Bulk, Emergency Pre-plated and Frozen Meals
Revised 2010
A.
Definition, Purpose, and Legal Basis
1.
Definition - At
least one hot or other appropriate meal provided to an eligible person in a
congregate setting which (
Older Americans Act of 1965, as
amended
(OAA), Section 331(1)):
a. Is offered at least five or more days a
week unless, with documented annual state approval, it is deemed such frequency
is not feasible secondary to a rural location; and
b. Can be offered at breakfast, lunch and/ or dinner;
and
c. Is identified by a printed
menu, signed and dated by the Registered, Licensed Dietitian who created it,
which is posted at least two weeks in advance; and
d. Complies with the most recent
Dietary Guidelines for Americans published by the Secretaries
of the United States Department of Health and Human Services and the United
States Department of Agriculture (OAA, Section 339(1)); and
e. Provides a minimum of
thirty-three and one-third percent (33a%) of the dietary reference intakes
(DRIs) as established by the Food and Nutrition Board of the National Research
Council of the National Academy of Sciences (OAA, Section
339(2)(A)); and
f. Is served in a
congregate setting opened at a minimum of three (3) hours a day, as defined as
locations where individuals can engage in social interaction, or various other
activities and services such as rehabilitative and supportive services; which
can include adult day care centers and multi-generational meal sites; and
g. That setting provides nutrition
education, nutrition screening and other nutrition services such as nutrition
counseling, as appropriate, based on the needs of program
participants.
2.
Purpose
a. To reduce
hunger and food insecurity; and
b.
To promote socialization of older individuals; and
c. To promote the health and well-being of
older individuals by assisting such individuals to gain access to nutrition and
other disease prevention and health promotion services to delay the onset of
adverse health conditions resulting from poor nutritional health or sedentary
behavior.
3.
Legal Basis
a. The
legal basis for the operation of the Elderly Nutrition Program is found in the
Older Americans Act of 1965, as amended
(OAA), Title III, Part C; and the
Code of Federal
Regulations, Title 45, Part 1321, as amended (
45 CFR Part
1321 ).
b.
NSIP - Section 311 authorizes the Nutrition Services
Incentive Program known as NSIP, which provides supplemental funding for
congregate and home delivered meals served under Title III in the form of cash
in lieu of commodity foods to provide incentives for the effective delivery of
nutritious meals to older adults, for meals which meet OAA requirements. NSIP
funds may only be used for the purchase of United States produced agricultural
commodities and other foods.
(1) NSIP funds
are no longer under USDA oversight and should not be referred to as a USDA
program or USDA reimbursement. (The Consolidated Appropriations Resolution,
2003,
Public Law
108-7, amended the OAA to transfer the NSIP from
the USDA to the Administration of Aging (AoA) within the Department of Health
and Human Services. (Sec.311, OAA 2000)).
(2) The AAA MAY use NSIP funds for food
purchases from U.S. sources, or as in the case of vendor-contracted meals at a
set price, in general up to 1/3 of the cost of an entire eligible meal
including transportation and labor; served to eligible participants.
A meal is required to meet the OAA nutrition requirements
stated in Part 1, Section 1 of this document and served to individuals who meet
the eligibility requirements stated in Part II, Eligibility,and who is not
means tested; and those individuals are provided the opportunity to voluntarily
contribute to the cost of service.
(3) The AAA MAY NOT use NSIP funds for the
following:
Incomplete meals IF an alternate vendor is
NOT used to fill the shortages or complete the meal;
Second meals/helpings served to
participants or
Any meals served to guests or staff
under 60 years of age or to anyone else who is not an eligible participant,
regardless of age or circumstances.
Any means tested programs such as Medicaid waiver and
CACFP.
c.
Title XIX Medicaid waiver- While a home-delivered meal
funded by the Medicaid waiver program does not fall under Title III standards,
a client may not receive a duplication of services in the form of
a meal from both Medicaid waiver and Title III. If a participant qualifies for
a meal under Medicaid waiver, this will be the first and only choice for meal
funding. If they are not deemed eligible for Medicaid waiver they can be
assessed for a meal under Title III. This is effective for both Title III
home-delivered and congregate meal service.
d. AAAs are required in their area plans to
establish procedures for coordination of services with entities conducting
other federal or federally assisted programs for older individuals at the local
level, and shall include language addressing how they will prevent duplication
of meal service between these two programs and how they will monitor this.
(Sec. 306 (42 U.S.C.
3026))
B.
Eligibility
(
OAA, Section 307(a)(13)(A) and (I))
Congregate nutrition services shall be available to eligible
persons, particularly those in greatest economic and social need, including
low-income minority older individuals, older individuals with limited English
proficiency and those at nutritional risk.
1. Except when noted in Section (c) below,
when eligibility is determined and documented by an active Consumer Information
Form (CIF) on file and/or documented in the current state approved client
tracking system, congregate meals will be provided to:
a. Any person 60 years of age or older; and
b. The spouse of an eligible
person, regardless of age (with a notation on the screening form that he/she is
the spouse of a 60+ participant), however;
c. In the event funding is such that there
are not enough congregate meal allotments for all persons aged 60 or older who
apply, the priority services waiting list guidelines set forth by each AAA will
serve to determine services.
