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(adm-02.1)Virginia WIC Policy and Procedures Manual ADM 02.1: Waiting Lists#

(adm-02.1)(document-1)#

Division of Community Nutrition

Subject: Waiting Lists Policy: ADM 02.1 Reference: CFR § 246.7 Effective: May 1, 2026 Supersedes: August 12, 2013

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I. Policy:

When the maximum caseload supported by federal funds is met, a waiting list must be implemented by the State WIC Office (SWO). Local agencies must maintain, by specific written direction from the SWO, a waiting list of all persons who visit the local agency to express interest in receiving WIC program benefits and who are likely to be served or requests placement on the waiting list. Local agencies must not make unilateral decisions to implement a waiting list.

Only applicants who visit a local agency must be placed on the waiting list. Applicants must be notified of their placement on a waiting list within 20 calendar days of the request for WIC benefits. The Competent Professional Authority (CPA) must apply the nutritional risk priority system, in accordance with CRT 06.5 to the waiting list to ensure that the highest priority persons are served first.

II. Procedure(s):

A. All applicants who visit a local agency and request to be placed on the waiting list must be placed on the waiting list.

1) The waiting list policy and procedures must be explained to the applicant, including why placement on a waiting list is necessary and what are realistic expectations for receiving benefits.

2) Each applicant must be placed on the appropriate waiting list for their assigned category/priority.

a. VOC transfers must be placed at the top of the waiting list, if one is applicable to the participant’s category/priority.

3) The waiting list must include the applicant’s name, address, phone number, category, birth date, and date he or she was placed on the waiting list.

4) All applicants placed on the waiting list must be referred to other programs and resources (e.g., Food Banks, SNAP, Salvation Army.)

5) The Notice of Waitlist, WIC-316, must be issued.

B. As openings become available, the CPA must contact applicants assigned the highest priority according to their position on the waiting list.

1) The applicant must be contacted by the preferred method they selected.

Division of Community Nutrition

Subject: Waiting Lists Policy: ADM 02.1 Reference: CFR § 246.7 Effective: May 1, 2026 Supersedes: August 12, 2013

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C. If the applicant does not return to the local agency within 10 calendar days of notification, his/her name must be removed from the waiting list and the next eligible applicant on the list must be notified.

D. Local agencies must report waiting list information as required by the State WIC Office.

(adm-03.0)Virginia WIC Policy and Procedures Manual ADM 03.0: Funding Principles#

(adm-03.0)(document-1)#

Division of Community Nutrition

Subject: Funding Principles Policy: ADM 03.0 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2008

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I. Policy:

The Virginia WIC Program (State Agency) receives funding from the U.S. Department of Agriculture on a federal fiscal year basis from October 1 through September 30 based on a per participant funding formula. Local agencies (LA) are funded on a federal fiscal year basis.

II. Procedure(s):

A. Local Agency funds are effective October 1 of each fiscal year. Changes in the federal budget allocation (i.e. inflation factor, continuing resolution) for the year may require adjustments to the budget allocation for each local agency. The State Agency reserves the right to adjust funding in accordance with provisions in the funding formula and based on the availability of funds.

B. Local agency allocations

1) Local agency funding is established based on a per-participant funding formula modeled after the federal per participant formula used to fund WIC State Agencies.

a. An initial LA budget allocation is calculated in May each year using average LA participation for pregnant women and other WIC categories during the months of January through March multiplied by the respective funding rate for pregnant women and other WIC categories.

b. Upon calculation of the initial stability budget allocation for each LA, an indirect deduction is subtracted for each LA based on that LA’s indirect cost from the previous state fiscal year.

c. Based on the availability of funds, growth funds may be offered to assist local agencies in serving potentially eligible pregnant women. These growth funds will be factored into the LA’s budget allocation.

d. The LA funding formula contains a hold harmless provision to ensure that LA funding cannot be reduced by any greater than 5% between any two fiscal years. Funding amounts will be added to any LA’s budget allocation to ensure that current year funding is at least 95% of the previous fiscal year amount.

Division of Community Nutrition

Subject: Funding Principles Policy: ADM 03.0 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2008

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e. Upon applying the hold harmless provision a final initial allocation is calculated and allocated across the WIC budget categories as outlined in bullet C below.

f. A final budget allocation is calculated in November of each year using the steps outlined in bullets a through e above using average participation for each LA for pregnant women and other WIC categories during the months of July through September.

C. Local agency category allotments

1) Annual local agency allocations will be broken down as to administration, client services, nutrition education and breastfeeding spending requirements. 2) Breastfeeding amounts are allocated based on Virginia’s allocation at the national level. The breastfeeding amounts are minimums, and local agencies are free to spend nutrition education funds for authorized breastfeeding activities. 3) Nutrition education allocations represent one-fifth of total funds allocated to the local agency. These nutrition education funds are also minimums, and while administrative/client services funds may be spent on nutrition education above the minimum, this is not encouraged beyond minimal amounts. This is necessary to ensure that adequate funding is available for all administrative/client services requirements.

(adm-03.5)Virginia WIC Policy and Procedures Manual ADM 03.5: Allowable WIC Expenditures and Allocations#

(adm-03.5)(document-1)#

Division of Community Nutrition

Subject: Allowable WIC Expenditures and Allocations Policy: ADM 03.5 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2009

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I. Policy:

WIC funds shall be used by the local agencies in support of WIC general administration, WIC client services, WIC nutrition education and WIC breastfeeding as stipulated in the federal fiscal year’s Memorandum of Agreement (MOA) or approved in writing by the State WIC Office (SWO). The following procedure(s) outline allowable costs under the MOA.

II. Procedure(s):

A. Administration - The cost of program monitoring/general oversight and food benefit accountability , including:

1) Salary and related costs specifically related to above activities

2) The cost of WIC fair hearings

3) The local agency cost of monitoring and reviewing WIC Program operations

4) The cost of travel and training, where associated with continuing education, is allowable where the primary purpose is the dissemination of technical information that will be directly related and applied to a WIC employee’s work profile (EWP) role and or responsibility

5) The cost of membership for a local agency in the National WIC Association and travel associated with National WIC Association committee membership

6) The cost of pre-employment screening for drug and other substance abuse

7) The cost of preparing and maintaining fiscal and program management reports

8) The cost of maintaining administrative records and WIC staff personnel records

B. Client Services – The cost of all direct and indirect costs expended for program certification, food benefit issuance, delivering food and other client services and benefits including staff salaries and benefits required in the certification process, salaries and benefits of staff who issue food benefits and explain their use. The following are examples of allowable uses of client services:

1) Cost for determining categorical, residential and income eligibility for services

2) Costs for conducting diet and health assessments and determine nutritional risk required food prescription process

3) Costs for issuing food benefits and explaining their use

4) Costs for referring participants to other health care and social services

5) Costs for coordinating services with other programs

6) Laboratory fees for no more than two hematological tests for anemia per participant per certification period if within WIC guidelines

Division of Community Nutrition

Subject: Allowable WIC Expenditures and Allocations Policy: ADM 03.5 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2009

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7) Expendable medical supplies necessary for WIC certification

8) Medical equipment used for assessing hematological status and taking anthropometric measurements for WIC certification

9) The cost of outreach services to persons potentially eligible for WIC

10) The cost of interpreters for WIC certification services

11) The cost of postage on postcards/letters for follow-up with delinquent participant(s) who(m) can not be contacted via telephone and or facsimile

12) The cost of facilities and associated utilities used for WIC purposes with the goal of increasing WIC participation

C. Nutrition Education - The cost of nutrition education including counseling at the time of certification and secondary contacts concurrent with food benefit issuance, including:

1) Salary and related costs for WIC nutrition education services

2) Educational reading and viewing materials such as handouts, flip charts, videos, food models or other teaching aids directly related to WIC nutrition education and promotion of healthy eating and given to WIC participants

3) Equipment used in the provision of nutrition education to WIC participants including but not limited to:

a. Video Cassette Recorders (VCR) b. Projectors, etc c. Digital Video Discs (DVD)

4) Postage for mailing WIC nutrition educational materials to WIC clients if food instruments are mailed

5) Training WIC nutrition educators (including para-professional personnel who have completed the required training modules in order to provide low-risk education) to ensure competent personnel and quality services are provided

6) Evaluations of WIC nutrition education programs

7) Monitoring WIC nutrition education activities

8) The cost of translators and interpreters for WIC nutrition education

9) Cost of space dedicated to the provision of WIC nutrition education

10) Collaboration with Head Start, Expanded Food and Nutrition Education Program (EFNEP), etc. regarding nutrition education to WIC participants

11) Nutrition education teaching aids provided by the SWO given to WIC participants that support nutrition education and or breastfeeding messages in an approved

Division of Community Nutrition

Subject: Allowable WIC Expenditures and Allocations Policy: ADM 03.5 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2009

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WIC Services Plan (WSP) and for which prior written approval has been obtained from the SWO

D. Breastfeeding - The cost of breastfeeding education and consultation to WIC

participants by WIC nutritionists, CPAs, or breastfeeding peer counselors; volunteer

organizing for WIC services, WIC peer counselors, and WIC plan development,

including:

1) Salary and related costs for WIC breastfeeding services

2) Breastfeeding educational materials given to WIC clients

3) Training such as breastfeeding conferences and workshops for WIC breastfeeding educators or staff who have a role in breastfeeding support and counseling

4) Costs related to conducting training sessions, purchasing and or producing materials. Policy BF 01.0 requires all WIC personnel to complete annual breastfeeding training and have breastfeeding in their Employee Work Profile (EWP)

5) Prorated cost of clinic space devoted solely to WIC BF educational and training activities, including space and office furniture set aside to breastfeed WIC infants during clinic hours which would help provide an environment conducive to breastfeeding

6) Costs of monitoring and evaluating breastfeeding activities

7) Travel and related costs incurred by WIC personnel to conduct breastfeeding

activities or attend training

8) Cost of reimbursable agreements with other organizations, public or private, to

undertake training, and, with pre-approval from the SWO, direct service delivery

to WIC participants concerning breastfeeding

9) Costs of promotional campaign items (print, radio, television) aimed at a general

audience concerning nutrition or breastfeeding are allowed only if materials can

legitimately be used with WIC participants in an education context and the local

agency has obtained prior written approval from the SWO

10) Educational reading and viewing materials such as handouts, flip charts, videos,

food models or other teaching aids directly related to promotion of breastfeeding

and given to WIC participants

11) Salary and benefit expenses and costs of materials utilized in the evaluation of

breastfeeding initiatives, or contractual agreements entered into for this purpose

12) Salary and benefit expenses for WIC staff to organize volunteers and community

groups to support breastfeeding WIC participants

(adm-03.6)Virginia WIC Policy and Procedures Manual ADM 03.6: Unallowable Spending Costs#

(adm-03.6)(document-1)#

Division of Community Nutrition

Subject: Unallowable WIC Expenditures and Allocations Policy: ADM 03.6 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2011

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I. Policy:

WIC funds shall be used by the local agencies in support of WIC client services, WIC general administration, nutrition education and WIC breastfeeding as stipulated in the federal fiscal year’s Memorandum of Agreement (MOA) or approved in writing by the State WIC Office (SWO). The following procedure(s) outline unallowable costs under the MOA.

II. Procedure(s):

A. Local agencies shall not use WIC funds for any of the following:

1) Bad debt

2) Contributions and donations

3) Entertainment

4) Fines and penalties

5) Interest and other financial costs

6) Any expenses which personally benefit employees (working lunches, awards, gifts)

7) Expenses to purchase or administer vaccines

8) Expenses to provide for blood lead testing

9) Charges for food to object code 1362 (State Food Account) with the exception of if food is purchased for nutrition education or breastfeeding classes, the local agency may charge the food to object code 1374 (Educational/Training Supplies). Use of food shall be documented in writing and approved by the assigned SWO Nutrition Education Liaison prior to the purchase or the expenses will be disallowed

10) Direct reimbursement to participants for the cost of transportation to a WIC clinic.

11) Bottled water is unallowable. If a local agency has a temporary problem with a building’s potable water and the system is shut down, temporary purchase of bottled water would be allowed

12) Costs of gifts or incentives designed to reward breastfeeding, nutrition education or participation in the WIC Program. These include, but are not limited to: a. Bags b. Cups c. T-shirts d. Buttons e. Infant slings f. Ponchos g. Diaper bags h. Squeeze bottles, etc.

Division of Community Nutrition

Subject: Unallowable WIC Expenditures and Allocations Policy: ADM 03.6 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2011

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(If considered teaching aid, (see ADM 03.5) Outreach items will be developed and purchased at the SWO for use in local agency outreach efforts. Unless specifically reviewed and approved by the SWO, costs related to the development and use of outreach materials are not allowable expenses of the local agency.

13) Breast Pumps - Purchase cost (s) of Breast Pumps – manual or electric that is already supplied by the SWO to all local agencies.

14) Any items that require written approval by the SWO or United States Department of Agriculture (USDA) for which prior written approval was not obtained

15) TV promotional advertising for breastfeeding awareness on cable/on-demand television for a region or the entire state

16) Computers and or laptops that are already purchased by the SWO for the local agency through the equipment replacement program

17) Breastfeeding aids which do not directly support the initiation and continuation of breastfeeding and are not within the scope of the WIC program. Some examples are the following:

a. Topical creams

b. Ointments

c. Vitamin E

d. Other medicinals

e. Foot Stools

f. Infant pillows

g. Nursing blouses

h. Electric Breast Pump Trolleys & Carts

18) The costs of celebratory items, or items designed primarily as staff morale boosters, generally for the personal use of the staff, with minimal public display

19) The costs of items of nominal value which have no outreach, breastfeeding, or nutrition education message

20) The costs of any program incentive item intended for persons who are not WIC participants, potential participants, or their parents/guardians, or for persons with no connection to the WIC program, such as staff and cooperating agency representatives

21) Purchase cost(s) of anthropometric equipment that is already supplied by the SWO to all local agencies

22) The cost of transporting, shipping or transferring SWO purchased equipment, for example, kiosk shells, computers, monitors, printers, electric breast pumps, anthropometric equipment, etc, from one local agency to another to be used by another local agency without SWO approval. The local agency must inquire

Division of Community Nutrition

Subject: Unallowable WIC Expenditures and Allocations Policy: ADM 03.6 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2011

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through the SWO, through a needs survey, if more SWO purchased equipment is needed for the local agency

23) Costs associated with the purchase of all apparatus or devices (e.g., enteral feeding tubes, bags and pumps) designed to administer WIC approved formulas. For a list of all non-WIC approved formula and other nutrition products, please see FDS 03.4.

(adm-03.7)Virginia WIC Policy and Procedures Manual ADM 03.7: Time & Effort Reporting#

(adm-03.7)(document-1)#

Division of Community Nutrition

Subject: Time & Effort Reporting Policy: ADM 03.7 Reference: CFR 246.14.c.1.i; DAMM Manual -Time and Effort Effective: July 1, 2026 Supersedes: July 1, 2017

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I. Policy:

All personnel providing WIC services will complete a daily Time and Effort reporting (T & E) in accordance with Virginia Department of Health (VDH) procedures and adhere to VDH Policy No. 6.05. T & E reporting is required for all VDH salaried / wage personnel funded in total or in part by federal funds, as well as for all local VDH agency personnel who are not federally funded yet provide WIC client services or are in direct contact with WIC clientele.

II. Procedure(s):

A. T & E reporting must be completed daily through the Virginia Department of Health (VDH) online Finance and Administration (F&A) T&E Module available at: https:// vdh fanda.vdh.virginia.gov/financials/index.jsp

B. All time reported will reflect time spent, and not times projected, nor time allocated according to HR-9 percentages.

C. Personnel will electronically submit daily records of time spent for each federal fiscal year.

D. Overtime hours must be pre-approved and reported.

E. “Free”, in-kind, or unpaid time shall not be reported by non-exempt personnel.

F. Compensatory time will be reported as non-direct service time when taken.

G. Annual leave and Sick leave will be reported as non-direct service time when taken.

H. Personnel reported T & E will be reviewed for accuracy and verified by the assigned supervisor validating T & E spent

I. Time and effort will be reported, and all errors corrected no later than the 25th of the following month. Program and district administrators are required to certify that the calculated value of time and effort supports the personnel cost incurred by T&E programs.

J. Time spent working with the WIC Program will be correctly identified in one of following four categories:

1) Administration time will be recorded with T & E Code 130. Listed below are the situations when this shall be required:

a. Program monitoring

b. Prevention of fraud

c. General oversight

Division of Community Nutrition

Subject: Time & Effort Reporting Policy: ADM 03.7 Reference: CFR 246.14.c.1.i; DAMM Manual -Time and Effort Effective: July 1, 2026 Supersedes: July 1, 2017

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d. Food instrument accountability;

e. Local WIC vendor on-site monitoring T & E

f. Maintaining WIC fiscal and program reports

g. WIC clerical support

2) Client Services will be recorded with T & E Code 129. Listed below are the situations when this shall be required:

a. Determining categorical, residential and income eligibility

b. Conducting diet and health assessments and determine nutritional risk required in the certification process

c. Issuing food benefits and explaining their use

d. Referring applicants / participants to other health care and social services

e. Coordinating services with other programs

f. Outreach

3) Nutrition Education will be recorded with T & E Code 131. Note that only part of the certification visit which is dedicated to counseling in response to identified nutritional risk will be counted as nutrition education. The certification process itself will be recorded as client service time. Listed below are the situations when this will be required:

a. Explaining the relationship of nutrition to good health.

b. Nutritional education provided to participants regarding identified nutritional and / or medical risk(s) in accordance with (NEd-02.3-C.pdf).

c. Providing individual or group follow-up education sessions.

d. Travel and training for WIC personnel who plan and / or conduct nutrition education.

e. Developing or procuring nutrition education materials.

f. Interpreting or translating nutrition education services or materials.

g. Evaluating and monitoring nutrition education services.

h. Outreach

4) Breastfeeding time will be recorded with T & E Code 134. Note the cost of any breastfeeding education and consultation to WIC participants by WIC

Division of Community Nutrition

Subject: Time & Effort Reporting Policy: ADM 03.7 Reference: CFR 246.14.c.1.i; DAMM Manual -Time and Effort Effective: July 1, 2026 Supersedes: July 1, 2017

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Nutritionists, CPA’s or breastfeeding peer counselors (ADM 03.5). Listed below are the situations when breastfeeding T & E time coding is required:

a. Promoting and supporting breastfeeding

b. Encouraging continuation of breastfeeding

c. Developing / procuring, printing and distributing materials devoted to breastfeeding education and support

d. Training WIC personnel to provide the aforementioned

e. Outreach

K. Non-direct service time will be coded to T & E Code 999 when personnel efforts cannot be related to a specific federal program. When training or travel is directly related to a specific program, the time will be charged to that program and its relative project code.

L. T & E reporting is a daily and 100% continuous time reporting process. As such if local personnel perform WIC and non-WIC activities related to another program, all time worked within each program (WIC and non-WIC) must be reported using the appropriate time and effort code designated for each program as well as the corresponding FIPS code, if available, for where the actual T & E took place.

M. Work for other State funded health programs (non-grant) that cannot be identified and/or are not listed in the T & E F & A system will be recorded as 898.

N. All T & E recorded will use the correct FIPS coding for where the work was actually performed.

(adm-03.8)Virginia WIC Policy and Procedures Manual ADM 03.8: Capital Expend., Eqpmnt. Cmptr. Purchase Requirements#

(adm-03.8)(document-1)#

Division of Community Nutrition

Subject: Capital Expenditures, Equipment, Computer Purchase Requirements Policy: ADM 03.8 Reference: CFR 3016.3, FNS Handbook 901, SFP 10-017, SFP 93-126 Effective: June 1, 2018 Supersedes: August 12, 2013

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I. Policy:

All capital expenditures made utilizing allocated federal WIC funds shall be coordinated with the State WIC Office (SWO) in order to meet federal approval requirements and assures control of assets and inventory.

II. Procedure(s):

A. In general, computer purchases will be centralized at the SWO and made from central office funds. Purchase of any computer equipment or software utilizing Local Agency (LA) WIC funds requires prior written approval from the SWO.

B. Purchases of capital assets, such as buildings, land, improvements to buildings or facilities that materially increase their useful life, renovations to buildings or facilities, real estate, or equipment using WIC funds with a total cost of more than $1,000 require prior written approval from the SWO. A capital asset is an economic resource owned, whose use will yield a benefit to a State or LA over two or more fiscal years. Renovations are rearrangements, alterations, and restorations of real property to make it suitable for program use or make building space suitable specifically for the WIC program. The following are examples in their respective categories which could require prior written approval from the SWO:

1. Capital Assets 1) Furniture 2) Cameras 3) Office equipment 4) Copiers 5) Scanners 6) Projectors 7) Other peripherals for computers

2. Renovations a. New carpet (where none previously existed) b. New floor tiles (where none previously existed) c. Re-design of space to provide enhanced participation flow and confidentiality (remodeling)

C. Purchases of capital assets, improvements to buildings or facilities that materially increase their useful life, repairs or renovations to buildings or facilities costing more than $5,000, require prior written approval from USDA Food and Nutrition Service

Division of Community Nutrition

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(FNS). Leases of capital assets costing more than $5,000 require prior written approval from the SWO. Purchases of equipment costing more than $25,000 require prior written approval from USDA FNS. The LA shall contact their assigned SWO Fiscal Monitoring Liaison when seeking approval from USDA FNS.

D. Maintenance, a non-capital expense and is the process of keeping capital assets, such as buildings and equipment, in a state of good repair, costing more than $1,000, requires notification of its cost and scope to the SWO within thirty (30) days of its purchase. This includes preventive maintenance and upkeep, routine repairs and alterations, activities to restore existing capital assets to their former, serviceable condition by replacing parts, putting together broken components, and other activities needed to maintain the property. Examples include the following: 1. Painting 2. Carpet and floor cleaning 3. Repairs of equipment or fixtures

E. Purchases of capital assets with a total cost of less than $1,000, but with a useful life greater than two fiscal years shall be reported in writing to the SWO within thirty (30) days of its purchase. Examples include the following: 1. Hemocue machines 2. TV(s) 3. VCR Players 4. DVD Players 5. Scales 6. Cameras 7. Furniture 8. Scanners 9. Laminators 10. Office equipment

F. For items requiring pre-approval, LA’s shall submit a written justification for the purchase along with a copy of the purchase requisition to the designated state Fiscal Monitoring Liaison prior to purchase. LA’s will receive written approval or denial in response to all requests. If the purchase requires USDA FNS prior written approval, this shall be obtained by the SWO prior to responding to the LA. Documentation of request for prior written approval shall be kept at the LA for State audit purposes and SWO on- site State Technical Assistance Review (STAR) reviews.

Division of Community Nutrition

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1. For items requiring subsequent notification, the state LA shall send a copy of the purchase order and invoice to the designated state Fiscal Monitoring Liaison. If USDA FNS requires notification, the SWO shall handle this procedure. Copies of the approval or disapproval notification shall be kept at the LA level for State audit purposes and WIC on-site STAR reviews.

(adm-03.9)Virginia WIC Policy and Procedures Manual ADM 03.9: Cost Allocation for Shared Expenses#

(adm-03.9)(document-1)#

Division of Community Nutrition

Subject: Cost Allocation for Shared Expenses Policy: ADM 03.9 Reference: N / A Effective: November 13, 2018 Supersedes: August 12, 2013

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I. Policy:

The cost of space in privately or publicly owned buildings used for the benefit of the WIC Program is an allowable expense. The total cost of space may not exceed the rental costs of comparable space and facilities in a public / private owned building in the same locality.

II. Procedure(s):

A. Charges should be determined on the basis of actual costs including depreciation based on the useful life of the building; interest paid or accrued, operation and maintenance.

B. Charges to WIC for building space shall be based on square footage used by the Program. All other federal programs shall be charged using the same rate. A written allocation plan shall remain on file for State audit purposes and on-site Local Agency Management Evaluation reviews as well.

C. The cost of space procured for WIC usage may not be charged to the Program for periods of non-occupancy without prior authorization from the State WIC Office (SWO). Space allocated to WIC that is used part of the week shall be prorated based on the percent of the week WIC uses the space.

D. No rental charges shall be for purchases or construction charges that were originally financed by the WIC Program.

E. Costs incurred for rearrangement and alteration of facilities required specifically for the WIC Program or those that materially increase the value or useful life of the facilities are allowable when pre-approved by the SWO and the USDA.

F. Alternate shared cost methodologies to the square footage methodology shall be submitted for SWO approval with supporting explanation and justification.

G. All local agencies are required to have an approved Cost Allocation Plan on file. If there are no shared expenses, the local agency shall notify the SWO in writing to state there are no shared costs. The Cost Allocation Plan or notice that there are no shared costs shall be submitted to the SWO for approval annually by August 15.

