GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING - PowerPoint Presentation

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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 15, 2013Slide2

Certification

2Slide3

IncomeIncome 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

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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.

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Certification: CT - 6An 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 applicant’s 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 migrant’s home base area before the migrant has entered the stream or in an in-stream area during the agricultural season.

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Certification: CT - 6The 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).

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Certification: CT - 8

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.

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Certification: CT - 8E.

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.

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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 participant’s 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).

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Certification: CT – 11 - 12

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)

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Certification: CT – 14Grandparents 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.

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Certification: CT – 14Joint 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 parent’s information must be documented in the medical record along with all legal documentation from court.

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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.

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Certification: CT – 18Look 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 22.

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Certification: CT – 21Procedures for Completing the

Verification of Residency and/or Incom

e:

(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

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Certification: CT – 24Procedures 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.

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Certification: CT – 25Income Inclusions

n. Student Grant, Scholarship (does not include Pell Grant).

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Certification: CT – 26-27Income 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.

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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.

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Medical Data2. 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:

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Certification: CT – 32Slide21

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.

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.

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Certification: CT – 33Slide22

Certification: CT – 37CERTIFICATION 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.

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Certification: CT – 37CERTIFICATION 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.

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Certification: CT – 45Staff 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 participant’s signature. An appropriate signature consists of first and last name and title of person verifying income and witnessing the participant’s signature.

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Certification: CT – 45f.

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)

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Certification: CT – 56Transferring 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)

.

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Certification: CT – 57

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.

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Certification: CT – 58

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)

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Certification: CT – 59VOC 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.

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Certification: CT – 68Certification 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

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Certification: CT – 74A 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.

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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.

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Rights and Obligation

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Rights and Obligation: RO 11-12

Conduct of the Hearing and the Appellant’s 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.

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Rights and Obligation: RO 11-12VOUCHER 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

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Administrative

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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

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Administrative: AD-6

District level administrative costs are collected through the

Uniform Accounting System

(UAS) subsystem of DPH’s 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 WIC’s 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.

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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.

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Administrative: AD-13

40

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)Slide41

Administrative: AD-13Acquire 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).

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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 $1,000.00 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.

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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.

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Administrative: AD-20

These are the additions to the program management activities for the NSA costs:

Visual Collaboration

Individual Nutrition Education

Group Nutrition EducationIndividual Breastfeeding EducationGroup 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)

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

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Administrative: AD-51

This is a new report available in PARs

Individual Employee Activity Report

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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

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Administrative: AD 76-78

XIX. LOCAL AGENCY STAFF

The Nutrition Services Director’s 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.

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Administrative: AD 76-78

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-26.

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Administrative: AD 76-78

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.

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Administrative: AD-85

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XXVII. STATE PLAN

The State Plan consists of Goals and Objective for the State.  Slide52

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

FFY

Total Vouchers

Produced

Unmatched

Original

CUR

1 & 2

Unmatched

Final

Manually

Reconciled

Total

Unreconciled

Total

Reconciliation

Rate

Total

Unreconciled

Rate

2009

12,414,216

50,975

13,780

7,104

6,676

99.9462%

0.0538%

2010

16,463,151

27,745

3,012

1,737

1,275

99.9923%

0.0077%

2011

12,285,222

33,760

6,937

6,724

213

99.9983%

0.0017%

2012

16,799,779

84,801

29,109

27,582

1,527

99.9909%

0.0091%

2013*

5,427,472

18,615

5,213

4,792

421

99.9922%

0.0078%Slide53

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.

2013 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, 2013. 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 e-mailed to at all vendors.

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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, 2018. Milestones and plans during these next several years are located in the State Plan.

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Administrative: AD-94

55

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.Slide56

Administrative: AD-94

56

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.Slide57

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 246.16a. 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.

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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

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Administrative: Attachment 1

59

PROGRAM NAME

: Georgia WIC, WIC Farmer’s Market Nutrition Program, WIC Breastfeeding

This attachment discusses the Georgia Farmer’s Market and WIC Breastfeeding

 Slide60

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 Slide61

Administrative: Attachment 25

This is a new attachment regarding standard operating procedures for returned food instruments.

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Administrative: Attachment 26

This attachment is for the job description for the Lactation Consultant.