2. Provided all the above eligible potential
service recipients needs are met, congregate nutrition services MAY be made
available to:
a. Disabled persons*,
regardless of age (with a notation on the screening form specifying
circumstances), when:
(1) The disabled person
resides in housing facilities occupied primarily by older persons at which
congregate nutrition services are provided; or
(2) The disabled person resides at home with
and accompanies an eligible participant to the congregate site; and
b. Volunteers, regardless of age,
who provide meal-related services regularly during meal hours IF his/her having
a meal does not deprive an eligible older person from having a meal, they sign
the meal sign in sheet and meet the criteria established in
Section
M. Records.
*A disability is defined as a mental or physical impairment,
or a combination of mental and physical impairment(s), that results in
substantial functional limitations in one or more areas of major life activity
such as self-care, learning, mobility, capacity for independent living,
cognitive functioning, etc.
3. A meal MAY be offered to paid staff
members and/or guests of any age
ONLY
IF:
a. The staff
member/guest pays the full cost of the meal; and
b. An eligible person will not be deprived of
a meal.
4.
Termination from the Program Each AAA will establish a
system delineating the criteria for termination of a participant from the
congregate meals program. Once a participant is placed on the program, they
cannot be terminated without sufficient rationale. This rationale will be
documented on the participant's Consumer Information Form. Recommendation for
termination can be made by program staff with approval from the AAA director.
This information will be found in the AAA Area Plan, updated annually or as
needed.
C.
Unit of Service
1.
Meals One meal served to an eligible person is one
unit of service. Except as described in Section H, Irregular Situations, Title
III C-1 money may not be used for second meals.
2.
Nutrition
Education - Entered into the current state approved client
tracking system, defined as one unit per attendee per session as a
nutrition education unit, for required NAPIS
reporting.
3.
Nutrition
Counseling Entered into the current state approved client tracking
system, is defined as one individualized session per participant, and required
on NAPIS reporting.
D.
Support Activities
1.
Nutrition
Screening-(OAA, Section 339(2)(J))
What and When - Nutrition screening
is completed on every recipient of the OAA Nutrition Program through the
Nutrition Risk Assessment of the Consumer Information Form (CIF) and/or current
state approved client tracking system and updated at a minimum annually. The
Nutrition Risk Assessment is comprised of the twelve questions in this section.
Two scores are derived from the CIF.
a.
A Nutritional Risk Assessment
score, with a possibility of 0 to 6 points, indicates the
potential for nutritional concerns and risk. Nutrition risk scores are a
required field and compiled and filed for the NAPIS report. This score
contributes to the Total Consumer score.
b.
The Total Consumer
score, which is the sum of all scores on the CIF, will determine
participant level of services, including meal service.
c.
A Nutrition Risk Assessment
Score of 6 or greater, which is defined as high risk by the OAA,
signals the need for further nutrition intervention, such as referral to a
medical doctor, or registered dietitian for nutritional assessment and
counseling. A diagnosis of diabetes automatically places the participant at
high nutritional risk with a score of 6.
2.
Nutrition
Education (
OAA, Section 330 (3), 331 (3) (339
(J))
a.
What-
Nutrition education is a program to promote better health by providing accurate
and culturally sensitive nutrition, physical fitness, or health, as it relates
to nutrition, information and instruction to participants, caregivers, or
participants and caregivers in a group or individual setting overseen by a
registered dietitian or individual of comparable expertise. In addition,
community nutrition resources and services shall be provided.
When and by Who - Nutrition
education shall be provided to participants in a group setting at least
quarterly. Nutrition education shall be
planned/scheduled by the nutrition coordinator/service provider and presented
by a registered dietitian, county extension agent, or other qualified person,
using printed material, demonstrations, audio-visual presentations, lectures,
and/or small group discussions.
b.
Documentation of
the topic, presenter, number of attendees, and date of nutrition education
shall be retained at the AAA and may be kept at the site as well; and
c. Entered into current state
approved client tracking system or other form of documentation as one unit per
attendee per presentation as a nutrition education
unit, for required NAPIS reporting.
d.
Expenses, if any,
shall be anticipated and included in the program budget.
3.
Nutrition Assessment and
Counseling (336, 339 (J)) NOTE: THE ACTIVITIES IN THE FOLLOWING
SECTION ARE RECOMMENDED BY THE NEWEST REVISION TO THE OLDER AMERICANS ACT,
HOWEVER DUE TO LIMITED FUNDING AND RESOURCES, MAY NOT BE FEASIBLE AT THIS TIME.
WHILE THESE ACTIVITIES ARE NOT REQUIRED, DEVELOPMENT IS ENCOURAGED.
a.
What and When
(1) A more specialized activity, which may be
included as a component of the nutrition education program. The provision of
professional, individualized advice and guidance to individuals who are at
nutritional risk because of their health or nutritional history, dietary
intake, medications use or chronic illnesses, about options and methods for
improving their nutritional status, performed by a Registered Dietitian (RD,
LD), working with the individual's physician as appropriate, in accordance with
state law and policy.
(2)
Participants who are designated at high nutritional risk on the Nutrition Risk
Assessment section of the Consumer Information Form (CIF), through scoring a 6
or above, or have a diagnosis of Diabetes Mellitus are candidates for follow-up
nutrition assessment and counseling.
(3) Participants at high nutritional risk
shall be referred to the appropriate health professional within six months of
entry into service.
b.
