10-144 C.M.R. ch. 286, § II - PROGRAM ADMINISTRATION

A. FUNDING LOCAL AGENCIES

Each local agency's administrative and food funding allocation will be determined by a funding formula contained in the most recent edition of the WIC Administrative Manual.

B. REVIEW AND MONITORING OF LOCAL AGENCIES

1. The State Agency will perform a management evaluation review of each local agency at least once biennially, and more frequently if the State Agency determines that such a review is necessary.

2. The local agency shall respond to management evaluation reviews within thirty days from the date of the State Agency letter.

C. RETENTION OF RECORDS/REPORTS

1. The local agency shall maintain all reports and records for three years.

2. If any litigation, claim, negotiation, audit or other action involving any record or report is initiated prior to the end of the three year period, any such report or record must be retained until all issues are resolved or until the three year period has expired, whichever is later.

D. BLOOD ACCIDENT POLICIES

1. Local agencies shall comply with the most recent edition of the OSHA regulations 29 CFR § 1910.1030, Subtitle: Bloodborne Pathogens, Final Rule, December 6, 1991 and Needlestick Safety and Prevention Act , P.L. 106-430.

2. The local agency must maintain exposure records in accordance with OSHA regulations 29 CFR § 1910.1030 -(f) (3).

3. In the event of an exposure incident, the State Agency will pay for HIV and HBV tests (for those not previously vaccinated for Hepatitis B) for both the source individual and the exposed WIC employee.

4. HIV tests shall be performed at anonymous test sites. If not feasible, alternative arrangements must be made with the State Agency.

5. Payment for HBV vaccinations is an allowable WIC expense for WIC Program employees who are required, as part of the job description, to perform hemoglobin testing.

E. CONFIDENTIALITY/RECORDS

1. Participant files must be secure. Only local agency staff and State and Federal officials with responsibility for the Program may have access to WIC Program files.

2. Written information in participant files or information stated verbally by participants or caretakers is confidential and may not be repeated or released to anyone other than the above stated personnel. Indiscriminate use is defined as information discussed in inappropriate places including, but not limited to, in front of other clients, in front of non-WIC local agency employees and outside of the local agency or clinic.

3. Release of medical information and requests for information must be authorized by the WIC participant. Procedures for the release of client information are established in the present edition of the WIC Clinic Manual.

4. Local agencies must have acceptable written policies stating the penalties for breach of participant confidentiality.

F. CERTIFICATION

1. Client applicants are placed on and removed from the waiting list according to the criteria established in the most recent edition of the WIC Administrative Manual

2. Agencies maintaining both a telephone list and a waiting list of client applicants must provide services to people from the waiting list first.

3. Applicants who are living in institutions that serve meals (e.g. homes for unwed mothers) may be eligible for Program benefits if they meet the following provisions.

a. The institution does not gain financially from the person's participation in the Program.

b. The WIC foods are not used for communal feeding.

c. The institution does not act as a proxy for all Program participants allowing them to purchase the food quantities in bulk. This practice could lead to the use of WIC foods in a communal setting.

d. The institution does not place constraints on WIC participants' ability to use WIC foods and all associated WIC services made available to WIC participants.

4. Local agency staff must document how applicants pay for necessities in those cases where applicants state that they have no income.

5. A foster child for whom the State is legally responsible shall be considered a one-member family.

6. Persons from families on strike for at least two weeks shall be income eligible while on strike if the loss of income causes the average income for the past twelve months to be less than Program limits.

7. At certification each applicant must present proof of residency, identity and income.

8. An applicant with no proof of identity and/or residency cannot be certified or issued food instruments except in situations where the applicant is a victim of theft, loss, or disaster; or a homeless individual; or a migrant.

G. FOOD INSTRUMENT/CASH VALUE VOUCHER ISSUANCE

1. Local agencies shall require participants to sign the food instrument/cash value voucher register when food instruments/cash value vouchers are issued.

2. Replacement food instruments/cash value vouchers will not be issued for valid food instruments/cash value vouchers except when the local agency director authorizes replacement due to extenuating circumstances such as fire, flood or domestic violence.

3. Replacement food instruments/cash value vouchers may be denied if the participant loses food instruments/cash value vouchers twice within a certification period.

4. Local agencies may mail food instruments/cash value vouchers to participants according to situations and procedures established in the most recent edition of the WIC Clinic Manual.

5. Participants may designate a proxy to pick up and redeem food instruments according to the procedures established in the most recent edition of the WIC Clinic Manual The proxy can also be allowed to act on the participant's behalf at follow-up nutrition education and re-certification appointments.

H. MISSED/LATE FOR APPOINTMENTS

1. The local agency shall send a notice to a participant who misses a scheduled appointment within fifteen days of the missed appointment asking him/her to reschedule the appointment.

2. When appointments are missed and food instruments are picked up late, the local agency must prorate the food package according to guidelines established in the most recent edition of the WIC Clinic Manual

I. PARTICIPANT VIOLATION

1. Local agencies shall investigate all reports of participant violations as quickly as possible.

2. Participant violations include but are not limited to:

a. Known and deliberate misrepresentation of circumstances to obtain benefits;

b. Exchanging food instruments/cash value vouchers or supplemental foods for cash, credit, non-food items, or unauthorized food items, including foods in excess of those listed on the participant's food instrument;

c. Physically harming, or threatening to harm clinic or vendor staff; and

d. Dual participation.

3. A participant violation may result in disqualification from the Program for up to one year. Sanctions for participant violations are based on criteria contained in the most recent edition of the WIC Administrative Manual..