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Administrative: Attachment 27

This attachment is for the job description of the District Breastfeeding Coordinator.

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Administrative: Attachment 33

This attachment is for the standard operating procedures for Infant Formula Rebate Changes (Product Name Changes)

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Administrative: Attachment 33

This attachment is for the Standard Operating Procedures for Infant Formula Rebate Changes.

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Vendor Management

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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

stSlide68

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. Accepting WIC vouchers prior to Authorization

.

The denial period is three (3) years.

Business Integrity and Related Denials

. For Business Integrity or Integrity-related reasons, the denial period will be two (2) years.

All Other Reasons for Denial

. The denial period is one (1) year.

Vendor Management

68

Re-application Limitations after Application Denial –

VM 1Slide69

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)Slide70

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)Slide71

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)Slide72

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)Slide73

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, 2013.

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)Slide74

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)Slide75

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

Type

Description

A

Small

5,000 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. Slide76

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 3Slide77

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 5Slide78

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 6Slide79

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 Slide80

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 Slide81

VENDOR AGREEMENT (attachment VM-4)3 year Agreement for Corporate Vendors2 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 Agency’s 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 Slide82

Food Package

82Slide83

Formula Names updated throughout sectionGerber Graduates (Gentle, Soy)

Enfagrow

Toddler

Transitions

(Regular, Soy, Gentlease)Enfagrow

Toddler

Next Step

Vanilla

PurAmino

Formula examples may have changed

Food Package

83Slide84

Contract Versus Non-Contract FormulaUpdated contract dateJuly 1, 2013 through June 30, 2016

Food Package FP-1

84Slide85

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

85Slide86

Feeding Type Assignment3.

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

86Slide87

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

87Slide88

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

88Slide89

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

89Slide90

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

90Slide91

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

91Slide92

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

92Slide93

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

93Slide94

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

94Slide95

Some Breastfeeding Packages addedInfant Food vouchers updated

Food Package Attachment FP-1 to FP-8, FP-18, FP-27

95Slide96

Voucher Codes for Special Formula Packages for Some Breastfeeding Infants – Recommended Amounts Tables added - Some Breastfeeding Special Formula Vouchers

Food Package Attachment FP-27

96Slide97

Supplemental Formula Table – ModularsDisplacement conversions added for

Human Milk Fortifier - liquid

Microlipid

Complete Amino Acid Mix

Food Package Attachment FP-28

97Slide98

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

Pending USDA final review and approval

98Slide99

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 mother’s food package to reflect her new feeding status. Slide100

100

Food Package FP-12

Pending USDA final review and approval

Food Package Code

Rank

VC

Voucher Message

190

9

190

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 WICSlide101

Nutrition Education

101Slide102

Totally reorganizedMajor sectionsIntroductionDefinitions

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

102Slide103

IntroductionNutrition Education is a major component of the WIC program.

Nutrition Education NE-1

103Slide104

State Plan1. 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

104Slide105

Participant Nutrition Education Plan1. 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

105Slide106

Methods for Providing Nutrition Education1. 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

106Slide107

Exit Counseling1. 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

107Slide108

Exit Counseling2. 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 infant’s certification period (birth to one year)

and

child’s certification period (one to five years):

Nutrition Education NE-6

108Slide109

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

109Slide110

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

110Slide111

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 (

S

ubjective,

O

bjective,

A

ssessment,

P

lan) 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

111Slide112

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 (

S

ubjective,

O

bjective,

A

ssessment,

P

lan) 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

112Slide113

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

113Slide114

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 Health’s 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. Slide115

New Nutrition Assistant Observation Form

Nutrition Education Attachment NE-1

115Slide116

Outreach

116Slide117

An Outreach Plan is required to be submitted to the State WIC office on a quarterly basis.

General Changes

Outreach: OR-1

117Slide118

16. Department of Family and Children Services20. Department of Labor

Outreach: OR - 2

118Slide119

Income Eligibility Guidelines effective July 1, 2013 to June 30, 2014

Outreach: OR - 7

119

Family Size

Yearly Income

1

$21,257

2

28,694

3

36,131

4

43,568

5

51,005

6

58,442

7

65,879

8

73,316

Each Additional Member Add

+$7,437Slide120

Food Delivery

120Slide121

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

121Slide122

Food Delivery: FD-3

122

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.Slide123

Food Delivery: FD-3 (cont’d) 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.