(adm-03.10)Virginia WIC Policy and Procedures Manual ADM 03.10: Fiscal Record Keeping: General Guidelines#

(adm-03.10)(document-1)#

Division of WIC & Community Nutrition Services

Subject: Fiscal Record Keeping: General Guidelines Policy: ADM 03.10 Reference: Title 7 CFR Subtitle B Ch. XXX §3016.32, (d)(1)-(d)(5)); ADM 11.0; Title 7 CFR §246.25 (a)1-(a)4; DAMM, XV Fixed Assets, B & C; Virginia General Schedule 102, Fiscal Records Effective: August 12, 2013 Supersedes: December 1, 2012

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I. Policy:

All financial operations, capital equipment purchases and inventory of capital equipment, and personnel actions are to be in accordance with established Federal (Title 7 CFR Ch. II §246.25 (a)1-(a)(4); Title 7 CFR Subtitle B Ch. XXX §3016.32, (d)(1)-(d)(5)) and state policy as explained in the Department Administrative Management Manual (DAMM) XV Fixed Assets B & C, Virginia General Schedule 102 Fiscal Records, both State and VDH Personnel Policy and Procedure Manual, and shall be in compliance with ADM 11.0.

II. Procedure(s):

A. Records shall include, but not limited to, information pertaining to financial operations, food delivery systems, food instrument issuance and redemption, certification, nutrition education, civil rights, fair hearing procedures, equipment purchases and inventory with classification, location and storage, level of use / activity, and categorization.

B. All records for capital equipment acquired in whole or in part with WIC funds shall be retained for three years after its final disposition.

C. Inventory listings of all WIC capital equipment shall be updated every six (6) months by the local agency. WIC capital equipment inventory reports shall include:

1) Controllable (non-FAACS) property which has a value or cost at date of acquisition of $200.00 to $4,999.00, and an expected useful life greater than one year. This may include electronic equipment maintained by VITA, but purchased with WIC federal funds.

2) Capitalized fixed assets (FAACS property) which have an expected life greater than one year and have a value or cost of $5,000.00 or more at the date of acquisition (including the cost of installation, freight and shipping associated with the acquisition

3) Classifying information, specific to the asset, according to the following criteria:

a. Description (Manufacturer, make, model, and serial number) b. Date of acquisition c. Cost or value at date of acquisition d. Asset tag number e. Physical location f. Responsible individual the asset is assigned to g. Equipment condition and availability

Division of WIC & Community Nutrition Services

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h. Asset billing coding (VITA maintained assets only) i. Verification of WIC only use, if not see ADM 03.4 j. Source of Property

D. All records shall be available during normal business hours for inspection, audit and copy by Commonwealth of Virginia inspectors and auditors and shall be available for representatives of the Department of the Comptroller of General of the United States.

E. All program records shall be maintained for three years and or according to asset useful life following the date of submission of the final expenditure report for the period in which the report pertains. This also includes records for non-expendable property acquired in whole or in part with WIC program funds. If any litigation, claim, negotiation, audit or other action involving the records has been started before the end of the three-year period, the records shall be kept until all issues are resolved.

F. The management requirements for the record keeping of the disposition of equipment purchased in whole or in part with Federal funds shall follow procedures set forth in Title 7 CFR Subtitle B Chapter XXX 3016.32(d) and Virginia Department of General Services (DGS) policy 12.0, State Surplus Property.

(adm-04.0.1)Virginia WIC Policy and Procedures Manual ADM 04.0.1: WIC Services Plan (WSP) & Memorandum of Agreement#

(adm-04.0.1)(document-1)#

Division of Community Nutrition

Subject: WIC Services Plan (WSP) & Memorandum of Agreement (MOA) Policy: ADM 04.0.1 Reference: CFR §246.6(a) Effective: August 12, 2013 Supersedes: July 15, 2012

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I. Policy:

Per 7 CFR Ch. 11, §246.6(a), the State WIC Office (SWO) shall enter into a signed written agreement with each local agency which sets forth the local agency’s responsibilities for Program operations. The signed written agreement used by the SWO is a Memorandum of Agreement (MOA) between the local agency and the Office of Family Health Services (OFHS). In order to obtain authorization and funding to provide local WIC services, local agencies shall reapply annually.

To receive an MOA, each local agency shall develop and obtain approval of an annual WIC Services Plan (WSP) that supports the SWO’s goals for the year. Failure to secure approval of its WSP shall result in the local agency not receiving an MOA in a timely fashion.

II. Procedure(s):

A. WIC Services Plan

1) The SWO shall notify all local agencies of the availability of the WSP application package on the WIC website Local Agency Corner.

2) Each local agency shall be responsible for developing its own objectives in support of the SWO goals and further completing the appropriate document(s) required for complete submission of the WSP package.

3) The local agency shall communicate with their assigned SWO personnel in a timely manner to ensure the timely completion of a detailed WSP product.

4) The local agency shall be responsible for submitting the WSP package to the SWO personnel identified in the WSP Guidance Document by the published deadline.

B. Memorandum of Agreement (MOA)

1) Upon receipt of an approved WSP, the SWO shall issue the local agency its MOA for the upcoming federal fiscal year.

2) The District Director (or designee) shall sign the MOA and return to the personnel identified in the MOA package by the published deadline. Failure to submit a signed MOA by the published deadline shall result in the delay of WIC Program funding for the local agency.

Division of Community Nutrition

Subject: WIC Services Plan (WSP) & Memorandum of Agreement (MOA) Policy: ADM 04.0.1 Reference: CFR §246.6(a) Effective: August 12, 2013 Supersedes: July 15, 2012

Page 2 of 2

3) In accordance with the MOA, the local agency shall inform the SWO of changes to personnel contact information as provided in the WIC Email-01 form, including District Director, WIC Coordinator, WIC Coordinator’s Immediate Supervisor, WIC Secondary Contact, and Business Manager.

(adm-04.1)Virginia WIC Policy and Procedures Manual ADM 04.1: State Technical Assistance Review (STAR)#

(adm-04.1)(document-1)#

Division of Community Nutrition

Subject: State Technical Assistance Reviews Policy: ADM 04.1 Reference: CFR §246.19(b)(1-6) Effective: February 1, 2018 Supersedes: November 1, 2017

Page 1 of 1

I. Policy:

Per CFR §246.19(b)(1), “The State agency shall establish an ongoing management evaluation system which includes at least the monitoring of local agency operations, the review of local agency financial and participation reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the implementation of corrective action plans, and on-site visits. The results of such actions shall be documented.”

State Technical Assistance Reviews (STAR) shall include, but not be limited to an evaluation of management, referrals, outreach, participation, eligibility, certification, fixed asset inventory, general security over WIC assets, time and effort reporting, nutrition education, participant services, civil rights compliance, accountability, breastfeeding promotion, financial management systems, and food delivery systems.

II. Procedure(s):

A. On-Site State Technical Assistance Reviews - The State WIC Office (SWO) shall conduct an on-site State Technical Assistance Review of local agency operations and implementation of the WIC Program a minimum of every two (2) years from the date of the previous on-site evaluation. The management evaluation shall include a minimum of twenty percent (20%) of the sites in each local agency or one (1) site, whichever is greater.

1) The local agency shall cooperate with all aspects of the State Technical Assistance Review, including, but not limited to:

a) Submitting all required documentation to the State WIC Office within the requested time frame(s):

i. On-site pre-review questionnaire (STAR-03) document within twenty (20) calendar days; ii. On-site follow-up report (STAR-05) document within twenty (20) calendar days of receipt of (STAR-04) final report; iii. Any other documents requested by the State WIC Office.

B. Self-Conducted State Technical Assistance Reviews - The local agency shall conduct a self-evaluation utilizing the same State Technical Assistance Review Tool in the years that the SWO evaluation is not conducted. The self-evaluation shall include a minimum of twenty percent of the sites in each local agency or one site, whichever is greater. The State WIC Office shall remind the local agency of their self-conducted management evaluation approximately thirty (30) days in advance of the due date.

(adm-04.2)Virginia WIC Policy and Procedures Manual ADM 04.2: Audits/Reviews#

(adm-04.2)(document-1)#

Division of Community Nutrition

Subject: Audits / Reviews Policy: ADM 04.2 Reference: N / A Effective: April 15, 2026 Supersedes: June 01, 2018

Page 1 of 1

I. Policy:

Local agencies must ensure effective communication with the State WIC Office (SWO) with regards to all audits and / or reviews, both announced and unannounced. Audits may be used to impose financial penalties.

II. Procedure(s):

A. Local agency personnel must notify their assigned Operations Liaison via email within two (2) business days of being notified of any announced audit and / or review. The local agency shall not require notification from their Operations Liaison when the State WIC Office notifies them of a scheduled on-site or self-conducted State Technical Assistance Review (STAR) audit. State or Federal agencies that may audit / review a local agency’s WIC Program operations include, but are not limited to:

1) State WIC Office: a. On-site STAR audits will be conducted every other year; and

b. Self-conducted STAR audits will be performed by said local agency which must be reviewed by the SWO in accordance with ADM-04.1.pdf

2) Virginia Department of Health - Division of Internal Audit,

3) Commonwealth of Virginia - Auditor of Public Accounts (APA),

4) United States Department of Agriculture (USDA) which may include:

a. The Office of the Inspector General; and

b. Management Evaluation Reviews (ME).

B. Local agency personnel must notify their assigned Operations Liaison via email within one (1) business day of any unannounced audit and / or review taking place. The local agency is not required to notify their Operations Liaison when the SWO conducts an unannounced local agency management evaluation.

C. Local agencies must email copies of any and all written correspondence (i.e., recommendations, findings, letters, summaries, reports, etc.) both received and sent to their assigned Operations Liaison within two (2) business days of receiving / sending said documentation.

(adm-05.0)Virginia WIC Policy and Procedures Manual ADM 05.0: Program Abuse and Sanctions#

(adm-05.0)(document-1)#

Division of Community Nutrition

Subject: Program Abuse and Sanctions Policy: ADM 05.0 Reference: CFR §246.7 Effective: January 20, 2020 Supersedes: August 12, 2013

Page 1 of 5

I. Policy

The State WIC Office determines Program abuses and sanctions that may be issued to applicants / participants. When more than one abuse is involved at a time, the sanction shall be based on the more serious abuse.

If an abuse occurs more than 12 months after the last abuse, the local agency shall process the abuse as a first offense. When more than three (3) abuses in a 12-month period occur, the local agency shall issue a three (3) month temporary disqualification.

The State WIC office shall disqualify the participant for one year for claims of $100 or more, dual participation, or a second or subsequent claim of any amount.

A disqualified participant shall be given the opportunity to appeal the disqualification.

II. Procedure

A. Program abuses and assigned sanctions are as follows:

ABUSE NUMBER OF OFFENSES SANCTION Class I Any deliberate misrepresentation of income, name, residence, family size, medical data, or date of birth to obtain WIC benefits All Three month disqualification Dual participation – redeeming food benefits from two programs/agencies in same month All One year disqualification Assessed claim for $100.00 or more

All One year disqualification Assessed second or subsequent claim for any amount. 2nd or subsequent One year disqualification Attempting to steal or actually stealing EBT Cards from the Local Agency or another participant, if under a $100.00 All Three month disqualification Selling, exchanging or giving away EBT cards, food, or formula All Three month disqualification Redeeming WIC food benefits reported as lost or stolen, if under a $100.00 All Three month disqualification Attempting to redeem or redeeming WIC food benefits for non-food items (i.e., diapers, wine, cigarettes) All Three month disqualification

Division of Community Nutrition

Subject: Program Abuse and Sanctions Policy: ADM 05.0 Reference: CFR §246.7 Effective: January 20, 2020 Supersedes: August 12, 2013

Page 2 of 5

Physically abusing the WIC or store staff [An incidence of physical abuse of WIC or store staff/property should be reported to the police] All Three month disqualification Accepting cash or credit from a store in connection with a WIC transaction 1st

2nd

3rd One month disqualification

Two month disqualification

Three month disqualification

ABUSE NUMBER OF OFFENSES SANCTION Class II Creating a public nuisance at the Local Agency or the store (i.e., verbally abusing, harassing, or threatening WIC or store staff, destroying store merchandise, or disrupting normal Local Agency or store activities). 1st

2nd

3rd Warning letter

Two month disqualification

Three month disqualification Attempting to redeem or redeeming WIC food benefits for unauthorized food, formula or food amounts

1st

2nd

3rd Warning letter

Two month disqualification

Three month disqualification Allowing unauthorized person(s) to use the WIC EBT Card to pick-up and/or redeem WIC food instruments

1st

2nd

3rd Warning letter

Two month disqualification

Three month disqualification Redeeming WIC food benefits before or after valid spend dates 1st

2nd

3rd Warning letter

One month disqualification

Two month disqualification Attempting to redeem or redeeming food benefits at unauthorized stores 1st

2nd

3rd Warning letter

One month disqualification

Two month disqualification

B. To report alleged Program abuse, complete the Complaint Against Participant or Local Agency Form, WIC-345B, and mail it with any supporting documentation to the State WIC Office designated Operations Liaison for review / investigation.

Division of Community Nutrition

Subject: Program Abuse and Sanctions Policy: ADM 05.0 Reference: CFR §246.7 Effective: January 20, 2020 Supersedes: August 12, 2013

Page 3 of 5

C. The State WIC Office designated Operations Liaison will investigate and notify the local agency if abuse was committed.

D. If abuse is confirmed by the State WIC Office designated Operations Liaison, the local agency shall discuss the abuse with the applicant / participant and issue a warning or disqualification letter, whichever applies.

1) The warning letter shall include:

a. Participant / applicant’s name b. Date and description of abuse c. Correct procedure to follow, and d. Local agency signature, title and date

2) The Disqualification Letter, WIC-393, shall be sent by certified mail or hand delivered, and scanned into the family record in Crossroads.

a. Procedures for a fair hearing shall accompany the WIC-393 b. A participant shall have fifteen (15) days’ notice before being disqualified from the Program 3) Within 30 days of issuance of either letter, the Local Agency shall notify the State WIC Office designated Operations Liaison, to ensure appropriate follow-up action has been taken.

E. Participants who appeal Program disqualification within fifteen (15) days of the notification date will continue to receive WIC benefits until the hearing decision is made or the certification period expires, whichever comes first.

1) If the decision is unfavorable, the participant will be disqualified from the Program for the specified time.

2) Follow Crossroads procedures for suspension of benefits.

F. Sanction Restrictions for Infants and Children

1) An infant or child participant cannot be disqualified if the parent / legal guardian commits abuse. See sanction restrictions for infants and children.

2) The sanction restriction for an infant or child participant does not apply when deliberate misrepresentation to obtain WIC benefits or dual participation is documented.

3) Sanction restrictions for infants and children do not apply to adult participants.

4) When the participant commits a Class I abuse, issue the sanction assigned to the abuse.

a. Assign a Caretaker to the infant / child participant.

Division of Community Nutrition

Subject: Program Abuse and Sanctions Policy: ADM 05.0 Reference: CFR §246.7 Effective: January 20, 2020 Supersedes: August 12, 2013

Page 4 of 5

b. Have the participant share their eWIC card with the Caretaker. c. Notify the State WIC Office designated Operations Liaison

5) When the participant commits a Class II abuse, issue a warning letter.

a. If the participant commits more than three (3) abuses in a 12-month period or the abuse results in disqualification from the program, a new participant shall be assigned to the infant or child participant. b. Issue the new participant an eWIC card, provide appropriate education, and document in the participant’s record. c. Notify the State WIC Office designated Operations Liaison.

G. Applicant Abuse

1) Program abuses and assigned sanctions may also be issued to abusive applicants.

2) Issue a Letter of Ineligibility, WIC-315, to abusive applicants.

3) Abusive applicants can be denied the right to reapply for a period up to 3 months.

H. Proxy Abuse

1) The applicant / participant is responsible for the actions of the proxy(s). In cases of abuse by a proxy, disqualify the proxy and issue a warning letter to the applicant / participant. A new proxy may be named, if requested.

I. Reinstatement of WIC benefits

1) A disqualified participant may receive or reapply for WIC benefits at the end of the disqualification period.

2) If the certification period has not expired, immediately contact the participant and schedule nutrition education.

3) If the certification period expired, recertify the client in Crossroads with new medical data.

J. Mandatory disqualification

1) Except as provided in paragraphs (2) and (3) of this section, whenever the State WIC office assesses claims of $100 or more, dual participation, or a second or subsequent claim of any amount, the State WIC Office shall disqualify the participant for one year.

2) Exceptions to mandatory disqualification. The State WIC Office may decide not to impose a mandatory disqualification if:

Division of Community Nutrition

Subject: Program Abuse and Sanctions Policy: ADM 05.0 Reference: CFR §246.7 Effective: January 20, 2020 Supersedes: August 12, 2013

Page 5 of 5

a. Within 30 days of receipt of the letter demanding repayment, full restitution is made b. A repayment schedule is agreed to in writing. or c. In the case of a participant who is an infant, child, or under age 18, the State WIC Office approves the designation of a proxy/caretaker.

3) Terminating a mandatory disqualification. The State WIC Office may permit a participant to reapply for the Program before the end of a mandatory disqualification period:

a. If full restitution is made or a repayment schedule is agreed upon; or b. In the case of a participant who is an infant, child, or under age 18, the State WIC Office approves the designation of a proxy/caretaker.

K. Warnings before sanctions

1) The State WIC Office may provide warnings before imposing participant sanctions, except under mandatory disqualification.

L. Fair hearings

1) At the time the State WIC Office notifies a participant of a disqualification, the State shall advise the participant of their opportunity to appeal and the procedures to follow to obtain a fair hearing pursuant to CFR 246.9.

M. Referral to law enforcement authorities

1) When appropriate, the State WIC Office shall refer vendors, home food delivery contractors, and participants who violate program requirements to Federal, State, or local authorities for prosecution under applicable statutes.

(adm-05.1)Virginia WIC Policy and Procedures Manual ADM 05.1: Dual Participation#

(adm-05.1)(document-1)#

Division of Community Nutrition

Subject: Dual Participation Policy: ADM 05.1 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2011

Page 1 of 2

I. Policy:

No participant shall receive benefits in two or more WIC programs or under two or more identities. Such dual participation is a form of program abuse and as such is subject to sanctions. Program benefits obtained or disbursed improperly will result in a claim against the participant for the full value of such benefits.

The State agency in conjunction with WIC local agencies is responsible for the following: the prevention and identification of dual participation within each local agency and between local agencies under the State agency’s jurisdiction, including actions to identify suspected instances of dual participation at least semiannually. The State or local agency must take follow-up action within 120 days of detecting instances of suspected dual participation.

In areas where a local agency serves the same population as an Indian State agency or a Commodity Supplemental Food Program (CSFP) agency, and in areas where geographical or other factors make it likely that participants travel regularly between contiguous local service areas located across State agency borders, the State will enter into an agreement with the other agency for the detection and prevention of dual participation.

II. Procedure:

A. Definitions

1) The terminating local agency is the agency in whose district the participant does not / no longer reside(s), or is participating under a false identity or address.

2) The sanctioning local agency is the agency in whose districts the participant currently resides and is participating under his / her true identity and address.

3) The terminating and sanctioning local agencies may in some cases be the same where the participant is receiving benefits from one local agency under two identities.

B. The State WIC Office shall conduct an annual audit of Program participation and notify the local agency concerned in cases of possible dual participation.

C. The local agency shall investigate the matter.

D. The local agency shall report its findings to the State WIC Office. If abuse is confirmed by the State WIC Office:

1) The terminating local agency shall issue a Letter of Ineligibility, WIC-315. 2) The sanctioning local agency shall discuss the abuse with the participant and impose sanctions immediately in accordance with ADM 05.0.

Division of Community Nutrition

Subject: Dual Participation Policy: ADM 05.1 Reference: N / A Effective: August 12, 2013 Supersedes: December 15, 2011

Page 2 of 2

E. The State WIC Office shall establish the claim against the participant in accordance with ADM 05.2.

(adm-05.2)Virginia WIC Policy and Procedures Manual ADM 05.2: Collection of Improp. Issued Benefits / Claims Against Participants#

(adm-05.2)(document-1)#

Division of Community Nutrition

Subject: Collection of Improperly Issued Benefits / Claims Against Participants Policy: ADM 05.2 Reference: CFR §246.7 & §246.23 Effective: August 12, 2013 Supersedes: January 25, 2010

Page 1 of 2

I. Policy:

The State WIC Office (SWO) may establish a claim against the participant for the full value of such benefits improperly obtained or disposed of and any fees or additional expenses incurred. These improper acts include but are not limited to inaccurate certification information, dual participation violations, proxy abuses, redemption of future food benefits after being disqualified or program abuses as defined by policy or regulatory statute.

II. Procedure

A. The participant who defrauds or abuses the program will be liable for prosecution under Federal, State or local laws when appropriate. The local agency shall report findings of possible fraud or abuse to the SWO Operations Liaison for consultation, review and resolution.

B. The designated SWO Operations Liaison shall report findings to the appropriate Federal USDA office, if required.

1) For all claims, the State agency shall issue a letter demanding repayment. The letter shall contain the following:

a. Clarify the reasons for the claim and the value of the improperly issued benefits, which shall be re-paid.

b. Inform the participant that s/he has 15 days from receipt of the letter to contact the State WIC Office.

c. Inform the participant that failure to pay the claim may result in disqualification for future program benefits.

d. Be mailed by certified mail with return receipt requested and also a copy mailed through first class mail to the address on file.

e. Also shall be mailed to any other address associated with the client in the file, any other address discovered through subsequent investigations, and addresses of all proxies, if available.

f. Advise the participant of the procedures to follow to obtain a fair hearing, in accordance with PRR 06.0. The timeframes noted in PRR 06.0 do not apply in these situations.

Division of Community Nutrition

Subject: Collection of Improperly Issued Benefits / Claims Against Participants Policy: ADM 05.2 Reference: CFR §246.7 & §246.23 Effective: August 12, 2013 Supersedes: January 25, 2010

Page 2 of 2

2) If full restitution is not made or a repayment schedule is not agreed on within 30 days of receipt of the letter, the SWO will take legal collection actions until restitution is made or a repayment schedule is agreed upon, unless the SWO determines that such collection actions would not be cost-effective.

3) The standard for determining that collection actions are no longer cost-effective will weigh the amount of the claim against the cost of reclaiming the program benefits. This cost of reclaiming will include time and effort of the State or local agency, as well as collection and legal cost.

4) The SWO will determine whether disqualification of the participant is required by the Mandatory Disqualification Section, in accordance with ADM 05.0. If the SWO assesses a claim(s) of $100 or more, dual participation, or assess a second or subsequent claim of any amount, the SWO shall disqualify the participant for one year

C. Types of restitution.

1) In lieu of financial restitution, the SWO may opt to allow participants, parents or caretakers of infant or child participants for whom financial restitution would cause undue hardship to provide restitution by performing in-kind services approved only by the SWO.

2) Restitution may not include offsetting the claim against future program benefits, even if agreed to by the participant or the parent or caretaker of an infant or child participant.

D. Disposition of claims.

1) The SWO will document the disposition of all participant claims.

E. Delegation of claims responsibility.

1) The SWO may delegate to its local agencies the responsibility for collecting participant claims under the supervision and monitoring by the Program.

(adm-06.0)Virginia WIC Policy and Procedures Manual ADM 06.0: Separation of Duties#

(adm-06.0)(document-1)#

Division of Community Nutrition

Subject: Separation of Duties Policy: ADM 06.0 Reference: N / A Effective: July 20, 2020 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Separate WIC personnel shall determine income eligibility and medical or nutritional risk to the same participant during the same visit. Either person may issue food benefits.

A. Separate WIC personnel shall be assigned to determine income eligibility and determine medical or nutritional risk to the same participant at certification or subsequent certification visits (i.e. the same person cannot complete the income screen and click the certify button on the certification summary screen).

1) WIC personnel designated as either a CPA or CPPA must complete the medical and/or nutritional risk eligibility. 2) All documents to be scanned into the participant’s record within Crossroads during the certification visit shall be scanned prior to completion of the visit to prevent documents scanned following the visit from being reported as separation of duties violations.

Any documents that need to be scanned other than income related material should be scanned by an individual other than the one that completed the income screen and should be scanned to another screen in Crossroads (i.e. Medical documentation, immunization screen, Dietary and health screen, etc.)

B. Review of the separation of duties violations shall be documented by the local agency on the WIC-400, Separation of Duties Log. This would be listing the violations from the Crossroads Separation of Duties Report, causes for the violations, documentation of the required reviews, and corrective actions taken to prevent future violations/discrepancies. If it is determined that an applicant was certified incorrectly, the applicant will be brought back in to review his/her eligibility and the prescribed food benefits. The Separation of Duties Log must be maintained in accordance with policy ADM 11.0 Record Retention.

C. The WIC Coordinator shall run the Crossroads Separation of Duties Report a minimum of once every two weeks and compare the report to the Separation of Duties Log (WIC-400) for ensure consistency and completeness between the two reports.(i.e. all exceptions identified on the report are properly documented on the exception log). If there are separation of duty violations on the report, the WIC Coordinator shall conduct a review of all certification records within two (2) weeks of the certification. Documentation of the reviews shall be maintained on file at the local agency .

D. In an effort to minimize the potential for Fraud and abuse, an individual other than the certifier (e.g. the WIC Local Agency Director, or Coordinator’s Supervisor) must conduct a post review of all non-breastfeeding infant certification records and at least 20 percent of a random sample of the remaining certification records within 2 weeks of the certification. It is recommended that the same staff person is not the only person that

Division of Community Nutrition

Subject: Separation of Duties Policy: ADM 06.0 Reference: N / A Effective: July 20, 2020 Supersedes: August 12, 2013

Page 2 of 2

performs this review. Documentation of this review (Refer to section C. above) must be maintained on file at the local agency for review during management evaluations.