Who and How
(1) At
this time, individual dietary evaluation and counseling for therapeutic needs
is not provided directly. Clients needing these services are to be referred to
a local hospital, their private physician or registered dietitian. The AAA will
assist in making this referral.
(2)
As this component of the OAA Nutrition Program is developing, clients may be
referred to their individual physician until funding and/or contract services
with a Registered Dietitian (RD, LD) are available.
(3) The health care provider may choose to
follow-up though his/her office, or refer the participant to a Register
Dietitian.
(4) The AAA/service
provider may partner with a Registered Dietitian (RD/LD) through the local
hospital, medical groups or private contractors.
(5) Participants with a diagnosis of diabetes
may be referred to a Registered Dietitian, certified diabetic educator or a
local diabetes self-management class.
c. A notation will be made on the CIF and/or
the current state approved client tracking system in the notes section, stating
to whom the client was referred and the date referred.
4.
Social Activities
- Games, outings, art appreciation, gardening, crafts, fitness programs, site
clubs, etc. shall be demonstrated by a list or calendar of monthly
activities.
5.
Contributions (
OAA, Section
307(a)(13)(C)(i)(ii);
45 CFR, 1321.67) - Participants shall be
encouraged and provided an opportunity to contribute voluntarily and
confidentially to the cost of the meals for the express purpose of expanding
nutrition services. AAAs/service providers may develop and post a suggested
contribution schedule for meals, but shall not deny
any eligible person a meal if he/she is unable or unwilling to contribute to
the cost of the meal service. Minimally, signage noting that donations are
accepted and there is a box for cash donations visible in the meal dining area.
a.
Safekeeping and
Accountability - Contributions shall be safeguarded against loss,
mishandling, or theft. Each congregate site shall have a lock box with a space
in the top or other appropriate container into which contributions may be
placed confidentially. The container shall be kept locked at all times, except
at set times, preferably weekly, when two people shall access the box, count
the contributions, and certify the amount. Between meal hours, the container
shall be stored in a secure place.
b.
Direct Services
Documentation - For those AAAs who provide direct services, site
personnel shall purchase a money order or cashier=s check, indicate on it the
service that generated the income (congregate meals and/or home-delivered
meals), and forward it to the AAA/PDD.
c.
Indirect Services
Documentation - For those AAAs who provide indirect services, site
personnel shall certify the program income, indicate the service from which the
income was generated (congregate and/or home-delivered), and forward the income
to the service provider who shall, in turn, forward a contribution report to
the AAA/PDD.
E.
Location
(
OAA, Section 307(a)(13)(D))
Congregate nutrition sites shall be located at approved
private or public community facilities, and meeting rooms, particularly
churches, schools, community centers, and senior centers that meet the
following requirements:
1. Are clean
and neat and have adequate lighting, heating, cooling, and
ventilation;
2. Meet all applicable
state and local health, fire, safety, building, zoning, and sanitation laws,
ordinances, and codes and have
annual inspections by
the local
fire and *
health
authorities (with a plan for corrective action if deficiencies are noted).
Requirements for the safe and sanitary facilities and food
handling are described in the 2009 USDA Food Code and the DAAS Food Safety and
Sanitation Manual for the Older Americans Act Nutrition Program.
Current health inspection documentation and fire inspection
documentation must be posted at each facility or kept in a secure location at
the facility, available on request. It is the responsibility of the AAA to
insure that inspections are kept current by calling the inspecting entity to
make an appointment for inspection, if it is about to expire. A cost may be
incurred for the inspection and program costs should be
anticipated.
3. Required
Equipment on Site
a. If bulk meals are
served, the site must have a kitchen or approved area for the set-up and
dispensing of bulk meals and a three-compartment sink or approved alternative
sink set up as specified in The Food Safety and Sanitation Manual for washing,
rinsing, and sanitizing utensils.
b. Congregate sites where frozen meals are
stored, reheated/cooked, and served to participants and hot food/bulk,
pre-plated sites may need to be reheated must have:
Freezer(s) with the capacity to hold
five (5) days of frozen meals for all participants served from that
site(including those for homebound if their meals are not delivered immediately
upon receipt from vendor). The frozen meals may be removed from the outer
delivery boxes and stacked in the freezer(s) by meal, by day (e.g. all of
Monday=s together, all of Tuesday=s together, etc) to ensure that all
congregate participants receive the identical meal on the same day and consume
the week=s variety of nutrients as planned by the vendor=s dietitian.
Freezers must contain a freezer/refrigerator thermometer (not
a food or oral thermometer) to ensure that a temperature between 0-20
Fahrenheit is maintained at all times. To ensure safety from contamination and
/or theft freezers must remain locked at all times and a designated person
responsible for the key.
c.
Oven(s), conventional and/or microwave, for
reheating/cooking.
4. Are
free of architectural barriers which limit the participation of older persons,
including those with disabilities, to ensure compliance with the
Americans with Disabilities Act of 1990 (ADA) as related to
the following:
a. Restrooms shall be adequate
and accessible and contain toilet tissue, a soap dispenser (a hand-held,
portable one is acceptable), disposable hand towels, and a waste container; and
in addition, meet sanitation standards as outlined in the Food Safety and
Sanitation manual.
b. Tables and
chairs shall be sturdy and appropriate for eligible
participants.
5. Have
clearly marked exits that are obvious to the observer and have an evacuation
plan posted of the room(s) used by the elderly participants. (Example: There
could be a drawn diagram of the room(s) with "YOU ARE HERE" marked with an "X"
and the exit doors clearly noted.)