123Slide124

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 clinic’s 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.

124Slide125

Food Delivery: FD-5III. 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.

125Slide126

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 participant’s 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 participant’s 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.

126Slide127

Food Delivery: FD-7E. Categorically Ineligible

Vouchers cannot be issued if the pickup code is after

the birthdate.

If the child’s birthdate is in the first week

of the month, he/she will only receive one voucher plus

the produce/fruit and vegetable voucher.

127Slide128

Food Delivery: FD-11V.

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.

128Slide129

Food Delivery: FD-12Inventory 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.

129Slide130

Food Delivery: FD-12 (cont’d)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

.

130Slide131

Food Delivery: FD-13Manual 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.

131Slide132

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.

132Slide133

Food Delivery: FD-14 (cont’d)

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 voucherin 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 contractor’s Bank. Do not send

any manual vouchers back

To the bank

.

133Slide134

Food Delivery: FD-15All 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 participant’s name, the participants WIC ID

number and the clerk’s 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.

134Slide135

Food Delivery: FD-16H. Corrective Actions for VPOD

is required for the following

:

Missing receipts

2. Incomplete log sheetsMore than one percent “Fail to Sign” on receipts

Vouchers issued during an invalid certification period

Missing and/or any incomplete Daily Activity reports

Any vouchers filed with receipts that do not have “VOID” stamped or written on them

Voucher printing problems that are not documented properly

Voucher numbers that did not print, and are not voided in the computer

9. Missing participant signatures

135Slide136

Food Delivery: FD-17

VII. VMARS PROCEDURES

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.

136Slide137

Food Delivery: FD-17 (cont’d)

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.

137Slide138

Food Delivery: FD-17 (cont’d)

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.

138Slide139

Food Delivery: FD-17 (cont’d)

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 participant’s 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.

139Slide140

Food Delivery: FD-17 (cont’d)

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)

140Slide141

Food Delivery: FD-17 (cont’d)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.

141Slide142

Food Delivery: FD-17 (cont’d)

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 participant’s 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.

142Slide143

Food Delivery: FD-17 (cont’d)

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.

143Slide144

Food Delivery: FD-17 (cont’d)

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.

144Slide145

Food Delivery: FD-25B. 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 1-800-796-1850.

b. Hours of operation are from 7:30 am to 5:00 pm, Eastern Standard Time (EST).

145Slide146

Food Delivery: FD-25 (cont’d)4.Document the voucher information for lost vouchers that have

NOT

BEEN CASHED

on the

Lost/Stolen/Destroyed Voided VoucherReport

,

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

.”

146Slide147

Food Delivery: FD-34Monthly 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.

147Slide148

Food Delivery: FD-34 (cont’d)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.

148Slide149

Compliance Analysis

149Slide150

OIG will forward substantiated fraud claims to the local agency for finaldisposition 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 0360 6.1.13).

Compliance Analysis: CA-1

150Slide151

Dual ParticipationThe 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

151Slide152

Compliance Analysis: CA-3C. 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.

152Slide153

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

onjennings@dhr.state.ga.us

or faxed to 770-359-4593.

153Slide154

Compliance Analysis: CA-5Terminations

The local agency may permit a participant to reapply for WIC before

the end of a mandatory disqualification period if:

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.

154Slide155

Compliance Analysis: CA-13

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 employee’s 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.

155Slide156

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 program

s

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

156Slide157

Monitoring

157Slide158

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 Slide159

159

F. Orientation Checklist: (Revised points awarded and wording

for this section to ensure critical points are evaluated)

Monitoring Tool Attachment MO-1

Orientation Checklist

:

S

SN

U

NA

Possible

Points

Points Awarded

NE (V)

Orientation Checklist Overall Rating:

5

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

2Slide160

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

Clinic and Health Record Selection

160Slide161

POLICY UNIT “PRIOR TO” FORM – ADMINISTRATIVE MANAGEMENT EVALUATIONWere 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-14

161Slide162

RECORD REVIEWWas 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 28-29

162Slide163

Food Instrument Accountability: MO-44E. DUAL PARTICIPATION/PARTICIPANT AND/OR EMPLOYEE ABUSE

Does the district distribute the monthly Dual Participation List to

clinics to prevent certifications and/or voucher issuance to dual

participants?