(adm-06.1)Virginia WIC Policy and Procedures Manual ADM 06.1: Conflict of Interest#

(adm-06.1)(document-1)#

Division of Community Nutrition

Subject: Conflict of Interest Policy: ADM 06.1 Reference: N / A Effective: August 1, 2025 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Local agency personnel and state personnel involved in the WIC eligibility / certification / food benefits process shall not certify or issue food benefits to themselves or relatives. This policy also applies to personnel who perform minimum stocking visits at WIC authorized retailers/applicants. Relatives include: spouse, parent, child, brother, sister, aunt, uncle, nephew, niece, grandparent, or grandchild. Personnel shall not have a financial interest in an authorized WIC retail store. Personnel shall not be a caretaker or proxy for a participant.

II. Procedure:

A. Local agencies shall maintain a list of all WIC personnel who are participants.

B. Local agencies shall maintain a list of all WIC personnel who are related to participants.

C. Local agencies shall maintain a list of all WIC personnel or their relatives, who have been identified as an owner or employee of a WIC authorized retailer (this includes full time, part time and seasonal employment). Employees shall be surveyed in writing and the list updated at least every 12 months and for new employees when hired.

D. Personnel who participate in the WIC program or who have relatives as participants in the WIC program shall not issue or complete the following (or portions of the following) for themselves or relatives. If other personnel are not available at the site, the participant shall receive services at an alternate site. Refer to ADM 06.0. Eligibility screening (categorical, financial, residential, or proof of identity)

1) Letter of Ineligibility (WIC-315)

2) Participant Rights and Responsibilities Form (WIC-310)

3) Request for WIC Proxy (WIC-314A)

4) WIC Transfer Document(VOC)

5) Issuance of WIC food benefits (eWIC)

6) Food prescription assignments and changes

E. WIC personnel shall not direct or influence participants to use a particular retail store to redeem food benefits.

Division of Community Nutrition

Subject: Conflict of Interest Policy: ADM 06.1 Reference: N / A Effective: August 1, 2025 Supersedes: August 12, 2013

Page 2 of 2

F. WIC personnel who are Program participants and work at an authorized retail store or who have relatives who own a WIC authorized retail store shall not redeem WIC food benefits at these retailers.

G. WIC participants shall not redeem their food benefits at WIC authorized retail stores where their relatives are employed.

I. Personnel who participate in the WIC program or who have relatives as participants in the WIC program shall only review their own records or the records of their relatives in the presence of other personnel upon receipt of a written request.

J. The local agency shall make available to federal or state auditors the file of personnel who are participants or who have relatives in the WIC program.

K. An onsite stocking visit shall not be completed by WIC personnel who are employed by both the Local Agency and the WIC authorized retailer being reviewed. Additionally, WIC personnel shall not complete an onsite stocking visit at any WIC authorized retailer/applicant where a relative is employed.

L. WIC personnel shall not request or accept any type of benefit or special treatment from an authorized WIC retailer. Examples of benefits and/or special treatment would be free or reduced cost food, donations and free space in retailer’s store for special event WIC stand/booth.

(adm-09.0)Virginia WIC Policy and Procedures Manual ADM 09.0: National Voter Registration Act#

(adm-09.0)(document-1)#

Division of Community Nutrition

Subject: National Voter Registration Act Policy: ADM 09.0 Reference: N / A Effective: August 1, 2025 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Program applicants, participants, and anyone who inquires shall be provided with the opportunity to register to vote or to change their voter registration in elections for federal and / or state office at all initial and subsequent certifications, or if there is a name or address change.

II. Procedure(s):

A. The local agency is required to keep voter registration forms available on site. Voter registration forms are available at a variety of locations, which are available at https://www.elections.virginia.gov/registration/

B. WIC personnel shall verbally ask all applicants / participants / anyone who inquires if he / she is of legal voting age (18 years old) and currently registered to vote.

1) If the applicant / participant answers yes, then he / she shall be asked if he / she needs to change their registration. If they do, then personnel shall offer a form and assistance to the applicant / participant in completing the change in registration.

2) If the applicant / participant answers no, personnel shall ask if the applicant / participant would like to register to vote and offer to provide assistance if needed.

3) If assistance is requested, personnel shall assist in completing the registration form and forward completed forms to the State Board of Elections.

C. The appropriate entry shall be made in Crossroads.

D. The local agency is prohibited from the following:

1) Seeking to influence an applicant’s / participant’s political party preference

2) Displaying any political or candidate preference or party allegiance

3) Making any statements or taking any action whose purpose or effect is to discourage the applicant from registering to vote, or

4) Making any statement to an applicant or taking any action that leaves the applicant with the impression that a decision to register or not to register has any bearing on the availability of Program services or benefits.

Division of Community Nutrition

Subject: National Voter Registration Act Policy: ADM 09.0 Reference: N / A Effective: August 1, 2025 Supersedes: August 12, 2013

Page 2 of 2

(adm-10.0)Virginia WIC Policy and Procedures Manual ADM 10.0: Emergency Procedures#

(adm-10.0)(document-1)#

Division of Community Nutrition

Subject: Emergency Procedures Policy: ADM 10.0 Reference: N / A Effective: August 12, 2013 Supersedes: April 15, 2008

Page 1 of 2

I. Policy:

Local agencies shall follow emergency procedures in the event of an emergency situation. Incorporate procedures to continue WIC benefits into the district’s Emergency and Business Recovery Plan.

II. Procedure(s):

A. The local agency shall follow procedures outlined in the district’s Emergency and Business Recovery Plan when reporting an emergency situation to the District Director.

1) The District Director (or designee) contacts the State WIC Office on the local agency’s operational status by reporting the following information: a. The number of WIC staff and participants affected by the disaster; b. The extent of damage to service delivery; c. If Program records / equipment have been damaged or destroyed; d. The number of WIC vendors closed and if retail purchase is still possible; e. The estimated number of newly eligible applicants as a result of the disaster; f. The estimated length of service disruption; g. If electricity and / or water service has been disrupted; h. The safety of the water supply; and i. If assistance is needed.

2) The District Director and the State WIC Office shall jointly determine whether or not WIC services will continue, be interrupted, or be altered.

B. Protect all Program records, supplies and equipment from possible damage or destruction.

1) Secure and / or move computer / medical equipment, supplies and participant records.

C. Follow policy and procedure requirements related to financial eligibility, certification and nutrition education, prescribing the appropriate food package, and food benefit preparation and issuance.

D. Deliver full benefits to participants under emergency situations by following procedures to ensure provision of services:

1) Maintain a list of names, addresses, telephone numbers and contact persons for emergency centers in order to coordinate services

Division of Community Nutrition

Subject: Emergency Procedures Policy: ADM 10.0 Reference: N / A Effective: August 12, 2013 Supersedes: April 15, 2008

Page 2 of 2

2) Coordinate services with emergency centers by providing staff for certification and / or food benefit issuance

3) Establish alternative certification and / or food benefit issuance sites

4) Use mobile equipment to provide certification and / or food benefit issuance

5) Inform participants on how to access WIC benefits

6) Inform potential applicants of WIC Program benefits and availability

7) Provide information on food preparation and safety concerns

8) Issue WIC Transfer Cards to participants who relocate

9) Develop or update an alternative emergency food services list

10) Refer participants to alternative emergency food services

E. Follow evacuation procedures in the event the local agency evacuates the location.

1) Secure computer and / or medical equipment, supplies, formula samples, and Program records

2) Notify the State WIC Office that the clinic site is closing

F. Local agency personnel shall be trained and knowledgeable of all emergency procedures and any updates.

(adm-13.0)Virginia WIC Policy and Procedures Manual ADM 13.0: System Outage#

(adm-13.0)(document-1)#

Division of Community Nutrition

Subject: Crossroads System Outage Policy: ADM 13.0 Reference: N/A Effective: November 1, 2015 Supersedes: August 12, 2013

Page 1 of 1

I. Policy:

When access to Crossroads is not available, certification and nutrition education records shall continue to be maintained, either manually or electronically.

II. Procedure(s):

A. Local agencies shall contact the SWO Help Desk if Crossroads becomes disabled. The local agency shall report all issues to the Help Desk to ensure that all potential system defects are captured, documented, and reviewed for potential system fixes.

B. Local agency staff may log into another site within the district to provide benefits when necessary due to a Crossroads system issue or other clinic situation that affects issuing benefits at the participant’s clinic.

C. The local agency shall also contact their Operations Liaison each day that Crossroads is not accessible to provide updates on the status of the outage.

D. Procedures for benefit issuance when Crossroads service is restored are addressed in FDS 04.2 Food Benefits Issuance.

E. Local agencies shall have a system in place to capture appropriate participant information for later entry into Crossroads. Local agencies shall continue to process applicant certifications and perform nutrition education and assessments for participants using the following forms to record information for later entry into Crossroads.

1) Appropriate recorded information for computer outages shall be scheduled appointments, record of service, income, residency and identity verification. Several forms (Crossroads-01 and Crossroads-02) shall be used to identify the detailed information that needs to be obtained from the participant if Crossroads is disabled.

F. A current manual copy of the WIC Policy and Procedure manual shall be located at the agency.

G. If Crossroads continues to be disabled after 5 business days have passed, collaboration needs to be made with the SWO to coordinate providing food benefits to participants.

(bf-01.0)Virginia WIC Policy and Procedures Manual BF 01.0: Breastfeeding Promotion and Support#

(bf-01.0)(document-1)#

Division of Community Nutrition

Subject: Breastfeeding Promotion and Support Policy: BF 01.0 Reference: C.F.R. §246.3 Effective: January 6, 2025 Supersedes: March 22, 2022

Page 1 of 2

I. Policy:

Local Agencies must ensure that all WIC staff promote breastfeeding as the standard infant feeding method and that all clinics provide a breastfeeding-supportive environment for WIC participants and staff. No financial or material inducements (pens, calendars, exhibition boxes etc.) offered by formula and/or food manufacturers or distributors will be accepted by staff or distributed to participants.

II. Procedure(s):

A. All WIC staff must have: 1. Position-specific breastfeeding promotion and support responsibilities outlined in their Employee Work Profile (EWP). 2. Scope of practice appropriate breastfeeding promotion and support training incorporated into their onboarding and annual training. 3. Throughout the year, all staff will promote breastfeeding to WIC participants within their scope of practice.

B. Each Local Agency shall have, at minimum, the following breastfeeding staff - 1. Breastfeeding Coordinator 2. Designated Breastfeeding Expert (DBE) a. The Breastfeeding Coordinator may serve as the DBE b. The WIC Coordinator must assure appropriate time be allocated to complete the duties required by each staff role 3. Breastfeeding Peer Counselor

C. Breastfeeding promotion and support services must be available for participants at all clinic locations.

Division of Community Nutrition

Subject: Breastfeeding Promotion and Support Policy: BF 01.0 Reference: C.F.R. §246.3 Effective: January 6, 2025 Supersedes: March 22, 2022

Page 2 of 2

1. All clinics must provide a breastfeeding-supportive environment, that displays the following- a. Posters, educational materials, and/or images that portray breastfeeding as the ideal method of infant feeding. b. Signage that encourages breastfeeding and/or the expression of milk anywhere in the clinic, including the waiting room. c. Signage that a private space is available for those wishing to breastfeed and/or express milk in private.

2. All clinics must be free from images, advertisements, or displays that show formula or bottle feeding. a. Formula containers, images, advertisements, or branded materials, must not be on display. b. Images (posters, pictures, brochures, etc.) that feature bottle feeding must not be on display. c. This does not apply to materials provided in individual counseling sessions (i.e. providing a handout on paced bottle feeding)

3. Breastfeeding Peer Counselors must be provided with a private space to provide confidential individual education and counseling to WIC participants.

(bf-01.1)Virginia WIC Policy and Procedures Manual BF 01.1: Local Agency Breastfeeding Coordinator#

(bf-01.1)(document-1)#

Division of Community Nutrition

Subject: Local Agency Breastfeeding Coordinators Policy: BF 01.1 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 1 of 2

I. Policy:

Each local agency will appoint a Breastfeeding Coordinator to ensure breastfeeding activities are incorporated into all WIC program operations.

II. Procedure(s):

A. Each local agency has a local agency, Breastfeeding Coordinator, who is separate from the local agency WIC Coordinator.

1. In the event of staff vacancy, the WIC Coordinator may serve temporarily as the Breastfeeding Coordinator with prior written approval from the State WIC Office. Local agency plans/attempts to fill the role must be submitted to the SWO quarterly.

B. Knowledge, skills and abilities for each local agency Breastfeeding Coordinator include:

1. A minimum of 1 year experience in lactation counseling. 2. Supervisory or program management experience. 3. Has successfully completed specialized training in lactation management and care (International Board Certified Lactation Consultant (IBCLC) is preferred, or at minimum completion of a (45 hour LEAARC approved training in lactation management within 6 months of hire. 4. Is a Competent Professional Authority (CPA) or Competent Paraprofessional Authority (CPPA) with IBCLC certification. 5. Meets Designated Breastfeeding Expert (DBE) qualifications.

C. Each local agency Breastfeeding Coordinator will:

1. Complete SWO approved trainings per policy NEd 04.0. 2. Ensure that local agency staff are properly trained on breastfeeding education and support. 3. Coordinate breastfeeding peer counselor services in each local agency

a. Incorporate breastfeeding peer counselors into WIC program operations.

b. Act as the direct supervisor for all breastfeeding peer counselors.

c. Ensure that each breastfeeding peer counselor has completed the WIC Breastfeeding Curriculum 1 & 2 Training Program and

Division of Community Nutrition

Subject: Local Agency Breastfeeding Coordinators Policy: BF 01.1 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 2 of 2

coordinating activities within ninety (90) days of hire as part of orientation to the WIC breastfeeding peer counselor program.

d. Ensure that each breastfeeding peer counselor is working within the Scope of Practice for the WIC Peer Counselor found in the WIC P&P Manual Appendix 17

4. Ensure that breast pump issuance, inventory, and maintenance are logged and monitored.

5. Ensure that WIC Staff effort spent on breastfeeding duties and activities are appropriately coded in the TEA system as breastfeeding per VDH policy 6.05.

(bf-01.2)Virginia WIC Policy and Procedures Manual BF 01.2: Designated Breastfeeding Expert (DBE) Qualifications and Responsibilities#

(bf-01.2)(document-1)#

Division of Community Nutrition

Subject: Designated Breastfeeding Expert (DBE) Qualifications and Responsibilities Policy: BF 01.2 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 1 of 2

I. Policy:

All Designated Breastfeeding Experts are qualified to provide advanced lactation support and have expertise in human lactation.

II. Procedure(s):

A. Each local agency will have a minimum of one (1) Designated Breastfeeding Expert (DBE). The WIC DBE has advanced lactation knowledge and expertise in human lactation and assists WIC families with complex lactation problems that are outside the scope of practice of WIC Breastfeeding Peer Counselors and other WIC staff. 1) Each WIC agency is required to have access to a breastfeeding expert in a timely manner. 2) The DBE operates within the policies and procedures of the WIC program and within the context of WICs role for breastfeeding support. B. Specific qualifications required: 1) Successful completion of the Food and Nutrition Service (FNS) competency-based training for WIC breastfeeding curriculum levels 1-4 and successful completion of a state approved competency based breastfeeding training See BF 01.1 II B.2.; International Board Certified Lactation Consultant (IBCLC) preferred. 2) Minimum of one year of experience in counseling breastfeeding dyads. C. Each DBE possesses the following experiences and skills: 1) Experience working in poorly resourced communities. 2) Experience working with complex lactation challenges. 3) Critical thinking and problem solving. 4) Experience providing training/adult education. 5) Active listening, rapport building and communication. 6) Literacy, language, and computer communication appropriate to meet the needs of a diverse population. D. Duties of the WIC DBE include, but are not limited to: 1) Acts on all referrals from other WIC staff regarding complex breastfeeding situations beyond their scope of practice. 2) Assess and counsel parents with complex feeding situations. 3) Provides follow-up breastfeeding support to participants. 4) Communicates care plan to the WIC team as appropriate. 5) Refers parent to health care providers for further assessment and care. 6) May provide lactation training for WIC staff. 7) May promote human milk feeding in the community.

Division of Community Nutrition

Subject: Designated Breastfeeding Expert (DBE) Qualifications and Responsibilities Policy: BF 01.2 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 2 of 2 8) Maintains lactation credentials and certifications and acquires ongoing continuing education to stay current with lactation management research and practice. 9) Operates within the Scope of Practice for the WIC Designated Breastfeeding Expert as defined within the FNS competency based training platform.

(bf-01.3)Virginia WIC Policy and Procedures Manual BF 01.3: Breastfeeding Peer Counselors Qualifications and Responsibilities#

(bf-01.3)(document-1)#

Division of Community Nutrition

Subject: Breastfeeding Peer Counselor Qualifications and Responsibilities Policy: BF 01.3 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: February 1, 2023

Page 1 of 3

I. Policy: All Breastfeeding Peer Counselors are qualified to promote breastfeeding within their scope of practice see Appendix 17.

II. Procedure(s):

A. Each local agency will have a minimum of one (1) Breastfeeding Peer Counselor (BFPC). Specific qualifications required:

1) Has successfully breastfed an infant for at least 6 months.

2) Can work a flexible part-time schedule between five (5) and twenty (20) hours per week. The minimum work hours will be agreed upon based on local agency needs and will not to exceed the yearly 1500 allowable hours for wage employees.

3) Can make and receive phone calls from home.

4) Has reliable transportation.

5) Has interpersonal skills needed to work with and counsel participants.

6) Is a paraprofessional (as described in the WIC breastfeeding curriculum) ideally from the community that the local agency serves.

7) Has basic computer skills and technical proficiency.

B. Breastfeeding Peer Counselors will:

1) Be incorporated into program operations (WIC clinic flow, outreach, general staff meetings) to promote and support breastfeeding.

2) Have a task appropriate orientation to the Virginia WIC Program, including successful completion of the Food and Nutrition Service (FNS) competency- based training for WIC breastfeeding curriculum levels 1-2 and associated activities within ninety (90) days of hire.

3) Create a breastfeeding-friendly environment. Refer to BF 02.0.

4) Counsel with cultural humility (an understanding of how cultural attitudes and practices) of the individual, family and community impact breastfeeding.

Division of Community Nutrition

Subject: Breastfeeding Peer Counselor Qualifications and Responsibilities Policy: BF 01.3 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: February 1, 2023

Page 2 of 3

5) Refer participants to the WIC-Designated Breastfeeding Expert, WIC nutritionist or other appropriate health or social service agency, including outside community breastfeeding resources, for situations outside the BFPC’s scope of practice (Appendix 17). (See Standard 11: Participant Referrals)

6) Demonstrate knowledge of basic breastfeeding skills: a. Various positioning techniques. b. Manual expression of breast milk. c. Collection and storage of breast milk.

7) Treat pregnant and breastfeeding participants with respect and keep their personal health information confidential.

8) Offer breastfeeding participants continued education and support on maintaining a positive breastfeeding relationship with their infant until the infant is weaned.

9) Work with activepregnant and breastfeeding WIC participants and their supporters (partner, family, etc.) individually and in groups or classes. Contacts may be made in the clinic setting, in the hospital, or at the participant’s home as determined by the Breastfeeding Coordinator.

10) Teach breastfeeding classes and assist with the breastfeeding segment of prenatal or newborn classes.

11) Facilitate or refer participants to breastfeeding support groups within the local agency or the community.

12) Contact each new pregnant participant before delivery to discuss infant feeding options according to BF 01.4. Utilize Crossroads to assess and document breastfeeding progress.

13) Contact each breastfeeding participant to discuss breastfeeding progress and/or issues according to BF 01.4. Utilize Crossroads to assess and document breastfeeding progress.

14) Make appropriate referrals according to CRT 08.0.

15) Abide by the limitations of the Peer Counselor scope of practice as follows:

a. Will not provide specific medical advice.

Division of Community Nutrition

Subject: Breastfeeding Peer Counselor Qualifications and Responsibilities Policy: BF 01.3 Reference: §C.F.R. 246.3 Effective: January 6, 2025 Supersedes: February 1, 2023

Page 3 of 3

b. Will not make hospital visits without prior approval by the WIC Breastfeeding Coordinator. c. Will not function in duties outside of the Breastfeeding Peer Counselor’s Scope of Practice. d. Will not perform non-BFPC duties without prior written approval from State WIC Office, part time BFPCs may work in other Health Department roles (Dual Role BFPCs). 1. Dual Role BFPCs are prohibited from working in any other WIC roles as part of the eligibility determination or certification process. Refer to USDA FNS Breastfeeding Policy and Guidance, p. 23. 2. Dual Role BFPCs may serve as Outreach Workers or other equivalent health district roles. 3. BFPC performing non-breastfeeding duties must be compensated for that time with NSA or other appropriate program funds.

16) Screen and assist with electric breast pump loan agreements according to BF 04.2, and BF 04.3. Utilize Crossroads to assess and document breastfeeding progress. May assist with maintenance of WIC breastfeeding pumps.

17) Attend local, regional, or state breastfeeding promotion and support training when possible. May participate in local breastfeeding coalitions.

18) Complete all State WIC Office required continuing education.

19) May provide outreach at community events and to community partners to educate about WIC breastfeeding services and human milk feeding.

(bf-02.0)Virginia WIC Policy and Procedures Manual BF 02.0: Breastfeeding Education#

(bf-02.0)(document-1)#

Division of Community Nutrition

Subject: Breastfeeding Education Policy: BF 02.0 Reference: §C.F.R. 246.11 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 1 of 1

I. Policy:

Local agencies must provide breastfeeding education to pregnant and breastfeeding participants.

II. Procedure(s):

A. Breastfeeding education must be participant-centered and in alignment with the goals and objectives of the Virginia WIC Annual State and Local Agency Nutrition Education and Breastfeeding Plans.

B. Nutrition staff must inform all pregnant participants of the following WIC benefits for breastfeeding participants:

1) Longer participation in the program- breastfeeding participants are certified for one year and non-breastfeeding participants are only certified for 6 months. 2) A greater quantity and variety of foods, with fully breastfeeding participants (those who do not receive any formula from WIC) receive receiving the greatest quantity and variety of foods. 3) Individualized anticipatory guidance and education to support each participant in achieving their personal breastfeeding goals. 4) Access to staff with specialized breastfeeding training. 5) Breastfeeding supplies and aids, such as breast pumps.

C. Nutrition staff or Breastfeeding Peer Counselors will educate each pregnant WIC participant on breastmilk hand expression utilizing:

1) WIC Breastfeeding Curriculum Level 2. 2) A breast model.

D. WIC staff will offer:

1) Each pregnant participant with a BAPT (Breastfeeding Attrition Prediction Tool) survey at certification. 2) BAPT survey results review and scoring. 3) Targeted counseling based on the BAPT screening. 4) Educational material highlighting sections that address the participant’s social support, breastfeeding knowledge, and confidence level. 5) Participants with a prenatal breastfeeding class within 3 months of certification. 6) Participants with a baby behavior class in the 3rd trimester.

(bf-04.2)Virginia WIC Policy and Procedures Manual BF 04.2: Personal Use Electric Breast Pump#

(bf-04.2)(document-1)#

Division of Community Nutrition

Subject: Personal Use Electric Breast Pumps Policy: BF 04.2 Reference: C.F.R. §246.2 Effective: January 6, 2025 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Personal use electric breast pumps and attachment kits will be given to WIC breastfeeding participants with an adequate or stable milk volume to maintain production and collect breast milk. Personal use electric breast pumps will not be issued to proxies. Personal use electric breast pumps may be issued to breastfeeding WIC employees who are certified WIC participants.

II. Procedure:

A. Give personal use electric breast pumps and attachment kits based on the following priority:

1) Priority 1: Participant/infant separation (work, school)

2) Priority 2: Occasional separation

3) Priority 3: Special needs – at the discretion of the district breastfeeding coordinator / designee

B. The breastfeeding coordinator / designee shall:

1) Ensure the participant:

a. Is enrolled in the WIC program as fully breastfeeding or mostly breastfeeding (infant is receiving less than 50% infant formula package) prior to issuing a personal use electric breast pump.

b. Has successfully breastfed for at least four (4) weeks prior to the issuance of a personal use electric breast pump.

c. Agrees to attempt to breastfeed for six (6) months or more.

d. Agrees to use the personal use electric breast pump for future children within the next three (3) years. Replacement pumps may be issued for reasons of manufacturer defects or recall at the discretion of the breastfeeding coordinator/designee.

e. Communicate directly with the manufacturer to attain warranty replacement.

2) Educate the participant on pumping frequency to maintain milk production.

3) Assure the participant is able to assemble, disassemble, clean and appropriately maintain the pump.

Division of Community Nutrition

Subject: Personal Use Electric Breast Pumps Policy: BF 04.2 Reference: C.F.R. §246.2 Effective: January 6, 2025 Supersedes: August 12, 2013

Page 2 of 2

4) Assure the flange size is appropriate for the participant per the manufacturer’s guidance.