6. Have adequate parking space;
7. Are approved by the Area Agency on Aging
(AAA) with a completed and approved Site Inspection
Report on file with the DAAS prior to opening a new site or
relocating an established one; and
8. Will not be closed, temporarily or
permanently, without the AAA notifying the DAAS and the vendor two
(2) weeks prior, except in an emergency.
F.
Access
- An eligible person may enter the service system through appropriate referral.
In the event there is a waiting list for congregate meal
service, fee-for-service options may be made available.
Fee-For-Service Meals Meals
purchased at full cost by a participant. These meals may not be counted as
Title III meals for reporting purposes on NAPIS nor for NSIP purposes. The AAA
may make available to individuals who meet the criteria for a congregate meal,
and who are to be placed on a waiting list, the option of purchasing a
congregate meal. The participant will pay for the full cost of meal until the
participant no longer needs the meal and cancels the service; or they reach the
top of the waiting list and subsequently stop paying for the meal. This
information must be clearly documented on the Consumer Information Form.
G.
Service Delivery
1.
a.
State Contract for Meals-Mississippi elects to
contract with a sole statewide vendor through means of an open bid RFP process
every three years. All meals provided through the Older Adult Nutrition Program
must be provided by the vendor.
b.
The exception to this rule is the few adult day care sites which have been
grandfathered in to provide self prepared meals. The AAA must request a
waiver annually in the area plan for these programs.
c. No other programs may start a
self-preparation site as this weakens the state contract and value pricing.
Existing self-preparation sites must meet all food safety and sanitation
standards, have minimally an annual health department inspection, score and
permit to operate and have a
Servesafe certified employee present
on duty during service and preparations hours. Serving a high-risk population
as in elderly day care clients, may warrant a health department inspection
three times a year. This determination is left to the discretion of the local
health department.
2.
Times of Operation - Except for holidays designated by
the DAAS, unforeseen emergency situations, or scheduled training, sites shall
be open and meals shall be served five (5) days a week, 52 weeks a year, three
(3) consecutive hours per day so that participants may eat a leisurely meal,
enjoy social contact, and take advantage of supportive services.
If it is not feasible or cost-effective to provide congregate
nutrition service five (5) days a week due to location, lack of participation
and/or transportation, etc., the AAA shall request approval annually from the
DAAS for the site to be open less than five (5) days.
3.
Minimum Meal
Numbers - Sites shall serve a minimum average, over a five day
period, of twenty (
20) total meals (congregate and
home-delivered combined) per day. This is a quality issue, and will not affect
eligibility of the meal.
a. Delivering less
than twenty meals to a site is not cost effective, nor does the food, whether
bulk or pre-plated, retain adequate temperatures to meet Health Code
requirements. The vendor is not required to deliver to a site where an average
of less than twenty meals are served however they are not restricted from
entering into a mutual agreement with the AAA, if so agreed upon.
b. To serve less than twenty (20) total meals
at a site, the AAA shall provide a written justification annually and receive
written approval from the DAAS.
c.
In the event a congregate site does not have the required 20 participants, if
the rest of the participants are made up of home-delivered meals, there must be
a clear documentation trail showing that the home-delivered meals are paid for
from Title III, C-2 funds and the congregate meals from C-1.
4.
Meal Orders/Meal
Order Changes
a.
Meal Orders - Site personnel shall encourage
participants to use a reservation system to accurately forecast and order meals
and keep the number of unserved meals to a minimum. Meal
orders shall be placed to the commissary
via fax or e-mail (not the phone) by AAA nutrition
coordinators/service providers only (not site managers).
Meals ordered and not consumed by an eligible participant,
including second meals, may not be paid for with Title
III, C-1 funds, except as noted in Section ((H), (1), (d))
below.
b.
Meal
Order Changes - Meal order changes must
be made to the commissary via fax or e-mail only by
AAA nutrition coordinators/service providers only (not site managers) no later
than 2:00 p.m. on the day
before the change is to take effect. The vendor is not expected to
honor phone orders/order changes or messages of any kind relayed through
drivers.
5.
Special Days - Congregate participants may have up to
four (4) field trips per year, excluding times when the sites may be closed for
an election, training, health fair, or other community activity. For those days
when sites will be closed, AAAs/service providers shall order via
fax or e-mail shelf-stable meals or picnic lunches for
congregate participants at least two (2)
weeks prior to the time they will be needed.
6.
Portion Control
a.
Proper Utensils -
Site personnel shall use only the utensils specified in the vendor=s daily Site
Serving Instructions guide to insure that each participant receives the proper
serving size. If a utensil is lost or misplaced, the
AAA nutrition coordinator/service provider/site manager shall request a
replacement from the commissary office (not the
driver) and it shall be sent with the driver the following day or, if it is not
in stock at the time, as soon as it is received from the supplier.
b.
"Stretching"-
Site personnel shall NOT "stretch" food to compensate for vendor shortage(s),
unacceptable food items, or unexpected participant "drop ins," but shall use an
alternate vendor (see below) to fill such shortages or unacceptable items and
document the same.
