into orientation programs for new staff involved in direct contact with WIC clients. d.A plan to ensure that women have access to breastfeeding promotion, education, and support activities during the prenatal and postpartum periods.

176 176 Breastfeeding BF-3 & 4 LOCAL AGENCY A. Breastfeeding Promotion, Education and Support Responsibilities The Georgia WIC Program is committed to the implementation of the Position Paper for Breastfeeding Promotion and Support in the WIC Program, developed by the National WIC Association (NWA) Breastfeeding Promotion Committee (http://www.nwica.org/?q=advocacy/positionpapers). The local agencies are encouraged to use the Position Paper in carrying out the following breastfeeding responsibilities: 1. Establish and maintain a positive clinic environment that clearly endorses and supports breastfeeding as the preferred method of infant feeding (NWA Recommendation #2,).

177 177 Breastfeeding BF-6 PARTICIPANT EDUCATION A.Participant Education Requirements 2. All pregnant participants must be encouraged to breastfeed unless contraindicated for health reasons. As recommended in the established reference materials, encouragement to breastfeed should continue throughout the prenatal period. As stated in the Healthy People 2020 National Health Promotion and Disease Prevention objectives for breastfeeding, 3. As part of the prenatal breastfeeding education, the following information should be offered on WIC benefits for breastfeeding women: b.Exclusively breastfeeding women may receive WIC supplemental food benefits for up to twelve (12) months postpartum. Non-breastfeeding women and women classified as Some Breastfeeding are both receiving formula from the Georgia WIC Program that exceeds the maximum allowance for mostly breastfed (MBF) infants and thus are eligible for supplemental foods for only six (6) months postpartum.

178 178 Breastfeeding BF-7 PARTICIPANT EDUCATION A.Participant Education Requirements 6. Breastfeeding women will need to receive four educational contacts during their one year certification. These contacts must be provided by a nutritionist, registered dietitian, competent professional authority, other certified health professionals or a nutrition assistant who has been trained by the state or local agency. Peer Counselors can assist the instructor. When providing breastfeeding education contacts, the CPA must attempt to assess and solve the problem before automatically referring to the designated breastfeeding specialist or Peer Counselor.

179 179 Breastfeeding BF-9 PARTICIPANT REFERRAL A.Referrals 1. Prenatal or breastfeeding participants needing additional breastfeeding information, assistance or support should be referred to the appropriate person(s) designated through the local agency breastfeeding program. The referral must be documented in the participants health record. 2. Referrals to and enrollment in other health services and programs must be documented in the participant's health record. A decision not to refer or a refusal by the participant must also be documented. 3. Local agencies are encouraged to identify and develop a list of breastfeeding resources for prenatal and breastfeeding women. This list may include hospital staff, physicians, local support groups (both informal and organized, such as La Leche League), public health staff with expertise in handling breastfeeding questions, sources for breast pumps, peer counselors, etc. 4. When risk: 602 (Breastfeeding Complications or Potential Complications) is used, documentation of the guidance provided must be in the participants health record.

180 180 Breastfeeding BF-11 & 12 BREASTFEEDING MATERIALS AND RESOURCES B.Breastfeeding Equipment and Supplies 2. Breast Pumps Breast pumps are not a direct program benefit that state agencies are required to provide but rather are aids that may be offered to certain WIC participants to facilitate breastfeeding. The pumps are to be offered free to WIC participants as a loan. 5. Equipment and Supplies Inventory Local agencies must maintain an inventory of all breastfeeding equipment and supplies. It is recommended that the inventory be updated on a quarterly basis. During program reviews, districts will be required to provide an inventory list. A report of purchased breast pumps must be sent to the State WIC Breastfeeding Coordinator by December 31 st, March 31 st,June 30 th and September 30 th of each year.

181 181 Breastfeeding BF-14 DOCUMENTATION OF BREASTFEEDING RATES A.Documentation of WIC Type Breastfeeding women should be entered into the system in the following ways: 1. Status Change from Prenatal (P) to Breastfeeding (B) During Subsequent Certification: A prenatal woman gives birth and is being certified as breastfeeding, within six weeks postpartum. 2. Assignment of Breastfeeding Status During Certification: A woman was not on the program while she was pregnant but is being certified as a breastfeeding woman. Note: A woman and her infant(s) can be certified as breastfeeding: (1) if the definition of breastfeeding is met, and (2) the mother/baby dyad food package must agree (Mother/baby dyad refers to the process of thinking of a mother and her infant as a unit or pair rather than two)

182 182 Breastfeeding BF-14 DOCUMENTATION OF BREASTFEEDING RATES B.Documentation of Weeks Breastfed Participants/caregivers should be asked about weeks breastfed, using the following, or similar words: "How long have you breastfed this baby/child?" or "How long has this baby/child been breastfed?" Also, refer to previous information documented in the medical record to improve consistency in data collected.