5) Provide USDA guidance information on the handling and storage of breast milk.

6) Instruct the participant to discontinue the use of the pump and contact the breastfeeding coordinator / designee if discomfort occurs.

7) Report the loss or damage of personal use electric breast pumps to the State WIC Office and document in Crossroads notes.

8) Document follow-up in the appropriate (per staff role) section of Crossroads within one week of issuance to participants who receive a personal use electric breast pump.

C. The breastfeeding coordinator / designee shall not issue a personal use electric breast pump to a participant if she has been issued a multi-user electric breast pump and has not returned it.

D. Accountability and security of personal use electric breast pumps:

1) The breastfeeding coordinator / designee is responsible for the care, security, storage, and inventory of the personal use electric breast pumps.

a. All personal use electric breast pumps and attachment kits shall be stored in a secure area.

b. All personal use electric attachment kits shall be stored in original, unopened packaging.

2) The participant shall sign the Pump Loan Agreement.

3) The breastfeeding coordinator / designee shall be responsible for the inventory of personal use electric breast pumps.

(bf-04.3)Virginia WIC Policy and Procedures Manual BF 04.3: Multi-User Electric Breast Pump#

(bf-04.3)(document-1)#

Division of Community Nutrition

Subject: Multi-User Electric Breast Pumps Policy: BF 04.3 Reference: C.F.R. §246.2 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 1 of 3

I. Policy:

Multi-user breast pumps are loaned and double attachment kits issued to WIC participants to establish, maintain, or collect breast milk when the milk production is at risk.

Multi-user breast pumps may not be loaned to breastfeeding WIC employees unless they are WIC participants.

II. Procedure(s):

A. Loan multi-user electric breast pumps and attachment kits based on the following priority:

1) Priority 1: Hospitalized participant or infant or the participant is temporarily on medication that contraindicates breastfeeding.

2) Priority 2: Relactation (bottle-feeding but decides to breastfeed)

3) Priority 3: Special Circumstances – at the discretion of the district Breastfeeding Coordinator / Designated Breastfeeding Expert (DBE). Ensure documentation of the special circumstance is clearly detailed in the Crossroads Family Care Plan.

B. The Breastfeeding Coordinator / designee shall:

1) Ensure the participant is a pregnant or breastfeeding active WIC Participant before issuing a multi-user breast pump.

a. If enrolled as a pregnant participant, certify the mother as breastfeeding within 10 days of issuing the pump.

b. A participant who is determined ineligible for WIC benefits will be given the Letter of Ineligibility, WIC-315, and be required to return the breast pump.

2) Assure participants are educated on pumping frequency to maintain and establish milk production.

3) Assure participants are educated about hand expression utilizing a breast model.

4) Assure the participant is able to assemble and disassemble the pump.

5) Provide USDA milk storage guidelines on the handling and storage of breast milk.

Division of Community Nutrition

Subject: Multi-User Electric Breast Pumps Policy: BF 04.3 Reference: C.F.R. §246.2 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 2 of 3

6) Assure participants are educated to discontinue the use of the pump if discomfort occurs. 7) Report the loss or damage of electric breast pumps to the State WIC Office.

8) Assure that participants are instructed to wipe down pump with a water dampened cloth before return. 9) Assure that the exterior surface of the electric breast pump and carrying case are cleaned with EPA recommended disinfectant prior to re-issuance.

a. Spray disinfectant onto a clean cloth and wipe the breast pump and inside and outside of the carrying case, making sure not to spray or pour liquid directly onto the pump.

b. Follow the manufacturer’s instructions regarding saturation time. C. Follow-up is conducted and documented within one week to participants who receive a multi-user electric breast pump in the appropriate (per staff role) section of Crossroads.

D. Accountability and security of multi-user electric breast pumps

1) The breastfeeding coordinator / designee shall be responsible for the care, security, and return of multi-user electric breast pumps.

a. In the event that a participant possesses an overdue electric breast pump, the local agency shall attempt to contact the participant via telephone and with a certified overdue breast pump letter, see WIC P & P Manuel Appendix 18. b. Document the contact in the family care plan, scan and attach the letter.

c. If the local agency has made reasonable attempts to contact and the participant still fails to return the electric breast pump, the local has the option to issue only one month of food benefits at a time to the participant until the electric breast pump has been returned.

2) All multi-user electric breast pumps and attachment kits are stored in a secure area.

3) All multi-user electric attachment kits are stored in original, unopened packaging.

a. The participant must sign the Pump Loan Agreement.

Division of Community Nutrition

Subject: Multi-User Electric Breast Pumps Policy: BF 04.3 Reference: C.F.R. §246.2 Effective: January 6, 2025 Supersedes: March 14, 2022

Page 3 of 3

b. The breastfeeding coordinator / designee is responsible for the tracking and inventory of multi-user electric breast pumps.

E. The breastfeeding coordinator / designee may recall a multi-user electric breast pump for a participant with a higher priority.

(bf-05.0)Virginia WIC Policy and Procedures Manual BF 05.0: Breastfeeding Contraindications#

(bf-05.0)(document-1)#

Division of Community Nutrition

Subject: Breastfeeding Contraindications Policy: BF 05.0 Reference: N / A Effective: February 12, 2025 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Breastfeeding is not recommended when the mother is experiencing untreated substance use disorder (SUD), is undergoing therapeutic doses of chemotherapy treatment, has been diagnosed with Human T-Cell Leukemia Virus Type 1 (HTLV-1) has untreated Active Tuberculosis (TB), or when the infant has been diagnosed with classic galatosemia (galactose 1-phosphate uridyltransferase deficiency). Participants who are HIV positive, should be educated about the CDC recommendations and encouraged to breastfeed, provided with the National Perinatal HIV/AIDS Hotline (1-888-448-8765), and referred to their healthcare provider. https://www.cdc.gov/breastfeeding/breastfeeding-special- circumstances/maternal-or-infant-illnesses/hiv.html,

II. Procedure(s):

A. Inform all participants of the following: 1) substance use disorder (SUD)

a. Advise participants who have untreated SUD or are chemically dependent or using unprescribed drugs such as amphetamines, cocaine, heroin, marijuana, opioids and phencyclidine not to breastfeed.

b. Advise all participants that not drinking alcohol is the safest option for breastfeeding mothers. However, moderate alcohol consumption, meaning up to 1 drink in a day, is not known to be harmful to the infant. Participants should be educated about the CDC recommendations, encouraged to breastfeed and be provided with the CDC website for more information: Alcohol | Breastfeeding special circumstances | CDC.

c. Advise all participants who are undergoing active chemotherapy or have HTLV-1 not to breastfeed.

2) Advise participants who are suspected to have TB, or confirmed to have untreated active TB, breastfeeding may be resumed once the participant is known to be or rendered no longer contagious. Provide an electric pump loan and instruct the participant to pump and dispose of the milk if she desires to breastfeed after the diagnosis is confirmed. Educate about maintaining milk production while undergoing treatment.

Division of Community Nutrition

Subject: Breastfeeding Contraindications Policy: BF 05.0 Reference: N / A Effective: February 12, 2025 Supersedes: August 12, 2013

Page 2 of 2

3) Infants who have been diagnosed with classic galatosemia (galactose 1- phosphate uridyltransferase deficiency) should not be breastfed.

B. Communicate the risks involved to the participant if she is breastfeeding with any of the above conditions.

(crt-01.0)Virginia WIC Policy and Procedures Manual CRT 01.0: Eligibility Overview#

(crt-01.0)(document-1)#

Division of Community Nutrition

Subject: Eligibility Overview Policy: CRT 01.0 Reference: CFR §246.8 Effective: August 12, 2013 Supersedes: August 1, 2007

Page 1 of 2

I. Policy:

At each certification visit, the eligibility status of an applicant shall be determined.

II. Procedure(s):

A. An applicant shall meet all of the following requirements to be eligible for WIC Program benefits:

1) Categorical (CRT 02.0)

2) Residential (CRT 03.0, CRT 04.0)

3) Financial (CRT 05.0)

4) Nutritional Risk (CRT 06.0)

B. All applicants / participants to be certified on the WIC Program shall be physically present during the certification process.

1) In accordance with the Federal Americans with Disabilities Act (ADA), the following exceptions apply:

a. The State or local agency shall 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 disability or applicants whose parents or legal guardians are individuals with disabilities that meet the following federal standard.

1. Documented medical condition that necessitates the use of medical equipment that is not easily transportable

2. Documented medical condition that requires confinement to bed rest, or

3. Documented serious illness that may be exacerbated by coming in to the WIC clinic

b. The documentation from a medical professional shall be scanned into the participant’s file

2) Any infant or child who is hospitalized and receiving ongoing health care shall be exempt from being physically present during the certification process

Division of Community Nutrition

Subject: Eligibility Overview Policy: CRT 01.0 Reference: CFR §246.8 Effective: August 12, 2013 Supersedes: August 1, 2007

Page 2 of 2

a. The documentation of ongoing health care from a medical professional shall be scanned in the participant’s record in Crossroads

b. Food benefits shall be issued upon hospital release in accordance with FDS 04.2

3) For homeless applicants or participants residing in homeless facilities, refer to CRT 04.1.

4) For incarcerated applicants / participants refer to PRR 02.1.

(crt-01.1.1)Virginia WIC Policy and Procedures Manual CRT 01.1.1: Immunization Screening & Referral#

(crt-01.1.1)(document-1)#

Division of Community Nutrition

Subject: Immunization Screening & Referral Policy: CRT 01.1.1 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2008

Page 1 of 2

I. Policy:

Local agencies shall ensure that WIC infants and children up to the age of two are screened and referred for immunizations using a documented immunization history.

II. Procedure(s):

A. When a certification visit is scheduled for a child under the age of two, an applicant is: 1) Advised that documented immunization records are needed as part of the WIC certification and health screening process.

2) Advised to bring the infant / child’s documented immunization records to the certification visit.

3) Informed that documented records include but are not limited to the parent’s hand-held immunization record, an immunization registry, an automated data system, or a client chart.

B. If an applicant is seeking to enroll an infant / child or infants / children under two years of age:

1) S/he is asked to provide a documented record of the infant / child’s immunizations to date.

2) All participant rights and responsibilities are explained.

3) The infant / child’s immunization is screened by counting the number of doses of DTaP (diphtheria and tetanus toxoids and a cellular pertussis) vaccines he/she has received in relation to his/her age, according to the following table: a. By 3 months of age, the infant/child should have at least 1 dose of DTaP. b. By 5 months of age, the infant/child should have at least 2 doses of DTaP. c. By 7 months of age, the infant/child should have at least 3 doses of DTaP. d. By 19 months of age, the infant/child should have at least 4 doses of DTaP.

4) If the documented immunization record is not provided by the parent / legal guardian or caretaker, information regarding the recommended

Division of Community Nutrition

Subject: Immunization Screening & Referral Policy: CRT 01.1.1 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2008

Page 2 of 2

immunization schedule appropriate to the infant / child’s current age is provided to the parent / legal guardian or caretaker. The parent / legal guardian or caretaker is encouraged to provide the documented immunization record on his/her next visit.

5) When appropriate, the parent / legal guardian / or caretaker is referred to infant / child’s usual source of medical care.

6) This policy reflects the maximum to be funded by WIC. Local agencies may cover a greater level of screening if performed by non-WIC personnel or if greater level of screening is funded by another source.

7) Immunization services funded by WIC only include screening of DTaP in accordance with ADM 03.5 and ADM 03.6.

(crt-03.0)Virginia WIC Policy and Procedures Manual CRT 03.0: Proof of Identification#

(crt-03.0)(document-1)#

Division of Community Nutrition

Subject: Proof of Identification Policy: CRT 03.0 Reference: CFR §246.7 Effective: February 15, 2017 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Applicants shall present proof of identification to obtain all WIC services and benefits. This includes, but is not limited to, certification and subsequent certification visits, food benefit issuance, special formula issuance, nutrition education, and Verification of Certification (VOC) transfers.

II. Procedure(s):

A. Request one of the following for proof of identification:

1) Valid Medicaid card / letter 2) Social Security card 3) Driver's license 4) Birth certificate 5) Marriage license 6) Crib card (for newborns) 7) Hospital card (for newborns) 8) Military identification card or discharge papers (DD214) 9) Clinic / hospital record or ID 10) TANF / Welfare Photo ID 11) Refugee settlement papers 12) Immigration or Naturalization Record (e.g., green card) 13) Passport / Visa 14) School records ( ID or report card, enrollment or health record )

B. The eWIC card shall be presented at all authorized retailers when food benefits are redeemed.

C. Document proof of identification by entering the type of ID presented in Crossroads (e.g., ID - Social Security Card) at the initial certification.

D. Applicants with no proof of identity such as, a victim of theft, loss, or disaster, a homeless individual, a migrant, an undocumented worker, or emancipated minor, shall complete the Affidavit Form, WIC-383.

1) Document why the applicant could not provide proof of identity on the Affidavit Form, WIC-383. Scan into the participant’s record.

2) Any other applicant without proof of identity will have to be rescheduled to return and bring the required proof before benefits will be given.

Division of Community Nutrition

Subject: Proof of Identification Policy: CRT 03.0 Reference: CFR §246.7 Effective: February 15, 2017 Supersedes: August 12, 2013

Page 2 of 2

E. Name changes in the system can only be made if the client brings in new, written proof to show the change in name. Such proof may be one of the above, as well as a certified marriage license or other such legal documentation.

(crt-04.0)Virginia WIC Policy and Procedures Manual CRT 04.0: Residential Eligibility#

(crt-04.0)(document-1)#

Division of Community Nutrition

Subject: Residential Eligibility Policy: CRT 04.0 Reference: CFR §246.7 Effective: August 12, 2013 Supersedes: July 15, 2012

Page 1 of 2

I. Policy:

An applicant shall live in the State of Virginia. A local WIC Program may choose to serve participants who live outside of their local agency area in cases of hardship. Applicants, including those with Out-of-State WIC transfer cards, shall present proof of residency unless they are a member of a homeless or migrant family, or an undocumented worker or emancipated minor who are exempt from providing proof of residency.

II. Procedure(s):

A. Applicants shall present proof of residency at initial certification and subsequent certification visits.

1) Determine the location or address where an applicant or participant routinely lives or spends the night. Residency does not have to be a legal residence and the length of residency cannot be a prerequisite to receiving WIC benefits.

2) Proof of residency shall be current and include the applicant’s name. Proof of residency includes:

a. Utility bills b. Other business mail with a Virginia address c. Deed, mortgage, monthly mortgage statement or residential rental / lease agreement d. Valid Virginia driver’s license e. Valid Virginia Medicaid Card or positive, official Medicaid Verification, or f. TANF / Welfare Photo ID

B. Proof of residency for military personnel shall be current and include the applicant’s name. Proof of residency includes:

1) A letter from the Company Commander on official letterhead

2) Copy of official DoD orders with Virginia installation assignment, or

3) Leave & Earning Statement (LES) listing Virginia as the service member’s Home of Record

C. Applicants with no proof of residency

1) Applicants who are members of a homeless or migrant family, an undocumented worker or emancipated minor shall sign the Affidavit Form,

Division of Community Nutrition

Subject: Residential Eligibility Policy: CRT 04.0 Reference: CFR §246.7 Effective: August 12, 2013 Supersedes: July 15, 2012

Page 2 of 2

WIC-383. The local agency shall document why the applicant / participant could not provide proof of residency on the Affidavit Form and scan in the participant’s record.

2) All other applicants without proof of residency shall be rescheduled to return with the required documentation before WIC benefits may be provided.

D. Document proof of residency in Crossroads

E. If an applicant / participant is not a resident of Virginia and does not qualify to complete the Affidavit form, the Letter of Ineligibility, WIC-315 shall be issued. The form shall be scanned in the applicant / participant’s record, and the applicant / participant shall be terminated in Crossroads.

(crt-05.1)Virginia WIC Policy and Procedures Manual CRT 05.1: Adjunctive Financial Eligibility#

(crt-05.1)(document-1)#

Division of Community Nutrition

Subject: Adjunctive Financial Eligibility Policy: CRT 05.1 Reference: CFR § 246.7 Effective: March 15, 2019 Supersedes: April 1, 2018

Page 1 of 3

I. Policy:

A. An applicant has adjunctive financial eligibility for WIC services if any of the following conditions apply:

1) It can be documented that he / she is fully eligible to receive Temporary Assistance for Needy Families (TANF), Medicaid, FAMIS Plus (Medicaid for children), or the Supplemental Nutrition Assistance Program (SNAP) / Food Stamps

2) It can be documented that he / she is enrolled in the Family Access to Medical Insurance Security Plan (FAMIS) and has a $2.00 co-pay level

3) It can be documented that he / she is a member of a family containing a TANF recipient

4) It can be documented that he / she is a member of a family containing a pregnant woman or infant who is enrolled in the Medicaid program; or

5) It can be documented that he / she is has a family member receiving free or reduced lunches through the National School Lunch Program

II. Procedure(s):

A. All applicants with adjunctive financial eligibility shall have their self-declared income recorded in Crossroads. If it comes to the attention of the local agency that a participant is no longer adjunctively eligible through a program, such as Medicaid, the local agency shall determine if the participant is eligible through a different program for adjunctive eligibility.

1) If the participant is adjunctively eligible through another program, local agency staff shall enter the program change in Crossroads.

2) If the participant is not adjunctively eligible through a different program, local agency staff shall determine if the participant is financially eligible by income as addressed in CRT 05.2.

B. The economic unit for an applicant with adjunctive eligibility shall be determined and recorded in Crossroads. See CRT 05.2.

C. The identification number assigned to the applicant by the qualifying adjunctive program shall be recorded in Crossroads.

D. Local agency staff may use online or telephone access to SNAP, Medicaid, or TANF, or the following documentation may be presented by the applicant to check an applicant's adjunctive income eligibility:

Division of Community Nutrition

Subject: Adjunctive Financial Eligibility Policy: CRT 05.1 Reference: CFR § 246.7 Effective: March 15, 2019 Supersedes: April 1, 2018

Page 2 of 3

1) SNAP / Food Stamps: “Notice of Eligibility” form.

2) TANF: Printout with case number or documentation from social services.

3) Medicaid / FAMIS Plus (Medicaid for Children): The applicant or the family member with Medicaid / FAMIS Plus shall present a Medicaid / FAMIS Plus card, Medicaid / FAMIS Plus HMO card, or letter from Medicaid stating that the applicant has been determined Medicaid / FAMIS Plus eligible (not pending) and that the Medicaid / FAMIS Plus eligibility period includes the WIC application date, unless Medicaid enrollment is able to be verified from information previously entered into Crossroads.

Medicaid / FAMIS Plus eligibility shall be verified unless a Medicaid / FAMIS Plus eligibility letter is provided. Local Agency personnel shall either utilize the “Verify Medicaid” feature on the Income Screen or the Medicaid portal to verify Medicaid / FAMIS Plus eligibility status. If the Medicaid portal is used, the verification shall be printed out and scanned into Crossroads.

In the event that Medicaid / FAMIS Plus eligibility information obtained from the Crossroads Medicaid verification function conflicts with statements from the applicant, WIC personnel shall contact the Medicaid Automated Help- Line or the HMO to obtain verification of current Medicaid / FAMIS Plus participation.

4) National School Lunch Program: Applicants who have family members receiving free or reduced lunches shall provide a letter from the school system to document participation in the National School Lunch Program.

5) FAMIS / FAMIS MOMS: Enrollment in FAMIS (if a co-pay is applicable) shall be verified through Crossroads or other means provided by FAMIS.

a. Applicants enrolled in the FAMIS MOMS program shall have the required income eligibility screening procedures performed to determine financial eligibility for WIC participation, unless a different adjunctive program can be used to meet financial eligibility requirements.

b. If a FAMIS applicant states s/he is responsible for $2.00 FAMIS co- pay amount, the co-pay amount shall be verified.

c. If the applicant does not have a FAMIS co-pay the required income eligibility screening procedures shall be performed to determine financial eligibility for WIC participation, unless a different

Division of Community Nutrition

Subject: Adjunctive Financial Eligibility Policy: CRT 05.1 Reference: CFR § 246.7 Effective: March 15, 2019 Supersedes: April 1, 2018

Page 3 of 3

adjunctive program can be used to meet financial eligibility requirements.

d. If the applicant is responsible for the $5.00 FAMIS co-pay amount, or if no co-pay amount is shown, the required income eligibility screening procedures shall be performed to determine financial eligibility for WIC participation, unless a different adjunctive program can be used to meet financial eligibility requirements.

(crt-05.2)Virginia WIC Policy and Procedures Manual CRT 05.2: Income Eligibility#

(crt-05.2)(document-1)#

Division of Community Nutrition

Subject: Income Eligibility Policy: CRT 05.2 Reference: C.F.R. § 246.7 Effective: August 1, 2025 Supersedes: August 12, 2013

Page 1 of 3

I. Policy:

It is the policy of the Division of Community Nutrition that applicants who are not adjunctively financially eligible shall have financial eligibility determined using the Federal Income Guidelines. WIC personnel shall determine financial eligibility and document the decision in the applicant’s record.

II. Procedure(s):

A. The financial eligibility status of a participant does not need to be re-evaluated during the certification period, unless a documented change from previous income eligibility information comes to the attention of the local agency.

B. If this occurs and the local agency determines that a participant is over income during the certification period, the entire family shall be disqualified from the program and issued a Letter of Ineligibility, WIC-315. This does not apply to individuals who were financially eligible based on adjunctive eligibility. All unspent food benefits issued to the participant and family members for future months shall be voided in Crossroads.

C. For persons claiming to have zero income, refer to CRT 05.2.2 on addressing gross income.

D. For determining income eligibility, local agency personnel shall use the applicant’s current or annualized income, whichever is the best indicator of current circumstances.

E. The size of the economic unit shall be determined. An economic unit shall have its own source of income and the income shall be adequate to sustain the economic unit. For purposes of the WIC Program, the terms “household,” "economic unit," and "family" can be used interchangeably.

1) An infant / child is counted in the economic unit of the parent / legal guardian with whom they reside.

2) Count all persons (related or unrelated) who share income as the economic unit. More than one economic unit may reside under the same roof. Two or more economic units that reside under the same roof shall be counted as separate units. For persons living in a residence with others (other than institutional and homeless settings), staff shall establish whether or not more than one economic unit lives under one roof through appropriate questioning to make a reasonable determination as to whether or not there is general economic independence of the units, i.e., that financial resources and support are retained independently.

The following questions need to be addressed to determine if an applicant is an economic unit of one, or is part of a larger economic unit:

Division of Community Nutrition

Subject: Income Eligibility Policy: CRT 05.2 Reference: C.F.R. § 246.7 Effective: August 1, 2025 Supersedes: August 12, 2013

Page 2 of 3

a. Is the applicant responsible for all, or a portion of, his / her own expenses and bills?

b. What type of income does s/he receive?

c. Who provides the food and clothing?

d. Is s/he primarily independent and receives some goods or services or do the goods and services received result from sharing of income with other individuals? 3) Include the number of fetus(es) in determining the economic unit for a pregnant woman.

a. Verification of a pregnancy with one fetus is not required in accordance with CRT 02.0.

b. An applicant claiming multiple fetuses shall have the stated number used at the time of certification but is required to provide written verification by a physician or nurse practitioner working under the supervision of a physician within sixty (60) days of certification in accordance with CRT 02.0. Failure to provide verification within the required period of time shall require that personnel recalculate the economic unit using one fetus and determine financial eligibility for continuation or termination of WIC benefits.

c. Proof of multiple fetuses shall be documented in Crossroads when provided.

4) If an infant / child resides in a school or institution, and the majority of financial support is provided by the parent / legal guardian the infant / child shall be counted in the economic unit of the parent / legal guardian.

5) If legal / physical custody is shared by parents living in separate households, only the economic unit and financial eligibility information for the parent with primary legal/physical custody shall be used to determine eligibility. The State WIC Office may be contacted if primary legal / physical custody is not able to be determined.

6) If an infant / child is in the temporary care of friends or relatives but the payee(s) are providing the majority of support, infant / child shall be counted in the economic unit of the parent / legal guardian.

F. Consideration of the child / infant as an economic unit of one.

1) If an infant / child resides in a foster home as the result of legal placement by a government social services agency, the infant / child shall be counted as an economic unit of one.

Division of Community Nutrition

Subject: Income Eligibility Policy: CRT 05.2 Reference: C.F.R. § 246.7 Effective: August 1, 2025 Supersedes: August 12, 2013

Page 3 of 3

2) If an infant / child has his / her own source of income which is adequate to provide the majority of support, the infant / child shall be counted as an economic unit of one.

3) A court declared emancipated minor is responsible for his / her own debts and shall be considered an economic unit of one. A minor is an individual less than eighteen (18) years of age. The minor shall present his / her Court Declaration of Emancipation, which shall be scanned into Crossroads.

4) A minor who states s/he is emancipated but has no court declaration shall present proof of income received for financial eligibility determination, and document that s/he is responsible for the majority of his / her own support (food, clothing, housing, medical). The documentation of self-support provided shall be noted in Crossroads. WIC personnel shall then determine if the majority of support is provided by the minor in order to count him / her economic unit of one.