If it is not feasible to secure food
from an alternate vendor, site personnel shall give properly measured meal
components to as many participants vailable food will serve, using the utensils
specified in the Site Serving Instructions guide and record the missing meal(s)
or meal components as shortages.
c. "Provide versus serve"- site personnel are
no longer required to place all items on the plate if a participant requests
that they do not receive a food item. Site personnel may provide a serving of
all food items to each participant, and shall NOT "skip" giving all meal
components to all participants; however, if a participant requests not to be
given and/or refuse to eat a certain food item, the item does not have to be
served on the plate. Participants have the right not to eat a meal or part of a
meal, but site personnel may not cut back on orders of certain foods or milk or
offer extras to another participant until it is refused. The correct amount of
food for the number of participants must be ordered and provided.
H.
Irregular Situations
1.
Extra Meals/Second
Meals - Whenever there is an extra congregate meal, it shall be
taken to the following, if possible:
a. A
congregate participant too ill* to come to the site; or
b. An eligible person on the home-delivered
waiting list.
c. Required
documentation on the meal log is the name of the participant the meal was given
to and social security number, (located on the CIF, which should be completed
if the client is on a waiting list).
*If the congregate person is still ill after two
weeks, he/she shall be reassessed for home-delivered service
unless there is a doctor's statement indicating that the condition is
temporary, in which case the congregate meal will be resumed when he/she
returns to the site.
If it is not feasible to deliver the meal to one of the
above, it may be given to:
d. A congregate participant, as
asecond helping, with a notation placed by his/her
name on the Monthly Client Service Report that it is a second helping. This
meal MAY NOT be claimed for Title III nor NSIP
reimbursement as a second meal.
e.
Second meals may only be paid for with Title III, C-1 funds if there is
available, current documentation, at the site and AAA, designating this person
has been assessed as severely underweight by a registered dietitian (RD, LD) or
a Medical Doctor and would benefit from extra food. A reassessment by the above
mentioned participant must be completed every 6 months to be considered
current.
f. No senior may be denied
a meal because another senior is receiving more than one
meal.
2.
Meal
Exchange - While it should not be actively promoted nor become a
common practice, it is within the custom of charity and good will to allow, in
unusual circumstances, a well congregate participant to freely and temporarily
"give up" his/her meal to an especially needy, eligible homebound person
on the waiting list. In rare instances when this may
be done, the meal shall be so documented. If the congregate person learns of
the need and freely chooses to give his/her meal to the needy homebound person
after he/she has already signed in at the site, a line should be drawn through
his/her name and the name of the homebound person receiving the meal shall be
entered on the home-delivered service log.
3.
Take-Out Meals -
Take-out congregate meals are
not allowed. Congregate
meals are intended to be eaten at the site and participants or their
representatives shall NOT pick up and/or take meals from the site. Because of
health, safety, and legal liability considerations resulting from possible
foodborne illnesses, participants should be discouraged from taking
any food leftover from their own or anyone else's meal from
the site and made to understand that doing so is at their own risk.
Exceptions: Cake, cookies, bread,
rolls, and fresh fruit MAY be taken from the site to eat later
IF they are wrapped (Note: citrus fruit and bananas do
not need to be wrapped). Wrapping material shall not be provided by the site,
AAA, local service provider, or vendor.
4.
Powdered milk -
All congregate sites, even those serving frozen meals, should do everything in
their power to serve fluid milk, as it has been shown consistently that the
reconstituted milk is not being used, nor even being reconstituted. Sanitation
concerns are frequently documented in centers that do reconstitute the powdered
milk, and the milk is not made sufficiently ahead of time to chill to improve
palatability.
Not consuming the milk does not benefit the nutritional
status of the participant, which is a goal of the program.
a. In the event powdered milk must be used by
a site, it first must be offered to the participants daily. It is in violation
of the previous guideline to not provide the powdered milk. If it is refused
every day in the week, it can then be offered to participants to be taken home
as a non-perishable food item on Friday for use in cooking.
b. If powdered milk is taken home by
congregate participants, the site shall provide a biannual nutrition education
session on how to use powdered milk in recipes along with a demonstration taste
testing and take home recipes.
5.
Substitutions
-Substitutions shall not arbitrarily be made by the vendor. In extreme and/or
rare instances when a change must be made the manager will verify with the
vendor dietitian that the substitution meets the nutritional specifications of
the original food item(s). The vendor shall notify the State and the AAA
Nutrition Coordinators of menu changes via phone, fax, e-mail, or other
electronic means, as soon as possible. Documentation of substitutions must be
noted on meal tickets by site manager.
I.
Alternate Vendor
1. AAA Nutrition Coordinators/service
providers/site managers may purchase meals or portions of meals from an
alternate meal source to substitute for meals ineligible only in the following
situations:
a. The vendor fails to deliver
any meal(s)*, or an entree which is equal in value to an entire meal, or any
other portion of the meal(s);
b.
All or any portion of the meal(s) is deemed unacceptable, for any reason(s),
including time temperature violations;
c. Meals are not delivered by 11:15 a.m.
and/or according to the specifications in the contract executed by the vendor
and the DAAS.
* Frozen Meals Exception - If, after
frozen meals have been delivered to recipient homes, it is learned that they
lack components or contain unacceptable components, the vendor shall discuss
the matter with the AAAs and make the adjustments to the invoice
accordingly.
2.
Payment - If an alternate meal source is used, the AAA
shall pay the alternate meal source(s) or individual who paid for the meals per
AAA policies. The AAA will bill the vendor the contract price of the food
replaced, less the mileage expense, for picking up food from the alternate meal
source.