183 183 Breastfeeding BF-16 Attachment BF-2 BREASTFEEDING RESOURCES RECOMMENDED BY THE NUTRITION SERVICES UNIT PAMPHLETS & TEAR SHEETS Childbirth Graphics Ltd., P.O. Box 21207, Waco, TX Great Reasons to Breastfeed (English and Spanish) Breastfeeding: Getting Started in 5 Easy Steps (English and Spanish) Breastfeeding and Returning to Work Helpful Hints on Breastfeeding (English and Spanish) Positions for Breastfeeding The Diaper Diary Tear Pad How Long Should I Breastfeed My Baby? Tear Pad BOOKS AND MANUALS Breastfeeding: A Guide for the Medical Profession, by Ruth Lawrence, C.V. Mosby Co., St. Louis, MO, th Edition Breastfeeding: A Parents Guide, 9 th Edition, by Amy Spangler, Amy Spangler/Amys Babies, Atlanta, GA, 2010; English & Spanish Breastfeeding: Keep It Simple, 3 rd Edition by Amy Spangler, Amy Spangler/Amys Babies, Atlanta, GA, 2012; English & Spanish Breastfeeding & Human Lactation, by Jan Riordan and Kathleen Auerbach Jones & Bartlett, Publishers, Boston, MA, 4 th Edition, November, 2010 The Breastfeeding Answer Book, by La Leche League International La Leche League International, Franklin Park, IL, 2012 Medications and Mothers Milk, by Thomas Hale, Hale Publishing, Amarillo, TX, 15 th Edition, 2012 Nursing Mother's Companion, by Kathleen Huggins Harvard Common Press, Boston, MA, 6 th Edition, 2010 The Womanly Art of Breastfeeding, La Leche League International, Franklin Park, IL, 8 th Edition 2010 Ten Steps to Successful Breastfeeding, 3 rd Edition, 2011 by Karin Cadwell, Jones & Bartlett Breastfeeding A-Z: Terminology and Telephone Triage, 2 nd Edition, 2013 by Karin Cadwell, Jones & Bartlett Impact of Birthing Practices on breastfeeding: Protecting the Mother and Baby Continuum, 2 nd Edition, 2010 by Linda Smith & Mary Kroeger, Jones & Bartlett

184 184 Breastfeeding BF-17 Attachment BF-2 DVDs Managing Early Breastfeeding Challenges; Injoy Videos, , Ext. 2, English, 2011 Breastfeeding: A Guide for Success; 2010, Northwest Georgia Breastfeeding Coalition; English & Spanish TELEPHONE INFORMATION SERVICES FOR HEALTH PROFESSIONALS Breastfeeding and Human Lactation Study Center University of Rochester School of Medicine & Dentistry, Box 777, Rochester, New York, (585) ; Service Provided: Database to assist with questions about pharmaceutical drugs and breastfeeding. Provides bibliographies on breastfeeding and lactation Charge: None, beyond cost of telephone call The Lactation Program 4600 Hale Parkway Suite 140 Denver, CO (303) Service Provided: Phone consultation with lactation consultants for difficult breastfeeding questions. Charge: None, beyond cost of telephone call

185 185 Breastfeeding BF-20 Attachment BF-4 Loaning Breast Pumps and Liability Issues Participants may not be terminated or suspended for unreimbursed loss or damage to loaned pumps. While a financial penalty, if included in the original agreement, could be imposed on a participant for failure to return or damage to a pump, the Georgia WIC Program recommends that this approach not be taken. The resources required to recover the cost of the lost or damaged breast pump could easily exceed the value of the pump itself. Building a relationship of trust with WIC participants may minimize the risk of the participant not fulfilling the obligation to return the pump. If the local agency provides breast pumps, the Georgia WIC Program may also be liable for injury to a WIC participant resulting from improper breast pump use, even when there is a signed release of liability. This is true whether pumps are given, sold, or loaned. All participants provided with breast pumps by the Georgia WIC Program must be instructed on safe pump use, including proper cleaning of pump and attachment kits and milk storage guidelines.