G. A person who contributes financially to the family and is considered part of the household but is required by work or other reason (e.g., military personnel, seasonal workers construction workers) to live elsewhere is considered a member of the economic unit.

H. Students who receive the majority of basic living necessities such as food, shelter, medical care and clothing from their parent(s) / legal guardian shall be included in the economic unit of their parent(s) / legal guardian.

(crt-05.2.1)Virginia WIC Policy and Procedures Manual CRT 05.2.1: Proof of Income#

(crt-05.2.1)(document-1)#

Division of Community Nutrition Page 1 of 3

Subject: Proof of Income Policy: CRT 05.2.1 Reference: N / A Effective: May 1, 2026 Supersedes: September 1, 2023

I. Policy:

It is the policy of the Division of Community Nutrition that applicants / participants shall present proof of income when financial income eligibility is determined.

II. Procedure(s):

A. Local agency staff should attempt to obtain income documents up to 30 days prior to the participants’ appointment. Documents should be reviewed to ensure that they qualify as their current income based on their pending appointment date. Participants should be notified if they are required to provide different or additional documents as proof of income.

B. All proof of income must be documented in Crossroads. A copy of all documentation provided for proof of income that was included in determining eligibility (examples include pay stubs, etc.) must be scanned in the participant’s record. For documentation of adjunctive financial eligibility, refer to policy CRT-05.1.pdf C. Electronic documentation from a mobile device or other electronic source must be accepted. If the LA has reason to believe this information is questionable, LA staff must take steps to verify the information presented. LA staff should send an encrypted email message to the participants requesting their electronic documentation. Once received this documentation must then be uploaded into Crossroads in their family record.

D. When an applicant cannot provide any written or electronic form of documentation of income, such as a member of a homeless or migrant family, an undocumented worker, or person who works for cash the WIC Affidavit Form, WIC-383., must be completed, specifying why he/she cannot provide the documentation of income.

E. The eligibility determination process must not continue for an applicant / participant who does not bring proof of income or qualify for self-declaration of income. Temporary certification for 30 days is not allowed. The applicant / participant must be rescheduled to return with required documentation.

F. No benefits shall be issued until the eligibility process is completed and the applicant / participant is determined to be eligible.

G. For military applicants / participants, military proof of income must comply in accordance with CRT 05.2.4

H. Proof of income may be obtained from the following documents:

1) Employed persons must present proof of income by means of written or electronic documents, such as current pay or unemployment benefits stubs, earnings statements, Adjusted Gross Income from the most recent income tax return (or W-2 forms if the tax return for the previous year has not yet been filed), or other appropriate documents sufficient for establishing the current

Division of Community Nutrition Page 2 of 3

Subject: Proof of Income Policy: CRT 05.2.1 Reference: N / A Effective: May 1, 2026 Supersedes: September 1, 2023

income level of the entire economic unit.

Current income is defined as income received by the household during the month (28 - 31 days) prior to the date the application for WIC benefits is made. The number of days considered is based on the current month in the year. Local agencies must use the family ‘s current rate of income or income during the past 12 months to determine income eligibility depending upon which indicator is considered to more accurately reflect the family’s status.

Current income may be determined by using Year to Date average. The current gross year-to-day earnings is divided by the number of weeks/months that have passed.

There are two exceptions to this provision:

a. People from families with adult members who are unemployed (including laid-off workers) must have income eligibility determined by their current rate of income. An unemployment letter/notice from the Virginia Employment Commission approving or denying unemployment compensation, or a Termination / Layoff notice from previous employer shall be provided for documentation.

b. Instream migrant farm workers (and their families) with expired Verification of Certification (VOC) cards must be considered income- eligible, provided that their income is redetermined once every 12 months

2) Local agencies have the option to require that such an applicant obtain verification from a reliable third party who has knowledge of the applicant’s income. Such verification is only to be conducted when the income information provided is considered unreliable. Reliable parties might include staff of a social service agency, church or legal aid society, or employers.

3) Self-employed people must be assessed for WIC income eligibility using net income rather than gross income. Local agency staff must use the applicant’s most recently completed Internal Revenue Service (IRS) tax return as a basis for calculating net income for self-employment income. Local agencies must use the adjusted net income figure indicated on the most recently completed Federal tax return. Local agency staff must not challenge or recalculate that amount.

4) A pay stub / letter from Social Security stating amount of benefits.

5) Income documentation submitted by a foreign student to the Immigration and Naturalization Service used to obtain the Student Visa. May also accept

Division of Community Nutrition Page 3 of 3

Subject: Proof of Income Policy: CRT 05.2.1 Reference: N / A Effective: May 1, 2026 Supersedes: September 1, 2023

information provided by the Financial Aid Office from the college or university.

6) A statement of disability income.

(crt-05.2.2)Virginia WIC Policy and Procedures Manual CRT 05.2.2: Gross Income#

(crt-05.2.2)(document-1)#

Division of Community Nutrition

Subject: Gross Income Policy: CRT 05.2.2 Reference: N / A Effective: May 1, 2026 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

It is the policy of the Division of Community Nutrition that gross income must include items based on USDA guidelines.

II. Procedure(s):

A. Gross income includes the following:

1) Earnings from work:

a. Wages / salary / fees / tips / commissions / bonuses.

b. Net income from self-owned businesses or farm.

c. Severance pay.

d. Military-see CRT 05.2.4.

2) Public assistance, child support, and alimony payments.

3) Strike benefits, unemployment compensation, and worker’s compensation.

a. Accept self-declaration of striker status if it is known in the community that the individual’s workplace is on strike. Document in the participant’s file.

b. Income for strikers or unemployed people is based on the period of unemployment only

c. Request letter of unemployment for unemployed people. Scan in the participant’s record.

4) Pensions / Retirement / Social Security.

a. Pensions. b. Retirement income. c. Social Security. d. Supplemental Social Security (SSI) income. e. Veteran’s payments.

5) Other Income.

a. Disability payments for non-medical purposes.

b. Cash withdrawn from savings.

Division of Community Nutrition

Subject: Gross Income Policy: CRT 05.2.2 Reference: N / A Effective: May 1, 2026 Supersedes: August 12, 2013

Page 2 of 2

c. Interest / Dividends.

d. Income from Estates / Trusts / Investments.

e. Regular contributions from people who do not live in the household.

f. Net royalties / annuities / net rental income / net gambling and lottery winnings.

g. Inheritances.

h. Other cash income.

B. If an applicant / participant declares zero income, local agencies must determine how the applicant obtains basic living necessities such as food, shelter, medical care and clothing. If the applicant / participant has zero income with minimal or no resources, they are financially eligible upon verification by a reliable third party.

1) Instruct the applicant / participant to bring a written statement from a reliable third party that has knowledge of the applicant / participant’s income prior to final eligibility determination.

2) Reliable third parties include a social service agency, church, legal aid society, or employer.

3) Scan the written statement in the participant’s file.

4) Refer applicants/participants to appropriate programs for additional aid and assistance.

(crt-05.2.3)Virginia WIC Policy and Procedures Manual CRT 05.2.3: Income Exclusions#

(crt-05.2.3)(document-1)#

Division of Community Nutrition

Subject: Income Exclusions Policy: CRT 05.2.3 Reference: CFR § 246.7 Effective: August 12, 2013 Supersedes: July 2, 2007

Page 1 of 2

I. Policy:

Specific income sources are not included as gross income for the purpose of WIC income eligibility determination.

II. Procedure(s):

A. Benefits or income from the following sources shall not be included in determining gross income:

1) Federal work assistance or volunteer programs

a. Job Training Partnership or Carl D. Perkins Vocational Education Program payments

b. Volunteer payments or allowances received under AmeriCorps, VISTA or similar programs

c. Income received for services performed under the Domestic Volunteer or Small Business Programs

2) The following public assistance programs:

a. SNAP / Food Stamp Program

b. The National School Lunch Program

c. Disaster relief payment

d. Home energy or housing assistance payments

3) Student financial assistance received under Title IV-Higher Education Act for costs related to attendance at the educational institution shall not be included as gross income to the extent the costs do not include room and board or dependent care expenses. These programs include:

a. Pell Grants, National Direct Student Loans, Supplemental Educational Opportunity Grants, Student Incentive Grants, PLUS, College Work Study, Byrd Honor Scholarship programs

4) Other income exclusions

a. Payments with written documentation that they are reimbursements for lost assets or for injuries, such as:

1. Amounts received from insurance companies for loss or damage of real or personal property, such as home or auto.

2. Payments for a specific expense incurred by the household, such as payment of medical bills resulting from an accident or injury.

Division of Community Nutrition

Subject: Income Exclusions Policy: CRT 05.2.3 Reference: CFR § 246.7 Effective: August 12, 2013 Supersedes: July 2, 2007

Page 2 of 2

b. Bank loans, including short-term, non-secured loans to which the applicant / participant does not have constant or unlimited access. Examples include payday loans, cash advances, and personal loans.

c. Income from payments under Native American claims and settlement programs

d. Payments received to purchase child care

e. See policy on military income regarding educational assistance payments and other payments or allowances received

B. The value of in-kind benefits not received in cash, such as housing, shall not be included as gross income.

(crt-05.2.4)Virginia WIC Policy and Procedures Manual CRT 05.2.4: Military Proof of Financial Eligibility#

(crt-05.2.4)(document-1)#

Division of Community Nutrition

Subject: Military Proof of Financial Eligibility Policy: CRT 05.2.4 Reference: C.F.R. § 246.7, WPM 2010-2, SFP 11-002 Effective: August 1, 2025 Supersedes: March 17, 2023

Page 1 of 3

I. Policy:

It is the policy of the Division of Community Nutrition that an applicant / participant shall meet federal financial eligibility requirements to receive WIC benefits. Financial eligibility shall be determined at each certification visit and documented in the applicant’s / participant’s record. Split Pay Option (SPO) is an option available to service members to assist them in paying their bills on time. It is not the type of pay that must be excluded.

II. Procedure(s):

A. To determine income eligibility of any applicant / participant whose family contains one or more active-duty military household members all gross income shall be counted except the following:

1) BAH - Basic Allowance for Housing 2) FSH - Family Separation Housing 3) OHA - Overseas Housing Allowance 4) OCONUS COLA - Overseas continental United States cost-of-living allowance 5) ADVANCE PAY- An advance in pay for relocating employees is intended to help defray extra, out-of-pocket expenses associated with moving between duty stations in the U.S. and its territories. DCPAS 6) Mandatory salary reduction amount for the Montgomery GI Bill 7) FSSA – Family Subsistence Supplemental Allowance 8) SPECIALTY PAY (ex: Combat IRS's list of combat zones, Jump, Dive, etc.)- excluded if it is: Note: WIC staff are required to ask applicant/participant about Combat pay and refer to the IRS's list of combat zones during the assessment process. a. Received in addition to the service member’s basic pay b. Received as a result of the service member’s deployment to, or service in, an area that has been designated as a combat zone, AND c. Not received by the service member prior to his/her deployment to, or service in, the designated combat zone

Division of Community Nutrition

Subject: Military Proof of Financial Eligibility Policy: CRT 05.2.4 Reference: C.F.R. § 246.7, WPM 2010-2, SFP 11-002 Effective: August 1, 2025 Supersedes: March 17, 2023

Page 2 of 3

$ 1,500.00 219.00 + 300.00 $ 2,019.00 Monthly gross income x 12 $ 24,228.00 + 291.60 $ 24,519.60 Annual gross income d. USDA Policy Memorandum 2010-2: Exclusion of Combat Pay from WIC Income Eligibility Determination is provided in Appendix 1

9) PAC (Pay and Allowance Continuation)– Continuation of pays and allowances (including any bonus, incentive pay, or similar benefits) being paid at the time wounds, injuries, or illness were incurred while on duty in a hostile fire area or exposed to an event of hostile fire or other hostile action.

10) Deployment Extension Incentive Pay (DEIP- DEIP ) – Payment to active-duty service members who agree to extend their military service by continuing deployment with their units without re-enlisting. Only DEIP income received before the service member returns to home station (home station meaning a military installation within the United States). Any DEIP pay received while serving at home station must be excluded from income. Local agency personnel shall inquire as to when the payment was received to determine if it is to be excluded from income eligibility determination.

B. If a military family member brings in a monthly Leave & Earning Statement (LES) which includes Cash Clothing Replacement Allowances or cash reenlistment / bonus entitlements, these pays are not included in the original monthly formula since they are paid annually.

C. To calculate annual income, apply the following formula:

1) Add all entitlements except BAH, FSH, OHA, OCONUS COLA, Advance Pay, FSSA, PAC, excluded Combat Pay or DEIP, and clothing allowance or cash reenlistment / bonus allowances.

2) Multiply by twelve (12).

3) Add in the one-time annual cash clothing allowance or cash re-enlistment / bonus entitlement if it appears on the monthly LES.

4) Total annual gross income completed.

EXAMPLE #1

Entitlements:

Calculations:

BASE PAY ...............................$ 1,500.00 BAH ..........................................$ 725.00

Division of Community Nutrition

Subject: Military Proof of Financial Eligibility Policy: CRT 05.2.4 Reference: C.F.R. § 246.7, WPM 2010-2, SFP 11-002 Effective: August 1, 2025 Supersedes: March 17, 2023

Page 3 of 3

$ 1,500.00 219.00 + 300.00 $ 2,019.00 Monthly gross income x 12 $ 24,228.00 + 1,500.00 $ 25,728.00 Annual gross income BAS ...........................................$ 219.00 CAREER SEA PAY .................$ 300.00

CLOTHING ..............................$ 291.60

EXAMPLE #2 *

* Add the cash reenlistment / bonus the same way as the clothing allowance in the above example.

Entitlements:

Calculations:

BASE PAY ...............................$ 1,500.00 BAH ..........................................$ 725.00

BAS ...........................................$ 219.00 CAREER SEA PAY .................$ 300.00

REENLIST BONUS .................$ 1,500.00

D. Using one LES may not be the best indicator of the family’s actual annual income. To annualize income of military families, use the current month LES and past month’s LES, up to a 12-month period, to determine if they financially qualify.

E. Local agencies who encounter applicants / participants from families in which one or more family members are military reservists, Air Guard, or National Guard who have been placed on active duty shall determine such a family’s income eligibility determination based on the family’s current rate of income (while the reservist or guardsmen is on active duty), as opposed to income received over the past 12 months.

F. A copy of the LES and other documentation used as proof of income for determining income eligibility shall be scanned into the participant’s record.

(crt-06.1)Virginia WIC Policy and Procedures Manual CRT 06.1: Determine Nutrition Risk - Anthropometric#

(crt-06.1)(document-1)#

Division of Community Nutrition

Subject: Determine Nutritional Risk – Anthropometric Policy: CRT 06.1 Reference: N / A Effective: August 15, 2017 Supersedes: August 12, 2013

Page 1 of 4

I. Policy:

Height / length and weight measurements shall be performed and documented in the applicant’s record at the time of certification, subsequent certification, and mid- certification. Height / length and weight shall be measured not more than 60 days prior to these appointments.

II. Procedure(s):

A. At each certification, subsequent certification, and mid-certification visit, collect the following anthropometric data in accordance with SWO guidelines:

1) Height / Length

a. The following tools are approved for measuring height and length:

1. For infants and children under the age of two and for children over the age of two who are less than 32 inches tall or have trouble standing, use a horizontal infant measuring board with a 90° fixed headboard and a sliding footpiece.

2. For children over the age of two and adults, use a vertical measuring board with a 90° moveable headboard. Measuring rods attached to platform scales are not an acceptable tool for height measurement.

2) Weight

a. The following tools are approved for measuring weight:

1. For infants and children under the age of two and for children who have trouble standing, use a horizontal or reclining double beam balance scale or a digital baby scale. The scale shall measure to a half of an ounce.

2. For children over the age of two and adults, use either a horizontal beam balance scale or a digital scale. The scale shall measure to a quarter of a pound.

3) For infants and children, the length for age and weight for length growth charts shall be used when measuring recumbent length. For children over 2, the height for age, weight for height and BMI (body mass index) for age growth charts shall be used when measuring standing height.

4) Document pre-pregnancy weight (PPW) of the pregnant woman in Crossroads. The CPA shall ask questions to determine the actual or best estimate of the client’s pre-pregnant weight.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Anthropometric Policy: CRT 06.1 Reference: N / A Effective: August 15, 2017 Supersedes: August 12, 2013

Page 2 of 4

5) Medical data from other health care services or providers may be used by the Local Agency to determine nutritional eligibility. Anthropometric data submitted must be signed by healthcare provider not on staff of the local agency

6) Scan health care services / provider forms that contain anthropometric information in the participant’s record

B. For infants/children 0-24 months of age, assess the length and weight using the World Health Organization (WHO) growth charts to identify nutrition risks:

1) Weight-for-length less than or equal to the 2.3rd percentile are classified as underweight 2) Weigh-for-length greater than the 2.3rd percentile but less than or equal to the 5th percentile are classified as at risk for underweight 3) Length-for-age less than or equal to the 2.3rd percentile are classified as short stature 4) Length-for-age greater than the 2.3rd percentile but less than or equal to the 5th percentile are classified as at risk for short stature 5) Weight-for-length greater than or equal to 97.7th percentile are classified as high weight-for-length

C. For children 2-5 years of age, assess the height/length and weight using the Centers for Disease Control (CDC) growth charts in Crossroads. The BMI for age growth chart is the preferred method of assessing children age 2 years and older for the nutrition risks:

1) Underweight (less than or equal to 5th percentile BMI-for-age) 2) At risk of underweight (6th through 10th percentile BMI-for-age) 3) Overweight (BMI for age > 85th percentile and < 95th percentile); or 4) Obese (BMI for age > 95th percentile).

a. Using the appropriate graph, determine if a detrimental or abnormal nutrition condition exists, such as underweight, overweight, abnormal patterns of weight gain, etc.

b. Review normal or abnormal anthropometric findings with the parent / legal guardian or caretaker

D. Assess pregnant women using the Prenatal Weight Gain Grid in Crossroads. Crossroads will calculate BMI and weight gain and shall assign the nutrition risks underweight, overweight, low maternal weight gain, high maternal weight gain or maternal weight loss during pregnancy. Refer to Appendix 15 for the BMI values for these nutrition risks. For breastfeeding and postpartum women, Crossroads will

Division of Community Nutrition

Subject: Determine Nutritional Risk – Anthropometric Policy: CRT 06.1 Reference: N / A Effective: August 15, 2017 Supersedes: August 12, 2013

Page 3 of 4

calculate BMI and will ask for total weight gain during the pregnancy and shall assign the nutrition risks underweight, overweight and high maternal weight gain.

1) The nutrition risk of low maternal weight gain or high maternal weight gain as appropriate for each category is determined using the following definitions.

a. Low maternal weight gain is a low rate of weight gain in the 2nd and 3rd trimesters as defined in the table below:

Pre-Pregnancy Weight Group Definition Total Weight Gain (lbs.)/Week Underweight BMI < 18.5 <1 Normal BMI 18.5-24.9 <0.8 Overweight BMI 25.0-29.9 <0.5 Obese BMI ≥ 30.0 <0.4

E. Maternal weight loss during pregnancy is defined as follows:

Definition Trimester Any weight loss below pre- pregnancy weight 1st Weight loss of > 2 pounds 2nd or 3rd

F. High maternal weight gain is defined for the following categories:

1) Pregnant women as defined by a high rate of weight gain, such that in the 2nd and 3rd trimesters:

Pre-Pregnancy Weight Group Definition Total Weight Gain (lbs.)/Week Underweight BMI <18.5 > 1.3 Normal weight BMI 18.5-24.9 > 1 Overweight BMI 25.0-29.9 > 0.7 Obese BMI > 30.0 > 0.6

Division of Community Nutrition

Subject: Determine Nutritional Risk – Anthropometric Policy: CRT 06.1 Reference: N / A Effective: August 15, 2017 Supersedes: August 12, 2013

Page 4 of 4

2) Breastfeeding or postpartum women (most recent pregnancy only) as defined in the table below:

Pre-Pregnancy Weight Group Definition Total Weight Gain for Pregnancy Just Ended Underweight BMI < 18.5 > 40 pounds Normal weight BMI 18.5-24.9 > 35 pounds Overweight BMI 25.0-29.9 > 25 pounds Obese BMI > 30.0 > 20 pounds

3) For multi-fetal gestations (more than one fetus in the current or most recent pregnancy) the appropriate weight recommendations for all categories are defined below:

a. For twin gestations, the recommendations provide provisional guidelines: normal weight women should gain 37-54 pounds; overweight women, 31-50 pounds; and obese women, 25-42 pounds. A gain of 1.5 pounds per week during the second and third trimesters has been associated with a reduced risk of preterm and low-birth weight delivery in twin pregnancy.

b. For triplet gestation, the recommended weight gain is around 50 pounds with a steady weight gain of approximately 1.5 pounds per week throughout the pregnancy.

c. Review normal or abnormal anthropometric findings with the participant or parent / guardian.

(crt-06.2)Virginia WIC Policy and Procedures Manual CRT 06.2: Determine Nutrition Risk - Hematological#

(crt-06.2)(document-1)#

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 1 of 4

I. Policy:

A hematological test for anemia shall be performed and documented at certification for applicants with no other risk factor present. For applicants with a qualifying risk factor present at certification, a hematological test shall be performed and documented within 90 days of the date of certification.

II. Procedure(s):

A. Infants

1) Infants who are seen for a certification or mid-certification appointment between the ages of 9 and 12 months of age shall have a hematological test preformed. Schedule and perform a hematological test after 9 months of age but before the infant’s first birthday.

2) Schedule the child’s certification at 11 months of age (in the 30 days prior to the child’s first birthday) and perform the infant hematological test at this visit

B. Children

1) Children must have at least 2 hematological tests performed before the age of 2, preferably with 6 months between them a. These tests shall be performed at the 1 year old child certification and mid-certification appointments. 1. If a hematological test was preformed while the child was between 9 and 12 months of age, this value can be used to fulfill the test at certification.

2) Children between 2 and 5 years of age must have a hematological test preformed at each certification appointment a. If the hematological value is low, another hematological test must be performed at the mid-certification appointment.

C. Women

1) Pregnant women shall have a hematological test performed during the current pregnancy

2) Breastfeeding women shall have a hematological test performed during the postpartum period, ideally within 6 weeks after termination of the pregnancy

3) Postpartum women shall have a hematological test performed during the postpartum period

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 2 of 4

D. Inform the participant, parent / legal guardian or caretaker if there is a finding of low hemoglobin.

1) Document the hematological test results on the Anthro/Lab screen in Crossroads

2) Provide appropriate nutrition education and make any necessary referrals

3) Document provided nutrition education and referrals on the appropriate screens in Crossroads

E. Exceptions to blood work policy

1) If an applicant / participant has a medical condition such as hemophilia, fragile bones, or a serious skin disease, obtain medical data from another source or screen for risks other than anemia.

a. A statement from the physician documenting the medical condition must be scanned in the participant’s record and information added into the Care Plan.

b. If the medical condition is considered treatable, a new statement from the physician is required at subsequent certifications

c. If the medical condition is considered “life-long,” a new statement is not required

2) If an applicant / participant refuses a hematological test due to religious beliefs, screen for risks other than anemia.

a. Document refusal on the Anthro/Lab screen of Crossroads and add information about the refusal into the Care Plan.

3) If obtaining a hematological test from an HIV infected applicant / participant would put the health and safety of local agency personnel at risk, due to circumstances such being hostile and/or physically abusive, refer the applicant / participant to another resource.

a. Document medical condition and referral in participant’s record on the appropriate screen in Crossroads and add information about the incident in the Care Plan.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 3 of 4

Infant and Child Hematological Test Schedule

Category Hematological Test Requirement Infant Less than 9 months of age Certification Mid-Certification No hematological test required 9 to 12 months of age Certification Mid-Certification Hematological test required

Use this hematological test for the 1 year old certification requirement Children 1 to 2 Years of Age Certification

Hematological test required at the 1 year old child certification appointment A child, who was not on WIC as an infant and is certified on or after 12 months of age and before 18 months of age, must have two hematological tests by 2 years of age. Mid-Certification Hematological test required at the 1 year old mid- certification appointment (Approximately 18 months of age) Children 2 to 5 Years of Age Certification

A Hematological test is required annually at the certification appointment.

Mid-Certification A hematological test is ONLY required when the results were abnormal at the previous certification or high risk appointment.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 4 of 4

Women’s Hematological Test Schedule

Category Hematological Test Requirement Pregnant Woman Certification Hematological test must be taken during current pregnancy.

Evaluate the test results according to the trimester in which the test was taken. Breastfeeding Woman Certification Hematological test required after delivery. Postpartum Woman Certification Hematological test required after delivery.

(crt-06.4)Virginia WIC Policy and Procedures Manual CRT 06.4: Determine Nutrition Risk - Other Nutr. / Medical Cond#

(crt-06.4)(document-1)#

Division of Community Nutrition

Subject: Determine Nutritional Risk – Other Nutrition / Medical Conditions Policy: CRT 06.4 Reference: CFR §246.7 Effective: August 12, 2013 Supersedes: August 1, 2008

Page 1 of 2

I. Policy:

All applicants shall be screened for nutrition risks or nutritionally related medical conditions at each certification visit.