3.
Commencement - The AAA will maintain a list including
the complete name(s), mailing address(es), and phone number(s) of prospective
alternate meal sources in their site areas to be used when meals or portions of
meals need to be replaced. The vendor will be notified when alternate meals
have been ordered and the reason.
4.
Agreement - The
AAA will maintain an agreement with the prospective alternate meal source(s).
The AAA Nutrition Coordinator shall send the list to their service providers
and/or site managers.
5.
Food Substitution -At the beginning of the contract,
the vendor shall provide the AAA Nutrition Coordinators/service providers with
a food substitution list so that food purchased from an alternate meal source,
in the event of default by the vendor, may be of like value to that being
replaced.
6.
Credit - When an alternate meal source is NOT used to
replace vendor shortages, the vendor shall issue a credit to the AAA based on
the following allocations:
|
Food Group
|
Meal Cost Percentage
|
| Meat/Meat Alternative |
100% |
| Fruit/Salad |
15% |
| Milk |
15% |
| Vegetable |
10% |
| Dessert (other than fruit) |
10% |
| Bread/Bread Alternative |
5% |
| Margarine |
2% |
| Condiments |
2% |
CACFP reimbursed meals, provided through Adult Day Care
Centers may not be credited, all components must be provided for the
meal.
7.
Alternate Meal Sources - Should alternate meals be
obtained, that is, not from the state contract approved meals vendor, the
alternate meals must be procured from a licensed food service establishment
with a current A' rating from the MS State Department of Health, exhibited by a
copy on file at the site. A copy of the establishment's health inspection must
be obtained before food may be served. This may be obtained from the MS State
Department of Health website for all licensed food establishments.
J.
Supplies:
Ordering, Handling, and Storing
1. AAAs/service providers/site managers shall
keep one week=s disposable
congregate and home-delivered supplies on hand at each site at all times and
order necessary supplies from the vendor on the day/time schedule requested by
the vendor.
2. If due to storage or
delivery limitations, this schedule is not beneficial to both the site and the
vendor, an alternative arrangement for supplies is acceptable, if both parties
are in agreement.
3. Site personnel
shall make every effort to safeguard all supplies from pilferage and/or
inappropriate use, such as packing home-delivered meals in congregate supplies
or serving congregate meals in home-delivered supplies. The vendor shall
maintain an ongoing record of supplies delivered to each site.
4. Supplies shall be commercially packaged
for individual use and shall be stored at the site in closed containers on
clean shelves above the floor and handled in a way that they are protected from
contamination at all times. Supplies may not be stored on the same shelf, below
or next to chemicals.
K.
Staff
There shall be an adequate number of staff to manage the
program=s fiscal and administrative responsibilities. Records for documenting
in-kind match shall be kept of volunteers= time and
activities.
1.
Registered
Dietitian - The meals program shall be operated under the
direction of the
DAAS registered and licensed dietitian (RD, LD). Menus and
nutritional information is prepared by a registered and licensed dietitian.
**NOTE: As expansion of the Title III programs continue including 1) in the
area of nutrition assessment of high risk participants, education and nutrition
counseling, and 2) chronic disease prevention through health promotion
activities including evidence based disease prevention programs, the services
of a Registered Dietitian (RD, LD) will become more in demand beyond what has
been required before. While not currently a requirement at the local level,
contracting with a credentialed nutrition professional on an as needed basis is
suggested to meet the growing need for health and nutrition related services.
Title III C-1 and D funding may be used for such services as
described.
2.
Nutrition Coordinator - The AAA nutrition coordinator
shall oversee the management and administration of the entire meals program.
She/he or the service provider shall determine the supervisory functions of the
site managers; plan training in food service safety and sanitation techniques
and practices for all site personnel, including volunteers; and consult with
the dietitian when desired and as necessary.
3.
Site Manager -
The site manager shall direct the day-to-day details and logistics of the
entire meal program under and according to the supervision of the AAA nutrition
coordinator/service provider.
4.
Volunteers may be recruited and shall be supervised.
Volunteers who handle food, including delivery must adhere to all food safety
and sanitation requirements.
5.
Delivery Drivers for congregate feeding sites that
also serve as distribution points for home-delivered meals, delivery drivers
hired by the AAA or service provider must adhere to all standards of food
safety.
L.
Training
The following training is required; training
documentation shall be retained; and sufficient funds
shall be budgeted to cover training expenses, if necessary:
1.
Personnel Orientation and
Inservice - All paid staff and volunteer food service workers
shall have orientation training
prior to working in
the program and at a minimum yearly training. AAA nutrition
coordinators/service providers shall plan and schedule the training which shall
include, at a minimum, the following:
a.
Nutrition Coordinator/Service Provider - Routine
management and administrative procedures, record keeping systems, reporting
requirements, program requirements and sanitation and food safety and meal
service;
b.
Site
Manager
(1) Food Safety and
Sanitation based on the Food Safety and Sanitation Manual, the Mississippi Food
Code 10.0 and Servsafe instruction,
(2) Meal service, with detailed instruction
on congregate meal service requirements, counting and claiming, participant
eligibility, and correct food portioning using the Site Serving Instructions
guide;
(3) Site
operations;
(4) Site record
keeping;
(5) Contribution policy
and cash reconciliation;
(6)
Community resources;
(7)
Coordinating volunteers; and
(8)
Methods of referrals.
c.