186 186 Breastfeeding BF-20 Attachment BF-4 Medicaid Reimbursement The cost of manual pump purchase and electric pump rentals are generally not covered as a separate benefit under the Medicaid Program. However, in Georgia, the state Medicaid Program; in some cases, do cover the rental of an electric pump and the price of an attachment kit. Coverage is based on the mother's Medicaid eligibility and is limited by the period of time the mother is covered by Medicaid in the postpartum period. In addition, coverage is provided for those cases in which the mother and infant are separated by hospitalization, i.e., premature birth.

187 187 Breastfeeding BF-21 Attachment BF-5 Assignment of Priority to Breastfeeding Dyad A. When a breastfeeding infant is certified for, and enrolled in the Georgia WIC Program prior to its mother being subsequently certified, the infant may be assigned one of the following priorities: 2.If the infant has only nutritional risk factor 701 (Infant of a WIC Mother or Mother with Nutritional Risk During Pregnancy), assign a Priority II. It may be helpful to flag the infants name/record through an internal tracking system (tickler card, computer, voucher register, etc.) to alert staff to the need to re- evaluate the infants priority at the mothers postpartum certification. Also, if a mother was on WIC during her prenatal period, assess her risk factors. For example; if risk 111 (Overweight) was used and the mother is <6 months Postpartum; than assign a Priority 1.

188 188 Breastfeeding BF-23 Attachment BF-7 Estimating Formula Needs Feeding Type Amount of Powder Formula to Issue Daily Formula Intake Weekly Formula Intake Monthly Amount Needed MBF 1 can3 oz14 – 20 oz oz MBF 2 cans6 oz21 – 41 oz oz MBF 3 cans9 oz42– 62 oz oz MBF 4 cans12 oz63– 83 oz oz MBF 5 cans16 oz84 – 104 oz oz SBF 6 cans18 oz105 – 125 oz 451 – 540 oz SBF 7 cans21 oz126 – 146 oz 541 – 630 oz

189 189 Breastfeeding BF-1 & 2 Breastfeeding BF-1 & 2 Pending USDA final review and approval Definitions Exclusively Breastfed (EBF) Infant: An infant who is being fed breastmilk and mother that is exclusively breastfeeding and receives no formula (infant formula, exempt infant formula, or medical foods) from the Georgia WIC Program. Exclusively Breastfeeding Infant includes the breastfed infant that has not been released from the hospital. Reference the Mother/baby breastfeeding dyad in the Food Package Section for more information. (Section III Infant part D Matching Mother/Baby Packages) Mostly Breastfed (MBF) Infant: An infant being fed breastmilk and mother is mostly breastfeeding, receive from the Georgia WIC Program formula in amounts that do not exceed the maximum allowances for mostly breastfed infants which is approximately half (50%) of the formula allowance for fully formula fed (FFF) infants. Some Breastfed (SBF) Infant: An infant being fed breastmilk from his/her some breastfeeding mother on an average of one (1) time per day and is accepting formula from the Georgia WIC Program that exceeds the maximum amount of formula allowed for mostly breastfed (MBF) infants. Fully Formula Fed (FFF) Infant: An infant not receiving breastmilk from his/her mother and receiving formula from the Georgia WIC Program in amounts that exceed the maximum allowances for mostly breastfed (MBF) infants. Some Breastfeeding Woman: A woman up to twelve (12) months postpartum who is providing breastmilk to her infant on average at least one (1) time per day and is accepting for her infant formula that exceeds the maximum amount of formula allowed for mostly breastfed (MBF) infants. Her infant is classified as a some breastfed (SBF) infant.

190 Emergency Plan 190

191 Emergency Plan: EP - 11 Food Vouchers and TADs 1.Obtain a supply of blank voucher paper stock for the Georgia WIC Program remote printing. 2.Obtain a supply of blank and manual food vouchers for issuance. 3. Print and ship pre-printed food vouchers to the emergency area. 4. Obtain a supply of both blank and pre-numbered TADs specific to the county or clinic. 5.Enter all manual vouchers and TAD information in the computer as soon as the emergency is over. 191

192 Emergency Plan: EP - 15 REPLACING LOST VOUCHERS 3. Call the CSC Help Desk to determine which lost vouchers have been cashed and processed by the bank a. Listed below is the information that staff will need to provide to CSC: – Voucher numbers – Participant ID number – Name of participant – Clinic, County and District number – Name of staff member requesting the information b. Phone number is c. Hours of operation are from 7:30 am to 5:00 pm, Eastern Standard Time (EST) 192

193 Emergency Plan: EP - 19 TIPS FOR OPERATING A MANUAL SYSTEM A. Verify the Manual Voucher beginning numberdaily to ensure that you start with the correct batch. (Remember that there are now eleven (11) sets of vouchers) 193


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