II. Procedure(s):

A. All applicants, parents / legal guardians or caretaker of infant / child applicants, shall have a nutritional risk assessment at each certification visit.

B. For any affirmative answer to a screening question, the CPA shall ask probing questions to verify the answers.

1) If after discussion with the applicant, parent / legal guardian or caretaker of the applicant the CPA determines the applicant misunderstood the question and thus responded incorrectly, the CPA shall change the answer to “no” in Crossroads.

2) If after discussion with the applicant, parent / legal guardian or caretaker of the applicant the CPA determines the affirmative answer does not meet the requirements to be considered a nutrition / medical condition (i.e. normal morning sickness as opposed to hyperemesis gravidarum), the CPA shall change the answer to “no” in Crossroads.

3) If after the discussion with the applicant, parent / legal guardian or caretaker of the applicant the CPA determines the affirmative does meet the requirements to be considered a nutrition / medical condition, the CPA shall document this affirmative answer in Crossroads.

C. During the counseling if the CPA becomes aware of a health history question that was answered incorrectly in the negative, the CPA shall change the answer to “yes” and initial the change as well as enter it in Crossroads.

D. Crossroads will automatically mark a participant with a nutrition / medical condition that meets predetermined parameters as “high risk. The CPA shall ask probing questions about the nutrition / medical condition during the certification or medical update.

1) If a Level 3 or Level 4 personnel determines that a participant marked as “high risk” in Crossroads is actually a “low risk” participant, personnel shall remove the “high risk” check mark in the participant’s Care Plan screen in Crossroads.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Other Nutrition / Medical Conditions Policy: CRT 06.4 Reference: CFR §246.7 Effective: August 12, 2013 Supersedes: August 1, 2008

Page 2 of 2

Personnel shall enter a note in the Comment section of the participant’s record of why the participant is not considered “high risk”.

2) If a Level 2, Level 3 or Level 4 personnel determines that a participant who is not marked as “high risk” automatically in Crossroads is actually a “high risk” participant; personnel shall mark the “high risk” box in the participant’s Care Plan screen in Crossroads.

3) Any participant who is marked as “high risk” in Crossroads hall be given a high risk, follow-up nutrition education appointment in accordance with NEd 02.3.

(crt-06.5)Virginia WIC Policy and Procedures Manual CRT 06.5: Table A: Virginia WIC Program Nutrition Risks#

(crt-06.5)(document-1)#

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 1 of 11 Risk Code Category and Priority

Risk Definition P B N I C

1000

Anthropometric Women USDA Code VA Code Priority Nutrition Risk 101 1100* 1 1 5

Underweight 111 1200 1 1 5

Overweight 111 1210* 1 1 5

Very overweight 131 1300* 1

Low Maternal Weight Gain 132 1310* 1

Maternal Weight Loss during Pregnancy 133 1400 1 1 5

High Maternal Weight Gain Infants and Children 151 1610*

1 3 Small for gestational age (SGA) 141 1630*

1 3 Low Birth Weight (< 5lbs 8oz or 2500 gm) For infants and children < 24 months of age 141 1629

1 3 Very Low Birth Weight ( < 3lbs 5oz or 1500 gm) For infants and children < 24 months of age 153 1631

Large for gestational age (BW > 9 lbs.) 103 1640

1 3 At Risk of Becoming Underweight (weight/length or BMI/age 6 -10%ile) 103 1641*

1 3 Underweight (weight/length or BMI/age < 5%ile) 121 1660

1 3 At Risk of Short Stature (Length/age or Stature/age 6- 10%ile) 121 1661

1 3 Short Stature (Length/age or Stature/age < 5%ile) 113 1711*

3 Overweight (WT for HT or BMI > 95th percentile) for children 2 to 5 years of age 134

1 3 Failure to Thrive (Diagnosed by a physician) 142

1 3 Prematurity (Infant born at < 37 weeks gestation) For infants and children < 24 months old 152

Low Head Circumference ( <5% head circumference based on NCHS growth charts) Infants and children up to 24 months of age and reported by referral sources

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 2 of 11

Risk Code Category and Priority

Risk Definition P B N I C

2000

Biochemical USDA Code VA Code Priority Nutrition Risk 201 2100 1 1 5 1 3 Low Hgb/Hct/Diagnosis of Iron Deficiency Anemia

"P" Wks Gestation Hgb (gms) Hct (%) 0-13 wks 10 to 10.9 29 to 32.9 14-26 wks 10 to 10.4 29 to 31.9 27-42 wks

10 to 10.9 29 to 32.9

Breastfeeding/Postpartum 12-14.9 yrs 11 to 11.7 33 to 35.6 15-17.9 yrs 11 to 11.9 33 to 35.8 18+ yrs 11 to 11.9 33 to 35.6

Infants/Children 6 mo to 2 yrs 10 to 10.9 29 to 32.8 2-5 yrs 10 to 11 29 to 32.9

201 2110*

1 1 5 1 3 Very Low Hgb or Hct or diagnosis of Iron Deficiency Anemia

Hgb (gms) Hct (%)

Pregnant/Infants/Children < 10 < 29%

Breastfeeding/Postpartum < 11 < 33% Other Biochemical Test Results which indicate Nutritional Abnormality 211 2300* 1 1 5 1 3 High lead - lead poisoning (> 10 ug/dL)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 3 of 11

Risk Code Category and Priority

Risk Definition P B N I C

3000

Pregnancy-related conditions (Current or Most Recent) Pregnancy History (Women's Condition) USDA Code VA Code Priority Nutrition Risk 332 3010 1 1 5

Closely spaced pregnancies (< 16 months) 334 3020R 1

Lack of prenatal care 303 3030* 1 1 5

Gestational diabetes 336 3040* 1

Fetal Growth Retardation (FGR) 335 3050* 1 1 5

Multifetal gestation 331 3060 1 1 5

Pregnancy at a young age (< 18 years) 311 3070 1 1 5

Preterm delivery of most recent infant 345 3080* 1

Pregnancy Induced Hypertension Pregnancy History (Infant's Condition) 312 3113 1 1 5

Infant with low birth weight(< or =2500 gms) 321 3115 1 1 5

Fetal or neonatal loss 339 3117 1 1 5

Infant with Spina bifida 339 3118 1 1 5

Infant with Cleft lip 339 3119 1 1 5

Infant with Cleft lip and palate 339 3120 1 1 5

Infant with Cleft palate 337 3130 1 1 5

Infant with high birth weight (> or = to 9 lbs.)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 4 of 11

Risk Code Category and Priority

Risk Definition P B N I C

USDA Code VA Code Priority Nutrition Risk 341 4100* 1 1 5 1 3 Kwashiorkor 341 4110* 1 1 5 1 3 Nutritional marasmus - severe calorie deficiency 341 4120* 1 1 5 1 3 Other severe, protein-calorie malnutrition Other and Unspecified Protein-Calorie Malnutrition 341 4210* 1 1 5 1 3 Malnutrition of moderate degree 341 4220* 1 1 5 1 3 Malnutrition of a mild degree 341 4230* 1 1 5 1 3 Arrested development following protein- caloriemalnutrition 341 4240* 1 1 5 1 3 Other protein-calorie malnutrition 341 4250* 1 1 5 1 3 Unspecified protein-calorie malnutrition Thiamine and Niacin Deficiency States 341 4410* 1 1 5 1 3 Beriberi 341 4420* 1 1 5 1 3 Other and unspecified manifestations of thiamine deficiency 341 4430* 1 1 5 1 3 Pellagra Deficiency of B-complex Components 341 4510* 1 1 5 1 3 Ariboflavinosis 341 4520* 1 1 5 1 3 Vitamin B6 deficiency 341 4530* 1 1 5 1 3 Other B-complex deficiencies 341 4540* 1 1 5 1 3 Unspecified vitamin B deficiency Vitamin D Deficiency 341 4710* 1 1 5 1 3 Rickets, active 341 4720* 1 1 5 1 3 Rickets, late effect 341 4730* 1 1 5 1 3 Osteomalacia, unspecified 341 4740* 1 1 5 1 3 Unspecified vitamin D deficiency Other Nutritional Deficiencies 341 4801* 1 1 5 1 3 Ascorbic Acid Deficiency 341 4802* 1 1 5 1 3 Vitamin A Deficiency

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 5 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 341 4810* 1 1 5 1 3 Deficiency of vitamin K 341 4820* 1 1 5 1 3 Deficiency of other vitamins 341 4830* 1 1 5 1 3 Unspecified vitamin deficiency 341 4840* 1 1 5 1 3 Mineral deficiency 341 4850* 1 1 5 1 3 Other nutritional deficiency 341 4860* 1 1 5 1 3 Unspecified nutritional deficiency 341 4900*

Infant malnutrition 347 5010* 1 1 5 1 3 Cancer Cardiovascular 360 5021* 1 1 5 1 3 Cardiac defects 360 5022* 1 1 5 1 3 Congenital heart disease 360 5023* 1 1 5 1 3 Congestive heart failure 345 5024* 1 1 5 1 3 Hypertension Central & Peripheral Nervous System 348 5031* 1 1 5 1 3 Cerebral Palsy 348 5032* 1 1 5 1 3 Epilepsy 348 5033* 1 1 5 1 3 Muscular Dystrophy 348 5034* 1 1 5 1 3 Multiple Sclerosis 348 5035* 1 1 5 1 3 Neural tube defects – Spina bifida or Myelomeningocele Chronic or Recurrent Infections 352 5041* 1 1 5 1 3 AIDS or HIV positive 352 5042* 1 1 5 1 3 Hepatitis- chronic or cirrhosis 352 5043* 1 1 5 1 3 Intestinal parasites (Giardiasis) 352 5044* 1 1 5 1 3 Meningitis 352 5045* 1 1 5 1 3 Pneumonia or influenza

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 6 of 11

Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 352 5046* 1 1 5 1 3 Tuberculosis (active) 352 5047* 1 1 5 1 3 Viral Hepatitis Congenital/Genetic Disorders Anemias 349 5052* 1 1 5 1 3 Sickle cell anemia 349 5053* 1 1 5 1 3 Thalassemia (major, minor, intermedia) 349 5054* 1 1 5 1 3 Cleft lip 349 5055* 1 1 5 1 3 Cleft palate 349 5056* 1 1 5 1 3 Cleft palate with cleft lip 349 5058* 1 1 5 1 3 Down’s Syndrome 349 5059* 1 1 5 1 3 Lowes Syndrome 349 5061* 1 1 5 1 3 Prader Willi Syndrome 349 5062* 1 1 5 1 3 Rhetts Syndrome 349 5063* 1 1 5 1 3 Williams Syndrome 350 5080*

Pyloric stenosis Endocrine 343 5091* 1 1 5 1 3 Diabetes 344 5092* 1 1 5 1 3 Hyperthyroidism 344 5093* 1 1 5 1 3 Hypothyroidism 356 5094* 1 1 5 1 3 Hypoglycemia Food Intolerance 355 5201 1 1 5 1 3 Lactose intolerance Gastrointestinal 354 5301* 1 1 5 1 3 Celiac disease 342 5302* 1 1 5 1 3 Cholecystitis/cholelithiasis 342 5303* 1 1 5 1 3 Crohn’s disease

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 7 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 342 5304* 1 1 5 1 3 Dumping Syndrome 342 5305* 1 1 5 1 3 Hiatal hernia 301 5306* 1

Hyperemesis gravidarum - Excessive nausea and vomiting 342 5307* 1 1 5 1 3 Irritable bowel syndrome/colitis 342 5308* 1 1 5 1 3 Malabsorption syndrome 342 5309* 1 1 5 1 3 Pancreatitis 342 5310* 1 1 5 1 3 Regional enteritis/ileitis 342 5311* 1 1 5 1 3 Ulcerative colitis 342 5312* 1 1 5 1 3 Short bowel syndrome Inborn Errors of Metabolism 351 5401* 1 1 5 1 3 Acidemia 351 5402* 1 1 5 1 3 Cystic Fibrosis 351 5403* 1 1 5 1 3 Disorders of lipid metabolism, pure Hypercholesterolemia, pure Hyperglyceridemia, Mixed Hyperlipidemia, hyperchylomicronemia 351 5404* 1 1 5 1 3 Disturbances of sulphur-bearing amino-acid

metabolism - Homocystinemia, Hypermethioninemia, Methioninemia 351 5405* 1 1 5 1 3 Galactosemia 351 5406* 1 1 5 1 3 Glucose-6-phosphate dehydrogenase (G6PD) 351 5407* 1 1 5 1 3 Histidinemia 351 5408* 1 1 5 1 3 Maple syrup urine disease (MSUD) 351 5409* 1 1 5 1 3 Phenylketonuria (PKU) 351 5410* 1 1 5 1 3 Tyrosinuria Pulmonary 360 5501* 1 1 5 1 3 Asthma (Severe)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 8 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) Other Medical Conditions USDA Code VA Code Priority Nutrition Risk 360 5502* 1 1 5 1 3 Broncho-pulmonary dysplasia (BPD) Other Medical Conditions 358 5601* 1 1 5

Anorexia or Bulimia 358 5602* 1 1 5

Eating Disorders 134 5603*

1 3 Failure to Thrive 382 5604*

1 3 Fetal alcohol syndrome 360 5605* 1 1 5 1 3 Hemophilia 360 5606* 1 1 5 1 3 Juvenile Rheumatoid Arthritis 360 5607* 1 1 5 1 3 Liver disease 360 5608* 1 1 5

Lupus erythematosus 346 5609* 1 1 5 1 3 Renal disease 360 2210* 1 1 5 1 3 Pernicious anemia 360 2220* 1 1 5 1 3 Vitamin B12 deficiency 360 2230* 1 1 5 1 3 Folate-deficiency anemia 360 2240* 1 1 5 1 3 Protein-deficiency anemia 360 2250*

Anemia of prematurity 360 5700* 1 1 5 1 3 Other 6000

Other Health Risks 603 6010

Infant breastfeeding complications or potential complications 602 6011*

Breastfeeding complications or potential complications 381 6020R 1 1 5 1 3 Dental/oral - cavities that interfere with eating/gum disease 361 6021* 1 1 5

3 Depression 353 6030* 1 1 5 1 3 Food allergies

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 9 of 11

Risk Code Category and Priority

Risk Definition P B N I C

7000

Other Risks USDA Code VA Code Priority Nutrition Risk 423 6041 4 4 6 4 5 Inappropriate or excessive intakes of dietary supplements including vitamins, minerals and herbal remedies 421 6050 4 4 6

5 Pica 338 6051 1

Pregnant woman currently breastfeeding 142 6060

Prematurity 359 6070* 1 1 5 1 3 Recent major surgery, trauma, burns, severe acute infections 801 7010 4 4 6 4 5 Homeless 802 7020 4 4 6 4 5 Migrant 502 7030 9 9 9 9 9 Transfer of certification (VOC) 601 7040

Breastfeeding an infant who is a WIC participant 701 7050

Infant born to a WIC participant 702 7051

Breastfed infant’s mother is a WIC participant 701 7052

Infant born to a non-WIC participant 903 7060 4 4 6 4 5 Foster Care – entering or changing homes within the last 6 months 8000

Substance abuse 372 8010R 1 1 5

Alcohol Use 372 8020R 1 1 5

Illegal Drug Use 371 8030R 1 1

Smoking 9000

Dietary Diet Low In Two Dietary Guidelines, missing one food group, or high intake in fat or sugar (Participants 2 years and older) 401 9110 4 4 6

5 Diet low in Fruits and Vegetables 401 9111 4 4 6

5 Diet low in Vitamin A foods 401 9112 4 4 6

5 Diet low in Vitamin C foods 401 9120 4 4 6

5 Diet low in Milk or Calcium rich foods

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 10 of 11 Risk Code Category and Priority

Risk Definition P B N I C

9000

Dietary (Cont.) Inappropriate Feeding Practices for Infants USDA Code VA Code Priority Nutrition Risk 401 9130 4 4 6

5 Diet low in Bread, Cereal and Grain foods 401 9140 4 4 6

5 Diet low in Meats and other protein foods 401 9150 4 4 6

5 Diet high in dietary fat 401 9160 4 4 6

5 Diet high in dietary sugar 420 9170

Excessive caffeine intake (Breastfeeding Woman) Restrictive Diets 403 9310 4 4 6 4 5 Highly restrictive diet 402 9320 4 4 6 4 5 Vegan diet 411 9501

Inappropriate infant feeding practices 412 9510

Early introduction of solid foods 415 9520

Improper dilution of formula 419 9530

4 5 Inappropriate use of nursing bottle 417 9540

Lack of sanitation in preparation of nursing bottles 418 9550

Infrequent breastfeeding as sole source of nutrients 413 9560

Feeding cow’s milk during 1st 12 months

416 9570

Feeding other foods low in essential nutrients 414 9580

No dependable source of iron after 4-6 months Inappropriate Feeding Practices for Children 425 9610

5 Excessive juice intake (>or = 12 oz a day) 425 9620

5 Non-fat/reduced fat milk as primary milk source (1-2 years) 425 9630

5 Foods low in essential nutrients/high in calories (1-2 years) 425 9640

5 Foods that put children at risk of choking (< 4 years) 425 9650

5 Forcing a child to eat a certain type/amount of food 425 9660

5 Ignoring child's requests for appropriate foods when hungry 425 9670

5 Restricting appropriate consumption of nutritional meals 425 9680

5 Not supporting a child's need for self-feeding

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 11 of 11 425 9690

5 Inappropriate feeding/offering primarily pureed/liquid food

(crt-07.0)Virginia WIC Policy and Procedures Manual CRT 07.0: Certification & Changes to Certification Period#

(crt-07.0)(document-1)#

Division of Community Nutrition

Subject: Certification and Change of Certification Periods Policy: CRT 07.0 Reference: §C.F.R. 246.7(f) Effective: August 1, 2025 Supersedes: August 12, 2013

Page 1 of 2 I. Policy:

Certification shall be conducted periodically to evaluate the individual’s residential, categorical, financial, and nutritional eligibility in accordance with the following time frames.

II. Procedure(s):

A. Crossroads shall automatically end all certifications on the certification end date.

B. The schedule for certification is as follows:

1) Pregnant Woman – for the duration of pregnancy and up to six (6) weeks postpartum.

2) Postpartum Woman – woman up to six (6) months after termination of pregnancy, including stillbirth, miscarriage, or therapeutic abortion.

3) Breastfeeding Woman – woman up to one (1) year based on the actual delivery date. For a Breastfeeding mom of an infant with a birthday on the first day of the month, the certification period for mom ends on the last day of the month prior to the infant’s birthday, since he / she was not an infant on any day of the month he/she turned one.

4) Infant – up to the first birthday. For an infant whose birthday is on the first day of a month, the certification period ends on the last day of the month prior to the birthday, since he / she was not an infant on any day of the month he /she turned one.

5) Child – for twelve (12) month periods, up to his / her fifth birthday. For children whose fifth birthday is on the first of a month, the certification period ends on the last day of the month prior to the fifth birthday, since the child was not eligible on any day of the month he /she turned five.

C. Change in Certification Periods

1) Breastfeeding Woman – A woman who discontinues breastfeeding and is less than six (6) months postpartum, shall continue to receive WIC benefits as a postpartum woman if she was certified due to a medical or nutritional condition.

a) If a woman was certified based solely on breastfeeding her infant, determine if she meets nutrition risk criteria that allows her to remain on the program as a postpartum woman. If not, WIC benefits must end.

Division of Community Nutrition

Subject: Certification and Change of Certification Periods Policy: CRT 07.0 Reference: §C.F.R. 246.7(f) Effective: August 1, 2025 Supersedes: August 12, 2013

Page 2 of 2 b) If a breastfeeding woman discontinues breastfeeding and is more than six (6) months postpartum, she shall no longer be categorically eligible to participate and shall be removed from the program.

c) Infant – If an infant was certified using only mother’s risk and the mother ceases to breastfeed, determine if the infant is eligible to receive WIC benefits.

(crt-09.1)Virginia WIC Policy and Procedures Manual CRT 09.1: System Termination from the WIC Program#

(crt-09.1)(document-1)#

Division of Community Nutrition

Subject: System Termination from the WIC Program Policy: CRT 09.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: March 15, 2019

Page 1 of 2

I. Policy:

Participants shall be notified at WIC food benefits issuance and / or 15 calendar days before they are terminated. Participants shall be verbally informed of the right to a fair hearing as required by federal law.

II. Procedure:

A. The following system terminations are automatically conducted in Crossroads. No action by the local agency is required.

1) Women’s period of eligibility has expired. Local agency shall verbally inform participant at the last certification appointment before expiration.

2) Child ineligible after fifth birthday. Local agency shall verbally inform participant at the last certification appointment before expiration.

3) Certification period expired. Participant verbally informed of this policy at each certification or subsequent certification.

4) Failure to receive WIC food benefits for ninety (90) days after the last date to spend. Participant is notified of this policy verbally at each WIC food benefits issuance.

B. Local agency personnel shall terminate a WIC participant for the following reasons and provide the notification listed.

Reason for Termination Notification Requirement Moved from State of Virginia Local agency issues a Verification of Certification (VOC) Is not financially eligible Issue Letter of Ineligibility, WIC-315 Does not have a nutritional risk Issue Letter of Ineligibility, WIC-315 Dual participation Issue Disqualification Letter for Program Abuse, WIC-315

Division of Community Nutrition

Subject: System Termination from the WIC Program Policy: CRT 09.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: March 15, 2019

Page 2 of 2

Program abuse Issue Disqualification Letter for Program Abuse, WIC-315 Deceased No notice issued Participant no longer wants benefits Issue Letter of Ineligibility, WIC-315 Applicant is in a priority for which there is a freeze on enrollment Issue Letter of Ineligibility, WIC-315 Applicant is in a category for which there is a freeze on enrollment Issue Letter of Ineligibility, WIC-315 Data entry error No notice issued. Residency Ineligible Issue Letter of Ineligibility, WIC-315 Participant is currently eligible but is placed on a waiting list due to funding. Issue Letter of Ineligibility, WIC-315

(crt-13.1.1)Virginia WIC Policy and Procedures Manual CRT 13.1.1: WIC Verification of Certification Card Acceptance#

(crt-13.1.1)(document-1)#

Division of Community Nutrition

Subject: WIC Verification of Certification Document Acceptance Policy: CRT 13.1.1 Reference: CFR §246.7 Effective: August 15, 2016 Supersedes: October 15, 2015

Page 1 of 2

I. Policy:

A WIC Transfer Verification of Certification document (VOC), or a Department of Defense (DoD) WIC Overseas transfer document, is valid until the certification period expires and shall be accepted as proof of financial and nutritional eligibility for WIC benefits. Both proof of identification and proof of residency are required when accepting a WIC Verification of Certification (VOC) Transfer document. In the event of a waiting list, participants with a valid WIC Verification of Certification (VOC) document shall be placed on the list ahead of all other applicants.

II. Procedure(s):

A. WIC personnel shall collect the WIC Verification of Certification document, enter the data into Crossroads to include race and ethnicity, and scan the WIC transfer documentation in the participant’s record. The race and ethnicity field must be completed on the participant demographics screen in Crossroads to assist in the identification of potential dual participants between states and within Crossroads.

Exception: For migrant and homeless participants, scan the WIC Verification of Certification document into the participant’s record and return the original document to the participant.

1) Collect, stamp void, and return any food instruments issued by the original agency

2) Send the voided food instruments to the State WIC Office if the original agency’s address is unknown

3) Provide basic nutrition education and make appropriate referrals

4) Issue a food prescription

5) Issue an eWIC card, card holder, and eWIC Cardholder Booklet, and explain food benefit usage procedures

6) Review the Participant’s Rights and Responsibilities and obtain the participant’s signature on the WIC-310

B. If a participant does not have a valid WIC Verification of Certification document, WIC personnel shall certify him / her as they would any other applicant.

Division of Community Nutrition

Subject: WIC Verification of Certification Document Acceptance Policy: CRT 13.1.1 Reference: CFR §246.7 Effective: August 15, 2016 Supersedes: October 15, 2015

Page 2 of 2

1) Participants with a WIC Transfer document that lack the name, certification date, and / or date certification expires are not immediately entitled to WIC benefits.

2) Contact the original agency for certification information. If the data is not readily available or the participant prefers, determine eligibility within 10 days of the request for services.

C. The WIC-318 Delayed Benefits Signature Form shall be completed at the initial certification for out-of-state VOC transfers. The signed form shall be scanned into the Crossroads Income Screen.

(ep-1.0)Virginia WIC Policy and Procedures Manual EP 1.0: Coordination Communication#

(ep-1.0)(document-1)#

Division of Community Nutrition

Subject: Coordination and Communication (Declared Emergencies) Policy: EP 1.0 Reference: C.F.R. § 246.x (reference in federal regs., if applicable) Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 1 of 2

I. Policy:

In response to a declared emergency, Virginia WIC shall temporarily operate under Emergency Procedures. Virginia State WIC Office (SWO) shall make alterations to the coordination and communication procedures to ensure the quality and continuity of WIC services remains throughout the declared disaster or emergency. These temporary provisions will be in place until WIC services can safely return to normal operations as declared by the Virginia State WIC Office (SWO) and/or the United States Department of Agriculture (USDA).