Volunteers - Site procedures and various volunteer
activities when they first enter the program and anytime thereafter as deemed
necessary by the AAA/ service provider. Specifically, any volunteer which deals
with the handling, distribution and/or delivery of meals must receive training
on basic food safety and sanitation and meal eligibility.
d.
All Staff -
Participant confidentiality; all aspects of food safety and sanitation; and
procedures for handling emergencies medical, fire or disaster, which includes
being able to locate participants' emergency contact information and to
evacuate participants safely.
e.
Any person who administers a Consumer Information Form
must receive training, with documentation retained.
f. Training is documented via sign-in sheets
with date, topic/training title. A training log of employees and volunteers may
be kept to compile all employee training in one at-a-glance form. (See
appendix).
2.
Training Opportunities for Nutrition Coordinators
While not mandatory, the following are opportunities to learn and share
regarding the Older Adult Nutrition Program:
a. Quarterly Menu and Nutrition Program Meetings-Attendance at the
quarterly menu meetings and the DAAS meetings that follow, as well as any other
special meetings called by the DAAS dietitian is encouraged to allow input and
discussion from all areas of the state, due to the rapidly changing Title III
program.
b.
ServeSafe It is recommended that at least one person
under advisement of the AAA, for example, a service provide or site manager, or
the Nutrition Coordinator, be ServeSafe certified to act as a resource person
and lead trainer due to the importance of food safety and sanitation in the
high risk older population we serve.
c.
3.
Fire/Evacuation
Drills for participants should take place at least once every six
months and documentation by sign-in sheets kept at the site and/or sent in to
the AAA as designated by the AAA; and
4.
Instruction in
general first aid, cardiopulmonary resuscitation (CPR), and the Heimlich
maneuver is recommended for everyone working with
older persons.
M.
Records
1.
General - Adequate records shall be maintained on each
participant to ensure the accuracy and authenticity of the number of eligible
congregate participant meals served each day. To the greatest extent possible,
all participant information and service records will be recorded in and all
forms, sign-in sheets, and records should be drawn from current state approved
client tracking system.
All records and reports shall be made available for audit,
assessment, or evaluation on demand by authorized representatives of area,
state, and federal agencies. Except for audit purposes, recipient
confidentiality shall not be violated and information about or obtained from an
individual shall not be disclosed without that individual's written consent.
However, the individual shall not be denied services if he refuses to provide
written consent.
2.
Documents to Reconcile - To determine that congregate
persons received meals on certain dates and to assure that the meals paid for
were served to eligible persons, the meal numbers on the following documents
must reconcile:
a.
Sign-in
Sheets- The Daily Service Unit Form, large spacing, printed from
the current state approved client tracking system is recommended or a similar
form, printed via the AAA's/service providers, affixed with the date and the
signature or mark of each person receiving a congregate meal (with the site
manager signing and initialing the name of any eligible person who refuses or
prefers not to sign, but with no one person signing for the majority of the
participants);
b.
Monthly Client Service Reports (also known as "Service
Logs") which shall be printed from current state approved client tracking
system by the AAAs/service providers and sent to each site manager who shall
complete and return it to the AAA/service provider who shall, in turn,
reconcile by funding source the number of meals listed on the monthly report to
the number of meals paid for;
c.
Meal Tickets; and
d.
Vendor Invoice.
3.
Program
Information shall include:
a.
All reconciled program documents, including
Sign-In Sheets with the signature or mark of each
person receiving a congregate meal (see details above);
b.
Waiting List of
persons eligible for congregate meal service;
c.
Contribution
Policy information provided to participants;
d.
Nutrition Education
Documentation listing the topic, presenter, number of attendees,
and date; and
e.
Program Income Records noting the daily/weekly
contribution amounts.
f.
Volunteer Records showing that the person is a
bonafide volunteer at that site or for that AAA and has received all
orientation and annual training, and thus able to receive a meal, paid for with
C-1 congregate, after signing the meal sign-in sheet for that
day.
4. Participant
Information is contained in the
Consumer Information
Form, which shall:
a. Be
completed by trained personnel prior to services being received, and
updated annually, either on the
anniversary date of the participant=s entrance into
the system (recommended system) OR at a single point in
time, e.g. October, for continuation or termination of meal
services with additional assessments made whenever necessary and/or
appropriate;
b. Identify
eligibility status for services;
c.
Contain emergency information such as the elderly
person=s family or contact person and a record of any special health, medical,
or dietary needs, when appropriate;
d. List all services
provided to the person in accordance with NAPIS/MIS reporting procedures, and
e. All forms with each previous
form filed together kept at the AAA, and a copy of the most recent form kept at
the site,
or, if the AAA has progressed to a paperless system
and all documentation can be located in the client tracking
system.
f. Be
entered into current state approved client tracking system within ten days of
completion.
N.
Reports
1.
Site to AAA or Service Provider
On Friday or the last food service day of each week, site
managers shall mail/scan to the AAAs the site=s delivery tickets and original
sign-in sheets for that week, retaining a copy at the site, or by any other
written procedure designated by the AAA so that meal count information is
entered in to the client tracking system by the current DAAS designated due
date.
2.
AAA
Nutrition Coordinator/Data Entry Person to Client tracking system
By the current DAAS designated due date, AAA nutrition
coordinators shall insure meal count and nutrition education units are provided
to the data entry person/entered into the client tracking
system.
