646.1 Policy 646 Mid-Certification Health Assessment September 23, 2019 POLICY Local programs shall provide a mid-certification health assessment (MCHA) for participants with a one-year certification period. During the MCHA appointment, participants shall receive a complete assessment and be provided with appropriate nutrition education, anticipatory guidance, breastfeeding promotion and support, and referrals. PURPOSE To ensure participants certified for greater than 6 months continue to receive quality nutrition services and education. RELEVANT REGULATIONS 7 CFR §246.7(g)(1)(iv)—Certification periods FNS Instruction 803-4, Rev. 1 Final WIC Policy Memorandum #2001-2 WIC Bloodwork Requirements OREGON WIC PPM REFERENCES

♦ 481—Immunization Screening & Referral Protocol ♦ 601—Physical Presence Requirement at Certification ♦ 625—Risk Assessment ♦ 626—Hemoglobin and Hematocrit Screening in WIC ♦ 650—WIC Transfers/VOC and WIC Overseas Program ♦ 661—Competent Professional Authority: Appropriate Counseling for Risk Levels ♦ 820—Nutrition Education: Participant Contacts ♦ 840—Documentation of Nutrition-Focused Education and Counseling TWIST TRAINING MANUAL REFERENCES: Chapter 3, Section 9: Second Nutrition Education Contact Lesson 900—Individual Follow-ups DEFINITIONS Mid-Certification Health Assessment (MCHA): A complete health assessment with appropriate nutrition education, anticipatory guidance, breastfeeding support and referrals that occurs approximately in the middle of a one-year certification. This is an expanded nutrition education appointment, not a certification. The MCHA must be completed by a Competent Professional Authority. PROCEDURE MCHA Requirements 1.0 Participants certified for a one-year period shall be scheduled for a MCHA with a Competent Professional Authority between the fifth and seventh month of their twelve-month certification period.

Mid-Certification Health Assessment, Continued 646.2

The MCHA shall include a complete assessment, appropriate nutrition education and referrals for the participant. At a minimum, a complete MCHA includes: 1.1.1. Length and weight or height measurements 1.1.2. Diet assessment 1.1.3. Health assessment 1.1.4. Hemoglobin or hematocrit when appropriate (see 625—Risk Assessment 1.1.5. Immunization screening and referral when appropriate (see 481— Immunization Screening & Referral Protocol) 1.1.6. Category, age, and developmentally appropriate anticipatory guidance and dietary recommendations 1.1.7. Updated food package assignment as appropriate 1.1.8. Referrals as appropriate 1.1.9. Breastfeeding assessment, support and encouragement for continued breastfeeding when appropriate Document in the data system

Document in the data system at the time of the MCHA: 1.2.1. Length/height and weight measurements 1.2.2. Hemoglobin or hematocrit test results, if obtained 1.2.3. Additional risk factors, if applicable 1.2.4. Diet assessment questionnaire 1.2.5. Health assessment questionnaire 1.2.6. Food package changes 1.2.7. Nutrition education provided 1.2.8. Referrals made Referral Data

Participants may bring in height and weight measurements from another provider taken within 60 days of the MCHA appointment.

A documented hemoglobin or hematocrit result performed by a medical provider within the biochemical screening guidelines for the participant’s category may be used. (See 626 -- Hemoglobin and Hematocrit Screening in WIC.)

Document the date the referral data was obtained in the “Medical Data” tab in the data system. In the “Notes” field, document the provider and the date of the actual MCHA appointment. (see 601—Physical Presence Requirement at Certification and 625—Risk Assessment.)

Mid-Certification Health Assessment, Continued 646.3 Scheduling the MCHA 2.0 The MCHA may be done as an individual appointment or a group appointment as long as the activities described in ¶1.0 are performed.

The data system will automatically generate an individual MCHA appointment request as MW for women, MI for infants or MC for children following a certification appointment.

The MCHA may be counted as one of the three required quarterly NE contacts during a one-year certification period. (See 820—Nutrition Education: Participant Contacts.) 2.2.1. Schedule the participant for a second nutrition education contact 2 to 3 months before and after the MCHA appointment. High-risk participants must be scheduled for two appointments with the registered dietitian per one-year certification period. The MCHA appointment may be one of these appointments. (see 661— Competent Professional Authority: Appropriate Counseling for Risk Levels.)

Participants transferring into Oregon after the seventh month of their one-year certification period do not need a MCHA. Instead, schedule them for a second nutrition education contact before the end of their certification period. (see 650—WIC Transfers/VOC and WIC Overseas Program) Rescheduling Missed MCHA 3.0 Do not withhold benefits if the MCHA is not completed on time or if the participant refuses the appointment.

If the initial MCHA appointment is missed, contact the participant to reschedule the appointment. Once two-way communication is made and the appointment is rescheduled, issue only one month of benefits at a time until the MCHA is complete or the participant’s next recertification appointment. Other quarterly NE options may not substitute for the MCHA. (see 840— Documentation of Nutrition-Focused Education and Counseling.)

If the participant refuses the MCHA appointment at the time of certification, document refusal in the “Family Appointment Record” under “NE Refusal.” (See 840-- Documentation of Nutrition-Focused Education and Counseling)

If you need this in large print or an alternate format, please call 971-673-0040. This institution is an equal opportunity provider.

Mid-Certification Health Assessment, Continued 646.4 POLICY HISTORY Date * Major Revision, Minor revision 3/27/2007 Revision 10/26/2011 Revision 4/11/2013 Revision 10/1/2014 Revision 12/7/2017 Revision 9/23/2019 Major revision

The date located at the top of the policy is the implementation date unless an “effective date” is noted on the policy. Policies will become compliance findings 6 months from the implementation date. Release notes can be found in the corresponding document on the Policy and Procedure Manual page. *Major Revisions: Significant content changes made to policy. Minor Revisions: Minor edits, grammatical updates, clarifications, and/or formatting changes have occurred. Date of Origin: Date policy was initially released