II. Procedure(s):

A. Designated Emergency Contacts: 1. During a declared emergency, designated emergency contacts are as follows: i. Primary Emergency Contact: Virginia State WIC Director ii. Secondary Emergency Contact: Virginia WIC Program Manager iii. Tertiary Emergency Contact: Virginia Local Agency Technical Support Supervisor 2. Contact information is available on the Virginia Department of Health and Food and Nutrition Services (FNS) websites. 3. The emergency contacts for participants with documented qualifying conditions that require Food Package III are as follows: i. Primary Emergency Contact: Virginia WIC Program Manager ii. Secondary Emergency Contact: Virginia State WIC Office Nutrition Liaison (Subject Matter Expert: Special Formula)

B. Relief Agency Coordination: 1. During a declared emergency, Virginia WIC shall participate and coordinate relief efforts with the: i. Virginia State Feeding Task Force ii. Access and Functional Needs Committee (AFNAC)

C. Communication Plans: 1. During declared emergencies, supplemental food recalls and/or supply chain disruptions, Virginia WIC shall enact communication plans to keep FNS, State and Local Agency Staff, Authorized WIC Vendors, WIC Participants and the Public as follows: i. FNS Communication: The Virginia State WIC Director (and/or designee) will communicate with FNS during emergencies. When emergency

Division of Community Nutrition

Subject: Coordination and Communication (Declared Emergencies) Policy: EP 1.0 Reference: C.F.R. § 246.x (reference in federal regs., if applicable) Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 2 of 2

procedures are instituted, the Virginia State WIC Director will notify FNS and request any potential waivers, as needed. ii. State and Local Agency Staff Communication: The Virginia WIC Program Manager (and/or designee) will communicate with the state and local agency staff during emergencies. iii. Authorized WIC Vendors: The Virginia WIC Vendor Manager will communicate with authorized vendors during emergencies through electronic means. iv. WIC Participants: Virginia State WIC Office will provide talking points to local agency staff to communicate with WIC participants and will provide updates via the Virginia WIC webpages. Additional contact methods may include email and/or text messages to participants, as needed. v. General Public: Virginia State WIC Office in coordination with the VDH Office of Communication will publish official statements concerning the relief efforts and/or any pertinent information applicable to the emergency.

(ep-2.0)Virginia WIC Policy and Procedures Manual EP 2.0: Continuation of Benefits_Remote Services#

(ep-2.0)(document-1)#

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 1 of 12

I. Policy: In response to a declared emergency, Virginia WIC shall temporarily suspend all in-person WIC services and transition to remote WIC services. Local Agencies shall make alterations to standard operating procedures to safeguard the health of WIC applicants, participants, staff, and the community while ensuring the quality and continuity of WIC services. These temporary provisions will be in place until WIC services can safely return to normal operations as declared by the Virginia State WIC Office (SWO) and/or the United States Department of Agriculture (USDA).

II. Procedures: A. All WIC services shall be completed remotely via telephone. 1. Remote WIC services shall be completed using an agency landline or agency issued cell phone. 2. Remote WIC services shall be provided in the applicant/participant’s preferred language. a. In cases where WIC staff who speak the preferred language are not available, over the phone interpreter services must be used. b. Procedures for over the phone interpreter services are provided in a supplemental document. 3. Remote WIC services require access to the Crossroads system.

B. When completing remote WIC services, WIC staff shall: 1. Call the telephone number(s) listed in the applicant/participant’s Crossroads record. 2. Verify that they are speaking to the applicant/participant, or an authorized representative listed in Crossroads. 3. If the applicant/participant or an authorized representative is on the phone, continue with the remote WIC services. 4. If the applicant/participant or an authorized representative is not available, leave contact information for the clinic and request a return phone call. a. Identify themselves by name and title, explain that they are calling to complete remote WIC services and confirm that the applicant/participant or authorized representative is able to complete the call at that time.

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 2 of 12 i. Let the applicant/participant or their authorized representative know you will be asking questions about potentially personal information so they can decide if they are in an area, they can answer these questions. ii. WIC services do not include all the components of in-person WIC services and therefore may be able to be completed in less time, the below are estimations of the time required for each remote WIC appointment type: 1) Initial certification: 45 minutes 2) Subsequent certification: 30 minutes 3) Mid-certification: 15 minutes 4) Nutrition education: 5 minutes iii. If the applicant/participant or an authorized representative can complete the call at that time, continue with the remote WIC services. iv. If the applicant/participant or an authorized representative is not able to complete the call at that time, reschedule their appointment. C. Requirements for physical presence of applicants, participants, and/or approved representatives shall be waived for all remote WIC services. 1. WIC staff shall ensure that physical presence for applicants is accurately documented in Crossroads for all initial and subsequent certification appointments a. “No” shall be selected for Physical Presence on the Participant Demographics screen in Crossroads b. “SWO-approved emergency” shall be selected as the Physical Presence Exception Reason on the Participant Demographics screen in Crossroads

D. Requirements for the following shall be deferred for all remote initial, subsequent, and mid-certifications should waivers be issued: 1. Anthropometric data a. Anthropometric data shall be collected, when possible, through the use of the WIC-349 and/or WIC-395 forms. When data is collected, it shall be entered into Crossroads.

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 3 of 12 b. If anthropometric data is unable to be obtained, Length/Height and Weight fields on the Anthro/Lab Screen in Crossroads shall be left blank. 2. Bloodwork data a. Bloodwork data shall be collected, when possible, through the use of the WIC-394 and/or WIC-395 forms. When data is collected, it shall be entered into Crossroads on the Anthro/Lab screen. b. If bloodwork is required but unable to be obtained “SWO-approved emergency” shall be selected as the reason for deferment on the Anthro/Lab screen in Crossroads.

E. Attempts shall be made to collect the following information for all remote initial and subsequent certifications: 1.Physical proof of identification a. Allowable forms of proof of identification, as outlined in policy CRT 03.0 shall be collected through encrypted emails or other approved collection methods. b. If proof of identification is unable to be collected, staff shall receive verbal consent to sign an Affidavit recording the information. i. Staff shall verbally communicate to the applicant that this information will be required at their first face-to- face visit and that the information must be factual or they could face financial liability for any benefits they received based on false information. ii. “AFFIDAVIT” shall be selected as proof of identification on both the Family Demographic Screen and the Participant Demographic Screen in Crossroads. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. 2.Proof of residency a. Allowable forms of proof of residency, as outlined in policy CRT 04.0 shall be collected through encrypted emails or other approved collection methods. b. If proof of residency is unable to be collected, staff shall receive verbal consent to sign an Affidavit recording the information. i. Staff shall verbally communicate to the applicant that this information will be required at their first face-to- face visit and that the information must be factual or

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 4 of 12 they could face financial liability for any benefits they received based on false information. ii. “AFFIDAVIT” shall be selected as proof of residency on the Family Demographic Screen in Crossroads. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. 3. Proof of income, for applicants/participants who are not adjunctively eligible a. Adjunctive income eligibility shall be used, when possible, as outlined in policy CRT 05.1. b. When adjunctive eligibility is not applicable, allowable forms of proof of income, as outlined in policy CRT 05.2.1 shall be collected through encrypted emails or other approved collection methods. c. If adjunctive income eligibility is not applicable and proof of income is unable to be collected, staff shall receive verbal consent to sign an Affidavit recording the information. i. Staff shall verbally communicate to the applicant that this information will be required at their first face-to- face visit and that the information must be factual or they could face financial liability for any benefits they received based on false information. ii. “AFFIDAVIT” shall be selected as proof of income when adjunctive eligibility is not applicable or cannot be verified. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. F. Remote Certifications 1. Eligibility staff shall: a. Provide a brief description of the WIC program and the certification process to the applicant/participant or authorized representative and inform them that staff will enter the information into a computer so they’re aware of what is occurring in the clinic during telephone call. b. Complete all required information on the Family Demographic Screen i. If the applicant would like to register to vote, the staff shall direct them to the U.S. Election Assistance Commission website:

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 5 of 12 https://www.eac.gov/voters/national-mail-voter- registration-form. ii. Interpreter shall be checked for ALL applicants/participants and/or authorized representatives whose preferred spoken language is NOT English. iii. For the telephone number designated as “primary”, ensure that the following information is entered: 1) Telephone type (ex. Home, cellular, etc.) 2) Carrier for all cellular numbers (ex. Verizon, AT&T, etc.) 3) Designation of Auto Dialer or Text for WIC appointment reminders c. Ensure that BOTH the physical and mailing address are correct i. In cases where the physical and mailing address are the SAME, the mailing address section shall be left blank. d. Complete the Family Assessment Screen e. Complete the Participant Demographic Screen i. Verbally obtain race and ethnicity information for all applicants and participants. f. Complete all required information on the Income Information Screen i. Adjunctive eligibility shall be used for all applicants who are currently enrolled in an eligible adjunctive program ii. If an applicant is enrolled in an adjunctive eligible program, they must self-declare their income. This information shall be documented in Crossroads in the appropriate field on the income screen. g. Complete all required information on the Certification Signature Screen. i. Read the complete Rights and Responsibilities and provide information on the options for Release of Information (to include the mandated civil rights statement):

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 6 of 12 1) If an applicant/participant or authorized representative declines to release their information, the confidentiality box shall be checked on the Family Demographics Screen of Crossroads. 2) An alert shall be added to the applicants Crossroads record to ensure that the WIC- 309 is completed and scanned into their record the next time they are in clinic. ii. Applicants/participants and authorized representatives shall be verbally informed, and staff shall ensure that they understand that all information provided to determine WIC eligibility must be true and that they could be held financially liable for obtaining benefits under false pretense should it be determined that falsified information was provided. iii. Ensure that staff alias is selected as the person signing and sign own signature for the certification signature.

h. For initial certifications ONLY: i. Complete the Issue EBT Card Screen 1) Ensure that the appropriate individual is selected as the cardholder. 2) Assign an eWIC card and verify assignment is transmitted successfully to the EBT host. 3) Explain how to set-up the eWIC card. ii. Inform the participant or their authorized representative that they will mail or permit pick-up from a local office (if allowable by local agency) the following items: 1) Participant Handbook 2) Copy of their WIC Right and Responsibilities 3) Copy of the Release of Information form 4) eWIC Card

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 7 of 12 5) eWIC brochure 6) Appointment card with details of next appointment 7) Current Virginia WIC Food List 8) Local Agency Referral List 9) Shopping list 10) Listing of local WIC-approved vendors 11) Nutrition and/or breastfeeding education materials (as applicable) iii. If the participant chooses to have the eWIC card and accompanying documents mailed, staff shall: 1. Mail the items listed above within 1 business day 2. Items shall be mailed through certified mail requesting a receipt signature 2) Inform the participant that the above items may arrive within 3-5 business days

2. CPA/CPPA staff shall: a. Complete the Health Information Screen. b. Complete the Anthro/Lab Screen when deferred blood work needs to be documented and/or when anthropometric/bloodwork referral data is received via a WIC Medical Referral Form (WIC-349) form. i. This screen is skipped in all other scenarios. c. Complete the Dietary & Health Screen. d. Use VENA to complete an assessment of dietary patterns and applicable social and health areas not already addressed. e. Complete the Assigned Risk Screen. i. All risks not automatically assigned by the system shall be added by the CPA/CPPA. f. Complete the Certification Summary Screen. i. The applicant shall be verbally informed of their assigned risks, the end date of their certification, and that once the certification expires,

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 8 of 12 they will need to complete a subsequent certification in order to continue to receive WIC benefits. g. Complete the Issue Benefits Screens i. Verbally explain milk substitution options available for women and children and update the food prescription to reflect desired benefits. ii. Verify all food prescriptions in the carousel for accuracy, ensuring all needed corrections are made iii. Issue Food Instruments: 1) Benefits should be issued for 3 months EXCEPT in cases where there are special formulas, CAP ordered formulas and/or Over-the-Max (OTM) amount of formula issued. 2) Benefits that contain special formulas, CAP orders and/or OTM amounts of formula MUST be issued on a 1-month interval. C) Ensure that staff alias is selected as the person signing and sign own signature to acknowledge the issuance of Food Instruments

h. Schedule the next appointment for the participant and/or other participants in the family. i. Schedule the next appointment and inform the participant or authorized representative of the appointment details, including which individuals and items/information need to be present.

i. For Initial Certifications ONLY: i. Additional information shall be provided on the WIC foods that have been issued, shopping with WIC benefits, and local WIC- approved vendors. j. Thank the participant for participating in WIC and offer a phone number for questions.

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 9 of 12 k. Document standard care plan documentation following the “ABCDEFGHI” format. l. Document WIC breastfeeding referrals on the Referral screen for all pregnant and breastfeeding women as is routinely required i. Ensure access to accurate and timely breastfeeding education and support is an increased priority at this time. ii. Refer postpartum women who are not currently breastfeeding but are interested in increasing their milk supply and/or re-lactating to a Designated Breastfeeding Expert (DBE).

G. Remote Mid-Certifications 1. The CPA/CPPA shall: a. Provide a brief description of the mid-certification appointment to the participant or authorized representative and inform them that staff will be entering the information provided into a computer so that they are aware of what is occurring in the clinic during telephone calls. b. Confirm that information on the Family Demographic Screen is up- to-date and make any needed updates c. Follow-up on previous nutrition risks and concerns identified at the certification. d. Ask if there are any current concerns about weight and/or overall health. e. Conduct a brief assessment of health and nutrition practices. f. Offer nutrition education and breastfeeding support, as appropriate. g. Offer appropriate referrals and follow up to previous referrals, as appropriate. h. Confirm the current food benefits meet the participant’s needs and that all prescriptions in the carousel are accurate. i. Make any needed updates to prescriptions. i. Issue Food Instruments: i. Benefits should be issued for 3-months EXCEPT in cases where there are special formulas, CAP ordered formulas and/or Over-the-Max (OTM) amount of formula issued.

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 10 of 12 ii. Benefits that contain special formulas, CAP orders and/or OTM amounts of formula MUST be issued on a 1-month interval. iii. Ensure that staff alias is selected as the person signing and sign own signature to acknowledge the issuance of Food Instruments j. Schedule next appointment and inform the participant or authorized representative of the appointment details k. Thank the participant for participating in WIC and offer a phone number for questions. l. Document by standard care plan documentation required for mid- certifications.

H. Remote Nutrition Education 1. The CPA/CPPA shall: a. Have a conversation about the participant’s needs and concerns. Follow up to nutrition, and as appropriate breastfeeding goals and discussions documented during the certification period. i. For pregnant participants, emphasis shall be placed on the importance of breastfeeding ii. For infant participants, emphasis shall be placed on normal baby behavior and developmentally appropriate feeding skills and foods iii. For breastfed infants, emphasis shall also include continued breastfeeding and provision of resources for any expressed questions or concerns. iv. For formula-fed infants, emphasis shall also include proper formula mixing and reminders that WIC is a supplemental program, and that additional formula will need to be purchased monthly beyond what is provided by WIC v. For Breastfeeding participants, emphasis shall be placed on continued breastfeeding and provision of resources for any expressed questions or concerns. vi. For child participants, emphasis shall be placed on any concerns included in previous care plan entries, age-

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 11 of 12 appropriate feeding skills, Division of Responsibility and family meals. b. Document by standard documentation required for individual nutrition education.

I. Remote High Risk 1. The Registered Dietitian shall: a. Conduct remote High Risk appointments as described in the procedure above for remote Nutrition Education appointments. b. If the Local Agency has a Registered Dietitian on staff, all efforts shall be made for the Registered Dietitian(s) to complete the High Risk appointments regardless of their clinic location within the local agency. c. If/when a Registered Dietitian is unavailable to complete the High Risk appointment, the appointment shall be completed by a nutritionist (CPA). d. Document by standard documentation required for high risk appointments.

J. Verification of Certification (VOC) 1. Intake of VOC a. If the participant has valid VOC documentation from another state, they may provide this to the local agency WIC clinic via mail, drop-off or transmitted using secure electronic means. b. If the participant does not have a copy of the VOC documentation, the local agency shall contact the WIC state agency for a copy of the documentation. c. Once the clinic receives VOC documentation, staff shall scan the VOC into the participant’s record. Information shall be keyed in the incoming transfer screen in Crossroads to complete the transfer process. 2. Issuance of VOC a. When a participant needs a VOC issued, they shall contact the local agency WIC clinic to inform the clinic of their intent and dates of relocation. b. Local agency staff shall select the transfer out of state option in the Family Services menu and print and sign the VOC documentation.

Division of Community Nutrition

Subject: Continuation of Benefits (Remote Services for Declared Emergencies) Policy: EP 2.0 Reference: C.F.R. § 246.x Memo 2024-3 Effective: 4/1/2025 Supersedes: N/A

Page 12 of 12 c. Staff shall offer to mail VOC documentation or permit pick-up from a local office (if allowable by local agency) to the participant or provide a copy via secure electronic means. d. If another state agency contacts the local WIC office for a VOC, staff shall follow the same procedures outlined above.

(fds-01.1)Virginia WIC Policy and Procedures Manual FDS 01.1: Allowable Food Selection Criteria#

(fds-01.1)(document-1)#

Division of Community Nutrition

Subject: Allowable Food Selection Criteria Policy: FDS 01.1 Reference: CFR §246.10 Effective: November 15, 2016 Supersedes: October 1, 2014

Page 1 of 2

I. Policy:

Foods for inclusion on the WIC Program Approved Food List shall be reviewed at least once every one to three years using specific criteria.

II. Procedure(s):

A. Criteria

1) Nutritional value is the primary factor in selecting authorized foods in accordance with Food Standards. The nutritional value of foods as it relates to the cost shall also be considered.

2) Food item availability shall be considered when determining the final choices available for each food type. Foods shall currently be in stock in WIC-approved retail stores located in approximately 75% of local agencies. The exception is approved store brands which may be available only at specified retail stores.

3) Consumer preference shall be evaluated periodically through participant surveys when selecting or eliminating authorized foods.

4) Foods that contain fat substitutes are not allowed. Additives, such as artificial colors, may be allowed as long as they are on the FDA GRAS (Generally Recognized As Safe) List.

5) Food items that convey consumer messages that conflict with the WIC Program mission / vision statements shall be excluded.

B. Food items that meet the general specifications may not be allowed for use in Virginia if:

1) They also exhibit properties that are inconsistent with sound nutrition practices as specified in this policy;

2) There is potential for confusion (i.e. group of juices or cereals from one manufacture that have a similar name and package design / appearance of other products that do not qualify for the WIC Program and, therefore, increase the potential for confusion by retail stores and participants;

3) They are not readily available in retail stores located in 75% or more of the local health districts service areas;

Division of Community Nutrition

Subject: Allowable Food Selection Criteria Policy: FDS 01.1 Reference: CFR §246.10 Effective: November 15, 2016 Supersedes: October 1, 2014

Page 2 of 2

4) Food is not consistent with agency administrative decisions, i.e. minimum size restriction and does not promote agencies philosophy of good consumerism; and

5) Other objective reasons as documented by the State WIC Office and/ or Nutrition Team.

C. New foods may be submitted to the VA WIC Program for review during the application acceptance period by using the Allowable Food Application Form Information on food submission shall be posted on the Virginia WIC Program's web page.

D. Consumer / participants surveys / studies at the national, state and local level shall be used to identify the demand for new and existing foods.

E. Foods can also be removed from the Program if there are changes in nutrient content, labeling, packaging, cost, or a product no longer meets federal or state standards. Foods that are to be eliminated shall be removed from the food list at the next revision.

F. Applicants shall be notified by the State WIC Office of their food item's acceptance or rejection. Selection decisions are subject to modification based on program changes in funding and resource availability. Acceptance does not guarantee inclusion on the revised food list.

G. Local agencies and WIC participants can submit food items for consideration using a Request for New Food Item Consideration form.

(fds-02.2)Virginia WIC Policy and Procedures Manual FDS 02.2: Maximum Food Allowed#

(fds-02.2)(document-1)#

Division of Community Nutrition

Subject: Maximum Food Allowed Policy: FDS 02.2 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 3 I. Policy: The maximum quantity of WIC foods shall be made available to any participant based upon nutrition needs. I: INFANTS 0 - 6 MONTHS FOOD MAXIMUM ALLOWED PER MONTH Concentrated Formula

0-3 months= 806 fl oz 4-5 months= 884 fl oz Powdered Formula 0-3 months= 870 fl oz 4-5 months= 960 fl oz Ready to Feed Formula 0-3 months= 832 fl oz 4-5 months= 913 fl oz II: INFANTS 6 - 12 MONTHS FOOD MAXIMUM ALLOWED PER MONTH Concentrated Formula 6-11 months= 624 fl oz Powdered Formula 6-11 months= 696 fl oz Ready to Feed Formula 6-11 months= 643 fl oz Infant Cereal 24-oz. dry Infant Food- Fruits and Vegetables 128 oz for fully formula or partially breastfeeding infants 256 oz for fully breastfeeding infants Infant Food- Meat 77.5 oz for fully breastfeeding infants III. SPECIAL NEEDS (women, infants, and children)  Anyone receiving special formula or medical foods  Anyone over the age of 2 receiving whole milk FOOD MAXIMUM ALLOWED PER MONTH Formula Women and Children  910 fl oz liquid concentrate  910 fl oz reconstituted powder  910 fl oz Ready to Feed Infants  Receiving food, as specified in Food Prescription I or II  Infants 6-11 months NOT receiving food, as specified for the 4-5 month maximum of Food Prescription I Infant Cereal 24 oz. dry Infant Food- Fruits and Vegetables 128 oz for fully formula or partially breastfeeding infants 256 oz for fully breastfeeding infants Infant Food- Meat 77.5 oz for fully breastfeeding infants Milk As specified in participant category Cheese As specified in participant category Eggs As specified in participant category Dry or Canned Beans/ Peanut Butter As specified in participant category Cereal (hot or cold) As specified in participant category Juice As specified in participant category Whole grains As specified in participant category Fruits and Vegetables As specified in participant category

Division of Community Nutrition

Subject: Maximum Food Allowed Policy: FDS 02.2 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 2 of 3 IV: CHILDREN 1 TO 5 YEARS Low-Fat, or Skim Milk (fluid) *Children 1-2 years will receive whole milk 16 quarts Cheese May substitute 1 lb. cheese for 3-qt. fluid milk Eggs 1 dozen Dry Beans or Peas 1 pound Canned Beans 4 15-16oz cans Peanut Butter 16-18 oz Cereal (hot or cold) 36 oz. dry Juice 2- 64 oz. liquid (128 fl. oz.) Fruits and Vegetables $8.00 Whole Grains 2 pounds V: PREGNANT AND WOMEN PROVIDING MOSTLY BREASTMILK FOOD MAXIMUM ALLOWED PER MONTH Low-Fat, or Skim Milk (fluid) 22 quarts Cheese May substitute 1 lb. cheese for 3-qt. fluid milk Eggs 1 dozen Dry Beans or Peas 1 pound Canned Beans 4 15-16oz cans Peanut Butter 16-18 oz Cereal (hot or cold) 36-oz. dry Juice 3 12-oz. cans frozen concentrate (144 fl. oz. reconstituted juice) Fruits and Vegetables $ 10.00 Whole Grains 1 pound VI: POSTPARTUM WOMEN AND WOMEN PROVIDING SOME BREASTMILK FOOD MAXIMUM ALLOWED PER MONTH Low-Fat, or Skim Milk (fluid) 16 quarts Cheese May substitute 1 lb. cheese for 3-qt. fluid milk Eggs 1 dozen Dry Beans or Peas 1 pound Canned Beans 4 15-16oz cans Peanut Butter 16-18 oz Cereal (hot or cold) 36-oz. dry Juice 2 12-oz. cans frozen concentrate (96 fl. oz. reconstituted juice) Fruits and Vegetables $ 10.00 Whole Grains none VII: FULLY BREASTFEEDING WOMEN AND PREGNANT WOMEN WITH MULTIPLES ( Women breastfeeding multiples will receive 1.5 times food package VII) FOOD MAXIMUM ALLOWED PER MONTH Low-Fat, or Skim Milk (fluid) 24 quarts Cheese May substitute 1 lb. cheese for 3-qt. fluid milk Eggs 2 dozen Canned Beans 4 15-16oz cans Dried Beans or Peas 1 pound Peanut Butter 16-18 oz

Division of Community Nutrition

Subject: Maximum Food Allowed Policy: FDS 02.2 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 3 of 3 Cereal (hot or cold) 36-oz. dry Juice 3 12-oz. cans frozen concentrate (144 fl. oz. reconstituted juice) Fruits and Vegetables $ 10.00 Whole Grains 1 pound Canned fish 30 oz

(fds-02.2.3)Virginia WIC Policy and Procedures Manual FDS 02.2.3: Food Package IV Child#

(fds-02.2.3)(document-1)#

Division of WIC & Community Nutrition Services

Subject: Food Prescription IV – Child Policy: FDS 02.2.3 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 3

I. Policy:

All children shall be prescribed a food prescription that is based on age, meets the participant’s nutritional needs, cultural preferences and household conditions.