3.
Vendor Reports
The vendor will provide to DAAS, in May and November, a
Semi-annual Meal Numbers Report; and a Self-assessment Report, which includes
the results of client satisfaction surveys administered prior to the second and
fourth quarter menu cycles.
4.
State Reports
The AAAs shall provide any additional information or reports
requested by the DAAS via the current state approved client tracking system.
The State nutrition coordinator shall conduct a regular statewide analysis of
the nutrition program and the state meal contract vendor from information
submitted by the AAAs.
5.
Adult Day Care Centers-CACFP
CACFP reports are absolutely due to designated DAAS staff, no
later than the date specified on the Reports Due Date Calendar. Failure of one
site to submit information may affect filing of the CACFP claim for all Adult
Day Care Centers and affect the statewide sponsorship. While mail is
acceptable, is must reach the state office by the due date. There may be no
late submissions. To avoid delays from the mail, preferably, the AAA/service
provider may fax or scan a copy of the report and keep the original on file at
the AAA and a copy at the site.
Required documentation is
a. the completed CACFP-4 Cost
worksheet
b. Monthly CACFP report
page
c. Any food receipts for
snacks or additional food items
d.
Current roster with changes
O.
Credits, Penalties and
Reimbursements
1.
Vendor Credit
a. The
AAA MAY claim vendor credit IF:
(1) The
vendor fails to deliver meals or portions of meals or fails to deliver meals by
the stated time, or if meals or portions of meals are deemed unacceptable
AND
(2)
The site manager/service provider/AAA does NOT use an
alternate vendor to fill the shortage.
b. The vendor shall credit the AAA according
to percentages listed below:
| Meat/Meat Alternative |
100% |
| Fruit/Salad |
41% |
| Milk |
15% |
| Vegetable |
10% |
| Dessert (other than fruit) |
10% |
| Bread/Bread Alternative |
5% |
| Margarine |
2% |
| Condiments |
2% |
2.
Penalties to Vendor
- After three occurrences per site, at the discretion of the AAA,
a penalty is permitted to be imposed upon the vendor, in addition to the cost
the AAA bills the vendor for meal replacement.
a. These occurrences reflect the most
critical situations when the provider will impose the penalty of $100 per site,
in addition to, the delivery cost of substitute meals, including salary,
mileage and food purchase. Vendor must credit the Area Agency on Aging in each
planning and service area as need arises. These occurrences include:
(1) No meal delivery;
(2) Meals arriving beyond the agreed upon
time;
(3) Meal shortages;
and,
(4) Sub-standard temperatures
at point of delivery and /or unacceptable food quality.
b. The penalty for Congregate Meals will be
$100 per site even if an alternate meal source is used.
c. The penalty for Frozen Meals delivered to
the site at any time other than the agreed upon designated date will include
$100, plus one shelf-stable meal for each participant, the expense of paying a
driver an hourly wage to deliver meals to participants, and vehicle mileage for
delivering meals. This amount shall be credited to the AAA.
d. The penalty for Adult Day Care Meals
deemed not allowed' due to failure of vendor to comply with laws, regulations,
and/or guidelines will result in cost of the alternate meals and payment of
meals disallowed.
3.
CACFP (Child and Adult Care Food Program)
Reimbursement - Providers of adult day care services are eligible
to receive funds from Mississippi Department of Education based on federally
published rates by participating in the State Unit on Aging sponsored program.
ADC Providers must
a. Serve a creditable
meal;
b. Comply with all program
policies and procedures;
c. File a
monthly report to the SUA;
d.
Maintain a completed and approved application on file for each
participant;
e. Attend training
given three times a year by the SUA; and
f. Be monitored three times each year by MDHS Division of
Monitoring/Program Integrity.
P.
Monitoring
1. The Mississippi Department of Health,
Division of Sanitation will conduct a site inspection annually to determine
food safety and sanitation standards are followed. This is not a pass/fail
inspection, however corrective action must be taken and follow up by the
inspector will take place within the time period determined by the inspector. A
report will be sent to the AAA. While some local health departments may keep up
a schedule, it is the responsibility of the AAA or the provider to call for an
appointment before an inspection has passed one year.
The cost for this service, if any, shall be anticipated and
included in the program budget.
2. The State Department of Human Services'
Office of Monitoring/Program Integrity shall monitor once a year the:
a. AAA nutrition program; and
the
b. Food service vendor; and
c. Shall monitor CACFP sites three
times a year.
3. Mississippi
Department of Education monitors a percentage of
CACFP, for Adult Day Care Programs annually,
unannounced.
4.
AAA
nutrition coordinators are required to monitor each nutrition site
annually using the same tools used by Program Integrity, Office of Monitoring.
Any findings or concerns shall be followed up on, in person, to insure the
required changes have taken place. More frequent site visits are encouraged to
provide technical assistance and assist is any revisions that should take place
to insure the nutrition program is provided correctly.
AAA nutrition coordinators should informally monitor or visit
the vendor commissary during early morning hours once a year or as often as
possible for the benefit of themselves and the overall nutrition program they
manage.
5.
The
vendor conducts a site visit to 75% of all sites yearly including
those with hot bulk, pre-plated and frozen delivery. While monetary penalties
are not incurred from these reports, the findings are meant to give the site,
service provider and AAA knowledge of problems and potential problems on meal
service, food safety and sanitation; as well as health inspections.