4. Local agencies must notify the State Agency prior to the disqualification of a participant.

5. Before disqualification from the Program the participant must be given full opportunity to appeal the disqualification as described in 7 CFR § 246.9.

J. TRAINING AND CONTINUING EDUCATION REQUIREMENTS FOR DIRECT SERVICE STAFF

1. All staff who take anthropometric measurements must complete refresher training at least once every two calendar years. Training can be provided by methods identified in the most recent edition of the WIC Clinic Manual. The local agency is responsible for maintaining records documenting the training type and dates for each employee.

2. All staff who perform blood tests must complete periodic refresher training at least once every two calendar years on the use of the hemoglobin testing equipment and procedure. Training can be provided by methods identified in the most recent edition of the WIC Clinic Manual The local agency is responsible for maintaining records documenting the training type and dates for each employee.

3. The local agency is responsible for providing annual training on bloodborne pathogens and universal precautions to all staff who are required to perform hemoglobin testing as a part of their job description. Training and documentation must follow guidelines set forth in OSHA Standard 29 CFR § 1910.1030 -(g) (2), as amended from time to time.

4. Continuing education requirements for licensed dietitians and dietetic technicians are the same as those set for them by the State Board of Licensing of Dietetic Practice and must include a minimum of four hours per calendar year of breastfeeding training.

5. Dietitians/nutritionists who are not licensed must receive at least fifteen hours of continuing education per calendar year, of which a minimum of four hours must be training in breastfeeding. Four of the fifteen hours must be successive in a program that has an evaluation component and where there are at least fifteen people in attendance.

6. WIC staff members who are not included in Paragraphs 4 and 5 above must attend at least ten hours of continuing education per calendar year, of which a minimum of four hours must be training in breastfeeding. Four of the ten hours must be successive in a program that has an evaluation component and where there are at least fifteen people in attendance.

7. Local agencies must ensure that training and continuing education requirements for nutrition staff are documented and complete.

8. Each local agency must designate a Breastfeeding Coordinator who is responsible for planning, evaluating and monitoring breastfeeding promotion and support activities.

K. HEMATOLOGICAL

1. Hematological tests for anemia must follow the periodicity table described in the most recent edition of the WIC Clinic Manual

2. Blood test data may be obtained from referral sources at the time of certification or within ninety days of the date of certification. The date of the blood test must be consistent with the participant's status.

3. Only local agency personnel who have completed training in bloodborne pathogens, universal precautions and testing equipment protocol may perform blood tests.

4. Personnel performing blood testing must follow procedures established in the most recent of the WIC Clinic Manual

5. A participant may refuse to provide blood work for sincere religious or philosophical reasons. Such a refusal must be documented in the participant's file, and is confidential.

L. ANTHROPOMETRIC RISK ASSESSMENT

1. At a minimum, height and weight measurements must be performed and/or documented in the applicant's file at the time of certification. Weight, height or length shall be measured not more that sixty days prior to certification for program participation.

2. At a minimum, pregnant women shall be weighed a) at certification, b) between 20-24 weeks gestation and c) between 35-40 weeks gestation.

3. Infants certified to their first birthday shall have an anthropometric assessment completed at least 3 times during the certification period. (excluding birth measurements)

4. Infants and children must be weighed and measured according to the procedure established in the present edition of the WIC Clinic Manual.

M. MEDICAL AND NUTRITION RISK ASSESSMENT

1. Medical and health information is collected and assessed according to the procedures established in the most recent edition of the WIC Clinic Manual

N. FOOD PACKAGES

1. Approved WIC foods and maximum quantities are limited to those allowed by Federal Regulations ( 7 CFR § 246.10) and those which meet the State Agency's criteria, as set forth in the most recent edition of the WIC Administrative and Clinic Manuals.

2. Formula fed infants shall receive the contract brand cow's milk or soy-based infant formula. Non-contract standard cow's milk or soy based infant formulas will not be issued. In the event that the contract brand is not certified as Kosher, a Kosher formula may be made available for an infant whose family follows Kosher or Halal eating practices.

3. According to Federal Regulations 7 CFR § 246.10, medical (exempt) infant formulas, and WIC-eligible medical foods may be provided with medical documentation by a licensed health care professional authorized to write medical prescriptions under State law. The prescription must include the name of the product, the amount prescribed per day, the duration of the prescription, the ICD-9-CM diagnosis code, the signature of the requesting health care professional, the contact information of the health care provider who has written the prescription, and the date of the medical determination for the product.

O. NUTRITION EDUCATION

1. Nutrition education shall be provided to all participants and the parent/caretaker of child participants as established in the most recent edition of the WIC Clinic Manual

P. MISCELLANEOUS

1. All materials regarding the WIC program that are produced by the local agency must include the U.S. Department of Agriculture's (USDA) nondiscrimination statement according to the most recent USDA Departmental Regulation (WIC Program Final Policy Memorandum #2006-3).

2. Each local agency shall complete an monthly time study in a format designed or approved by the State Agency. The time study will be used to demonstrate that the expenditure requirement for nutrition education and breastfeeding support has been met. The results of the time study must be reported to the State Agency within two weeks of its completion.

3. The local agency shall provide interpretive services at no charge to any WIC applicant or participant who requires such services.

Q. REFERRALS

1. Local agencies must provide WIC Program participants or their designated proxies with information on other health-related and public assistance programs. Local agency staff shall refer participants to such programs as necessary and provide appropriate follow-up.

Notes

10-144 C.M.R. ch. 286, § II