163Slide164

Food Instrument Accountability: MO-44 (cont’d)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?

164Slide165

Food Instrument Accountability: MO-45 B. MANUAL VOUCHER INVENTOY LOG

1. Is the log

completed in its entirety

on all vouchers?

165Slide166

Food Instrument Accountability: MO-46E. 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?

166Slide167

Food Instrument Accountability: MO-47F. 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?

167Slide168

Food Instrument Accountability: MO-47 (cont’d)G. DAILY ACTIVITY REPORTS

2. Are skipped Serial Numbers entered into the system as void and reconciled with the Daily Activity Report?

168Slide169

Food Instrument Accountability: MO-47 (cont’d)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?

169Slide170

Food Instrument Accountability: MO-48

PRORATING /VOUCHERS ISSUANCE

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).

Were vouchers issued to participants past the certification due date without a current certification completed?

170Slide171

Food Instrument Accountability: MO-50M. PARTICPANT ABUSE/DUAL PARTICIPATION

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?

171Slide172

Breastfeeding

172Slide173

173Breastfeeding 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.Slide174

174Breastfeeding BF-2 & 3

STATE AGENCY

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.

 Slide175

175Breastfeeding BF-3

STATE AGENCY

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.Slide176

176Breastfeeding 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,).Slide177

177Breastfeeding 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.Slide178

178Breastfeeding 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 professional

s

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.Slide179

179Breastfeeding 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 participant’s 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 participant’s health record. Slide180

180Breastfeeding BF-11 & 12

BREASTFEEDING MATERIALS AND RESOURCES

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. Slide181

181Breastfeeding 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)

 Slide182

182Breastfeeding 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. Slide183

183Breastfeeding 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 76702-1207

www.ChildbirthGraphics.com

20 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,

2011 7th Edition

♦

Breastfeeding: A Parent’s Guide

,

9

th

Edition

, by Amy Spangler, Amy Spangler/Amy’s Babies, Atlanta, GA,

2010

; English & Spanish

♦

Breastfeeding: Keep It Simple,

3

rd

Edition

by Amy Spangler, Amy Spangler/Amy’s 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

 Slide184

184Breastfeeding BF-17

Attachment BF-2

DVDs

♦

Managing Early Breastfeeding Challenges;

Injoy

Videos, 800-326-2082, 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, 14642

(585) 275-0088; www.bestfedbabies.org

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 80220

(303) 377-3016

Service Provided: Phone consultation with lactation consultants for difficult breastfeeding questions.

Charge: None, beyond cost of telephone callSlide185

185Breastfeeding 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.

 Slide186

186Breastfeeding 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.

 Slide187

187Breastfeeding 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 infant’s name/record through an internal tracking system (tickler card, computer, voucher register, etc.) to alert staff to the need to re-evaluate the infant’s priority at the mother’s 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.

Slide188

188Breastfeeding 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 can

3 oz

14 – 20 oz

60

- 90 oz

MBF

2 cans

6 oz

21

– 41 oz

91

- 180 oz

MBF

3 cans

9 oz

42

– 62 oz

181

- 270 oz

MBF

4 cans

12 oz

63

– 83 oz

271

- 360 oz

MBF

5 cans

16 oz

84

– 104 oz

361

- 450 oz

SBF

6 cans

18 oz

105 – 125 oz

451 – 540 oz

SBF

7 cans

21 oz

126 – 146 oz

541 – 630 ozSlide189

189

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. Slide190

Emergency Plan

190Slide191

Emergency Plan: EP - 11Food 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.

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Emergency Plan: EP - 15REPLACING 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 numbersParticipant ID number

Name of participantClinic, County and District numberName of staff member requesting the information b. Phone number is

1-800-786-7909

c. Hours of operation are from 7:30 am to 5:00 pm, Eastern Standard Time (EST)

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Emergency Plan: EP - 19TIPS FOR OPERATING A MANUAL SYSTEM

A. Verify the Manual Voucher

beginning number

daily to ensure that you start with the correct batch. (Remember that there are now

eleven (11) sets of vouchers)

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