II. Procedure:

A. The CPA shall use VENA to help determine the participant’s food usage.

B. All children under the age of 2 years old not requiring a special needs food package shall be offered the full nutrition benefit consisting of the following:

1) 4 gallons of whole milk 2) 1 dozen eggs 3) 1 pound of dry beans or 4 (15-16 oz) cans of beans OR 16-18 oz peanut butter 4) 2 (64 oz) bottles of liquid juice 5) 36 ounces of cereal 6) 2 pounds of whole grains (whole wheat bread, brown rice or soft corn or whole wheat tortilla) 7) $8.00 cash value voucher for fresh, frozen or canned fruits and vegetables

C. To determine the appropriate individual tailoring of the food prescription for children under the age of 2 years old, the CPA shall discuss the food and the amounts offered in the standard food prescription.

1) If the parent, legal guardian or caretaker of the participant requests milk other than whole milk the CPA shall explain that only whole milk can be offered to children of this age. They shall explain that the fat is still important for brain development. The CPA shall mention that at the age of 2 years old the child will no longer receive whole milk and can switch to lower fat milk at that time.

D. The CPA can do the following individual tailoring for each child participant under the age of 2 years old:

Division of WIC & Community Nutrition Services

Subject: Food Prescription IV – Child Policy: FDS 02.2.3 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 2 of 3

1) Provide lactose free milk or UHT milk when indicated by the household situation.

2) Provide a special needs food prescription in accordance with FDS 02.2.2 when required.

3) Reduce the quantity of food based on participant preference and food usage.

a. If the quantity of food is reduced the reason needs to be recorded in Crossroads

4) Provide 1 pound of cheese based on participant preference. a. If cheese is provided 0.75 gallons of milk will be reduced from the food package E. All children 2 years old and older not requiring a special needs food prescription shall be offered the standard prescription consisting of the following:

1) 4 gallons of 1% milk, low-fat milk or skim milk 2) 1 dozen eggs 3) 1 pound of dry beans or 4 (15-16 oz) cans of beans OR 16-18 oz peanut butter 4) 2 (64 oz) bottles of liquid juice 5) 36 ounces of cereal 6) 2 pounds of whole grains (whole wheat bread, brown rice or soft corn or whole wheat tortilla) 7) $8.00 cash value voucher for fresh, frozen or canned fruits and vegetables

F. To determine the appropriate individual tailoring of the food prescription for children 2 years old and older, the CPA shall discuss the foods and the amounts offered in the standard food prescription.

If the parent, legal guardian or caretaker of the participant requests whole milk, the CPA shall explain that whole milk is only prescribed for children with special needs that require additional calories and/or fat for their medical condition.

Division of WIC & Community Nutrition Services

Subject: Food Prescription IV – Child Policy: FDS 02.2.3 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 3 of 3

G. The CPA can do the following individual tailoring for each child participant 2 years old and older:

1) Provide lactose free milk or UHT milk when indicated by the household situation.

2) Provide a special needs food prescription in accordance with FDS 02.2.2 when required.

3) Reduce the quantity of food based on the participant preference and food usage.

a. If the quantity of food is reduced the reason needs to be recorded in Crossroads.

4) Provide 1 pound of cheese based on participant preference. a. If cheese is provided 0.75 gallons of milk will be reduced from the food package

(fds-02.2.4)Virginia WIC Policy and Procedures Manual FDS 02.2.4: Food Package V - Pregnant and Providing#

(fds-02.2.4)(document-1)#

Division of Community Nutrition

Subject: Food V – Pregnant and Women Providing “Mostly” Breast Milk Policy: FDS 02.2.4 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

All pregnant women and women providing “mostly” breast milk (receiving less than half of the maximum allowed amount of formula for their infant) shall be prescribed a food prescription that is based on age, meets the participant’s nutritional needs, cultural preferences and household conditions.

II. Procedure:

A. The CPA shall use VENA to help determine the participant’s food usage.

B. All pregnant or partially breastfeeding women not requiring a special needs food prescription shall be offered the full nutrition benefit consisting of the following:

1. 5.5 gallons of 1% milk, low-fat milk, or skim milk 2. 1 dozen eggs 3. 1 pound of dry beans or 4 (15-16 oz) cans of beans AND 16-18 oz peanut butter 4. 3 (12 oz) cans of frozen juice concentrate 5. 36 ounces of cereal 6. 1 pounds of whole grains (whole wheat bread, brown rice or soft corn or whole wheat tortilla) 7. $10.00 cash value benefit for fresh, frozen or canned fruits and vegetables

C. The CPA can do the following individual tailoring:

1) Provide lactose free milk, soy milk or UHT milk when indicated by the household situation.

2) Provide a special needs food prescription in accordance with FDS 02.2.2 when required.

3) Reduce the quantity of food based on the participant preference and food usage.

a. If the quantity of food is reduced the reason needs to be recorded in Crossroads.

Division of Community Nutrition

Subject: Food V – Pregnant and Women Providing “Mostly” Breast Milk Policy: FDS 02.2.4 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 2 of 2

4) Provide 1 pound of cheese based on participant preference. a. If cheese is provided 0.75 gallons of milk will be reduced from the food package

(fds-02.2.5)Virginia WIC Policy and Procedures Manual FDS 02.2.5: Food Package VI- Postpartum#

(fds-02.2.5)(document-1)#

Division of Community Nutrition

Subject: Food Prescription VI – Postpartum and Women Providing “Some” Breast Milk Policy: FDS 02.2.5 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

All postpartum women and women providing “some” breast milk (receiving more than half of the maximum allowed amount of formula for their infant) shall be prescribed a food package that is based on age, meets the participant’s nutritional needs, cultural preferences and household conditions. Women who are providing “some” breast milk and continue to breastfeed beyond 6 months will be maintained as active participants without a food prescription.

II. Procedure:

A. The CPA shall use VENA to help determine the participant’s food usage.

B. All postpartum women not requiring a special needs food package shall be offered the standard package consisting of the following:

1. 4 gallons of 1% milk, low-fat milk, or skim milk 2. 1 dozen eggs 3. 1 pound of dry beans or 4 (15-16 oz) cans of beans OR 16-18 oz peanut butter 4. 3 (12 oz) cans of frozen juice concentrate 5. 36 ounces of cereal 6. No whole grains (whole wheat bread, brown rice or soft corn or whole wheat tortilla) 7. $10.00 cash value benefit for fresh, frozen or canned fruits and vegetables

C. The CPA can do the following individual tailoring for each postpartum participant:

1) Provide lactose free milk, soy milk or UHT milk when indicated by the household situation

2) Provide a special needs food prescription in accordance with FDS 02.2.2 when required

3) Reduce the quantity of food based on the participant preference and food usage

Division of Community Nutrition

Subject: Food Prescription VI – Postpartum and Women Providing “Some” Breast Milk Policy: FDS 02.2.5 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 2 of 2

a. If the quantity of food is reduced the reason needs to be recorded in Crossroads

4) Provide 1 pound of cheese based on participant preference. a. If cheese is provided 0.75 gallons of milk will be reduced from the food package

(fds-02.2.6)Virginia WIC Policy and Procedures Manual FDS 02.2.6: Food Package VII - Fully Breastfeeding#

(fds-02.2.6)(document-1)#

Division of WIC & Community Nutrition Services

Subject: Food Package VII – Fully Breastfeeding Policy: FDS 02.2.6 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

All women who fully breastfeed their infants (i.e., does not receive any formula from the WIC Program) OR women who are pregnant and breastfeeding shall be prescribed a food package that is based on age, meets the participant’s nutritional needs, cultural preferences and household conditions. The Fully Breastfeeding Food Package VII includes more variety and quantity of food.

II. Procedure:

A. The CPA shall use VENA to help determine the participant’s food usage.

B. All fully breastfeeding participants not requiring a Special Needs food package shall be offered the standard package consisting of the following:

1. 6 gallons of 1% milk, low-fat milk, or skim milk 2. 1 pound of cheese 3. 2 dozen eggs 4. 1 pound of dry beans or 4 (15-16 oz) cans of beans AND 16-18 oz peanut butter 5. 3 (12 oz) cans of frozen juice concentrate 6. 36 ounces of cereal 7. 1 pounds of whole grains (whole wheat bread, brown rice or soft corn or whole wheat tortilla) 8. $10.00 cash value benefit for fresh, frozen or canned fruits and vegetables 9. 30 ounces tuna or salmon

C. If formula is requested for the infant(s), discontinue Food Package VII prescription.

1) Counsel the breastfeeding participant on the effects formula supplementation will have on breast milk production.

2) Refer the breastfeeding participant to a breastfeeding peer counselor.

Division of WIC & Community Nutrition Services

Subject: Food Package VII – Fully Breastfeeding Policy: FDS 02.2.6 Reference: N / A Effective: October 1, 2014 Supersedes: August 12, 2013

Page 2 of 2

D. Women who are fully breastfeeding multiple infants will receive 1.5 times the amount of food in Food Package VII.

E. Additional quantities of food will be added to the first month of food instruments in the certification period and will then alternate every other month on the food instruments.

F. The CPA can do the following individual tailoring:

1) Provide lactose free milk, soy milk or UHT milk when indicated by the household situation

2) Provide a special needs food prescription in accordance with FDS 02.2.2 when required

3) Reduce the quantity of food based on the participant preference and food usage

a. If the quantity of food is reduced the reason needs to be recorded in Crossroads.

4) Provide 1 pound of cheese based on participant preference. a. If cheese is provided 0.75 gallons of milk will be reduced from the food package

(fds-03.1)Virginia WIC Policy and Procedures Manual FDS 03.1: Contract Infant Formula#

(fds-03.1)(document-1)#

Division of Community Nutrition

Subject: Contract Infant Formula Policy: FDS 03.1 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 15, 2012

Page 1 of 2

I. Policy:

The local agency shall provide a contract formula (Abbott Similac Advance, Abbott Similac Sensitive or Abbott Similac Soy Isomil) unless a special formula is prescribed by a health care professional. Iron-fortified formula is provided for infants up to 12 months of age.

II. Procedure(s):

A. Powder or Concentrate Contract Formula

1) Abbott Similac Advance (13-fl oz concentrate or 12.4 oz. powder) shall routinely be provided

2) Abbott Similac Soy Isomil (13-fl oz. concentrate or 12.4 oz. powder) or Abbott Similac Sensitive (13-fl oz. concentrate or 12.6 oz. powder) shall be provided when a participant is intolerant to or has a medical condition which prohibits the use of Abbott Similac Advance

a. Abbott Similac Soy Isomil, Abbott Similac Sensitive and Abbott Similac Advance EarlyShield are kosher products and appropriate for individuals following religious dietary practices

b. Abbott Similac Soy Isomil and Abbott Similac Sensitive do not require the completion of a WIC-395

B. Ready-to-Feed Contract Infant Formula

1) Ready to feed formula shall be authorized when the CPA determines one or more of the following:

a. Unsanitary or restricted water supply.

b. Parent / legal guardian or caretaker has difficulty in correctly diluting concentrated or powdered formula.

c. RTF formula better accommodates the participant’s condition (special formula only)

d. RTF formula improves the participant’s compliance in consuming the prescribed formula (special formula only)

2) Upon determination that a participant is eligible to receive a ready-to-feed formula, the CPA shall complete and submit a Request for Ready to Feed Formula, WIC-407.

Division of Community Nutrition

Subject: Contract Infant Formula Policy: FDS 03.1 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 15, 2012

Page 2 of 2

a. File a copy of the WIC-407 in the participant’s record.

b. A request for ready-to-feed formula shall be renewed at each WIC certification.

c. This process does not apply to formulas that are only available in the ready-to-feed form.

C. Infants who transfer from another state shall use the contract formula unless the health care professional requests a special formula.

(fds-03.2)Virginia WIC Policy and Procedures Manual FDS 03.2: Medical Documentation for Special Formula and Supplemental Foods#

(fds-03.2)(document-1)#

Division of Community Nutrition

Subject: Medical Documentation for Special Formula and Supplemental Foods Policy: FDS 03.2 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 1, 2010

Page 1 of 4

I. Policy: Special formulas (include exempt infant formulas and medical foods) and supplemental foods are only allowed when a licensed health care professional, authorized to write medical prescriptions under State law, determines that a participant has a qualifying medical condition that restricts the use of Similac Advance, Similac Sensitive, or Similac Soy Isomil.

II. Procedure

A. Participants who are eligible to receive special formula shall have one or more qualifying conditions which include but are not limited too:

1) Premature birth 2) Low birth weight 3) Failure to thrive 4) Inborn errors of metabolism 5) Metabolic disorders 6) Gastrointestinal disorders 7) Malabsorption syndromes 8) Immune system disorders 9) Severe food allergies 10) Diseases or disorders that impair ingestion, digestion, absorption or utilization of nutrients

B. Refer to FDS 03.3 for special formulas approved for use in the Virginia WIC Program.

C. A Request for Special Food Package Form, WIC-395, shall be completed for all special formulas and supplemental foods. A new WIC-395 is required each certification period or whenever the special formula supplemental food is changed to another special formula supplemental food.

1) If a ready to feed formula is requested, the Request for Ready to Feed Formula form, WIC-407, shall be electronically submitted to the SWO, and a copy filed in the participant’s record. If the formula is only available in the ready to feed form, the WIC-407 does not need to be completed.

2) Ready to feed formula shall be authorized when the CPA determines one or more of the following:

a. Unsanitary or restricted water supply.

Division of Community Nutrition

Subject: Medical Documentation for Special Formula and Supplemental Foods Policy: FDS 03.2 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 1, 2010

Page 2 of 4 b. Parent / legal guardian or caretaker has difficulty in correctly diluting concentrated or powdered formula.

c. If a ready to feed form better accommodates the participant’s condition.

d. If a ready to feed form improves the participant’s compliance in consuming the prescribed formula.

D. Obtain a completed WIC-395 from the health care professional.

1) The CPA shall ensure the request form is complete and shall sign the form.

All medical documentation shall include the following:

a. The name of the approved WIC formula prescribed and the amount needed per day.

b. The authorized supplemental foods appropriate for the qualifying conditions and their amounts.

c. The length of time the prescribed WIC formula and/or supplemental food is required by the participant.

d. The qualifying condition(s) for issuance of the formula and/or supplemental food.

e. Signature, date and contact information of the licensed health care professional authorized to write medical prescriptions under State Law.

f. The CPA shall determine if the special formula is approved by the Virginia WIC Program in FDS 03.3.

i. If the special formula requested is not on the list of approved formulas, the CPA shall consult the Approved Infant Formula list or contact the State Nutrition Liaison, and notify the health care professional.

ii. If the special formula is not a WIC eligible formula that is approved by USDA, the CPA shall notify the health care professional.

2) Medical documentation shall be written and may be provided as an original document, and electronic document, by facsimile or by telephone to a CPA until written confirmation is received.

Division of Community Nutrition

Subject: Medical Documentation for Special Formula and Supplemental Foods Policy: FDS 03.2 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 1, 2010

Page 3 of 4

E. If the health care professional submits a referral form, note or hospital discharge sheet this may be used in place of the WIC-395 providing all information and the health care professional’s signature is obtained.

1) Staple the referral form, note, or hospital discharge sheet to the WIC-395. The CPA shall sign and date. Scan into the participant’s record.

F. Contact the health care professional if all of the information on the WIC-395 is not submitted.

1) Medical documentation may be provided by telephone to a CPA until written confirmation is received from the health care professional.

2) The missing information and the health care professional’s signature shall be provided in writing within 5 business days.

G. If a written request is not available, contact the health care professional to obtain a completed WIC-395. The CPA shall sign and date. File in the participant’s record.

H. Special formula shall not be issued without a completed WIC-395.

I. The CPA shall determine the maximum allowable amount of formula the WIC Program can provide. See the FDS 02.2 for the Maximum Formula Allowed.

1) If the requested amount of formula is more than the maximum amount allowed, the CPA shall notify the health care professional.

a. Inform the health care professional that the total amount requested can not be provided and explain the maximum amount WIC can provide.

b. Document in the participant’s record.

2) More than one special formula may be provided, but the total formula amount shall not exceed the maximum formula allowed.

J. For Nutramigen, Alimentum and Pediasure:

1) Food benefits for these special formulas shall be redeemed at a local store. Uncheck the “State Ordered” check box. Crossroads will automatically adjust the number of food benefits issued.

2) If the formula cannot be obtained at the local store, follow CAP ordering procedures in accordance with FDS 03.2.3.

3) Food instruments shall not exceed the $125.00 limit.

Division of Community Nutrition

Subject: Medical Documentation for Special Formula and Supplemental Foods Policy: FDS 03.2 Reference: CFR §246.10 Effective: August 12, 2013 Supersedes: September 1, 2010

Page 4 of 4

K. Whenever a formula is changed, instruct the parent / legal guardian, caretaker or proxy to return all unused formulas to the local agency. Formula shall not be returned to retail stores.

1) Follow the procedure for replacing formula or partial month’s food instruments in Crossroads.

2) The CPA shall change the food package.

3) Returned formula shall be provided to other participants in need of that specific formula.

4) Obtain a completed WIC-395 if a new special formula, medical food or supplemental food is requested or changed to a contract formula.

(fds-03.2.1)Virginia WIC Policy and Procedures Manual FDS 03.2.1: Returned Formula Issuance and Inventory#

(fds-03.2.1)(document-1)#

Division of Community Nutrition

Subject: Returned Formula and Nutritionals Policy: FDS 03.2.1 Reference: N / A Effective: July 1, 2020 Supersedes: August 12, 2013

Page 1 of 4

I. Policy: The local agency shall ensure that all unused formula and nutritionals issued to participants are returned to the Local Agency. Returned formula and nutritionals shall not be distributed to participants. Approved formulas and nutritionals shall be donated to local food assistance programs and all others shall be disposed of.

II. Procedure:

A) All unused formula and nutritionals issued by the Virginia WIC Program shall be returned to the Local Agency.

1) Participants, or the parent, legal guardian, or caretaker of participants, who are issued formula/nutritionals to their eWIC account shall be encouraged not purchase the full amount until tolerance has been established to decrease the incidence of formula/nutritionals returned to clinic.

2) Upon receiving WIC-issued formula/nutritionals, WIC personnel shall complete the Returned Formula and Nutritional Inventory (WIC-404) Form.

3) The WIC Coordinator or designated Site Supervisor shall review and sign all WIC- 404 forms for clinics within the Local Agency monthly, as outlined in the form procedures.

B) Local Agencies shall not accept, store, or distribute any formula/nutritional that was not WIC-issued, to include product samples not intended for sale.

C) WIC personnel shall inspect all returned formula/nutritionals to verify that they have not been opened and are still sealed and to also check for visible defects, dents, or evidence of tampering and the “use-by-date”.

1) All formula/nutritionals determined to have been opened, defective, dented, tampered with, expired, or otherwise unsafe for consumption shall be properly disposed, regardless of product type.

D) Local Agencies shall not provide formula/nutritionals directly to WIC applicants, participants, or employees for any reason.

Division of Community Nutrition

Subject: Returned Formula and Nutritionals Policy: FDS 03.2.1 Reference: N / A Effective: July 1, 2020 Supersedes: August 12, 2013

Page 2 of 4 E) Formula/nutritional orders delivered directly to the Local Agency from the formula distribution warehouse shall only be issued to the participant for which they were ordered.

1) Formula/nutritional orders that are delivered to the Local Agency and are not picked up prior to First Date to Spend (FDTS) of that participant’s next set of benefits shall be issued to the participant during their current certification period in place of ordering additional formula from the formula distribution warehouse.

(a) If the formula/nutritional is not approved for retail purchase, it shall be issued to the participant’s eWIC account to ensure that participation is accurately documented. A family alert should then be added to the participant’s record to document this occurrence.

(b) If the formula/nutritional is approved for retail purchase (even if the participant or their parent, legal guardian, and/or proxy cannot locate it at a local WIC-approved vendor), the placeholder formula “Previous CAP Order” shall be added to the participant’s food prescription to ensure that participation is accurately documented and to prevent over issuance of benefits. A family alert should then be added to the participant’s record to document this occurrence.

F) Local Agencies shall donate formula and nutritional products when possible.

1) Formulas and nutritionals that are approved for donation include:

(a) Contract infant formulas approved for donation: (i) Similac Advance (ii) Similac Sensitive (iii) Similac Total Comfort (iv) Similac for Spit-Up (v) Similac Soy Isomil

(b) Exempt Infant Formulas approved for donation: (i) Similac Alimentum (ii) Similac Neosure (iii) Enfamil Nutramigen (iv) Enfamil EnfaCare (v) EleCare Infant (vi) PurAmino (vii) Gerber Extensive HA

Division of Community Nutrition

Subject: Returned Formula and Nutritionals Policy: FDS 03.2.1 Reference: N / A Effective: July 1, 2020 Supersedes: August 12, 2013

Page 3 of 4 (c) Nutritionals approved for donation: (i) Pediasure (ii) Pediasure with Fiber (iii) Pediasure Sidekicks (iv) Boost Kid Essentials (v) Boost (vi) Ensure

2) Formula and nutritionals that are approved for donation shall only be donated to local food assistance programs with which the Local Agency has established a Coordination of Services, as outlined in policy CRT 08.0.

(a) Donation of formula/nutritionals shall occur at least quarterly.

(i) On the day of donation, the Local Agency shall complete the Local Agency Formula and Nutritional Donation Log (WIC-405) to document the details of all formula/nutritional donations.

(ii) On the day of the donation, the receiving local food assistance program shall complete the Donation of WIC Formula Acknowledgement Form (WIC-388) to document the receipt of all formula/nutritional donations.

G) Local Agencies shall dispose of all formula and nutritionals that are not approved for donation.

1) Formula and nutritionals not approved for donation include:

(a) All formula and nutritional varieties not explicitly listed above as being approved for donation.

(b) All formula and nutritionals deemed to be opened, defective, dented, tampered with, expired, or otherwise unsafe for consumption, regardless of product type.

2) Formula/nutritional disposal shall occur by the end of the on which the product was returned to clinic.

(a) Powder formula/nutritionals shall be opened and emptied into the garbage.

(b) Concentrate and Ready-To-Feed (RTF) formula/nutritionals shall be opened and emptied down the drain of a sink.

Division of Community Nutrition

Subject: Returned Formula and Nutritionals Policy: FDS 03.2.1 Reference: N / A Effective: July 1, 2020 Supersedes: August 12, 2013

Page 4 of 4 (c) Formula/Nutritional containers shall not be kept and must disposed of so that they are not visible in clinic.

(d) Local Agencies shall complete the Local Agency Formula and Nutritional Disposal (WIC-406) log daily to document the details of all formula/nutritional disposals.

(fds-03.2.2)Virginia WIC Policy and Procedures Manual FDS 03.2.2: Special Formula Ordering#

(fds-03.2.2)(document-1)#

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 1 of 15

I. Policy:

Non-contract formula (Special formula) shall be provided by the Community Action Program (CAP) Distribution Center. The CAP Distribution Center, herein referred to as the Distribution Center, shall ship requested formula to either the local agency or the participant’s home whichever is more appropriate.

II. Procedure(s):

A. Local Agency Determination of Ordering Special Formula - local agency shall determine:

1) Participant eligibility to receive special formula;

2) Quantity and type of special formula to be issued to the participant;

3) The full formula product name shall be written on the Formula Shipping Request Form WIC-396 (i.e. w / iron, w/o iron, w / fiber, 20 calorie, 24 calorie and flavor);

4) Availability of special formulas at retail store within a reasonable distance; Note: The following formulas shall be provided through approved retail stores unless they are not available: Nutramigen (all types), Alimentum (all types) and Pediasure (with or without fiber). Issue a maximum one-month issuance of these WIC food benefits to the parent or legal guardian. If either of these formulas is not available, the Distribution Center shall be used to supply these products. 5) All products packaged in glass containers shall be shipped to the local agency or other administrative offices designated by the local agency. All other special formulas shall be shipped to either the local agency or to the parent/ legal guardian / proxy’s home;

6) Local agency personnel shall discuss with parent / legal guardian / proxy / caretaker their availability and product safety before shipping formula to a parent / legal guardian’s home. The parent / legal guardian / proxy / caretaker shall be available at the home address between 8:00 am to 8:00 pm to sign for the delivery of formula;

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 2 of 15

7) The local agency shall inform the parent / legal guardian / proxy / caretaker requesting home delivery;

a) A person shall be at the parent / legal guardian / proxy’s home during the daytime to sign for receipt of the formula. Special formula orders shall not be replaced if the Distribution Center provides proof that formula was delivered.

b) Damaged formula shall be refused in total quantity and not signed for at the time of delivery. The parent / legal guardian / proxy shall refuse only the damaged box of a special formula order. Boxes not damaged in a special formula order shall be accepted. The parent / legal guardian / proxy shall contact the local agency for a total quantity replacement order.

B. Local Agency Special Formula Order

1) Local agency personnel in completing the Special Formula Shipping Request Form WIC-396 shall print in large, clearly legible handwriting to ensure the right product is provided. A maximum one-month issuance shall be ordered from the Distribution Center at a time. Special formula is ordered based upon number of cans needed by the participant. The local agency does not have to order special formula products by case.

2) The local agency shall issue only one WIC food benefit for each special formula order.

3) A thirty-day spend period shall be issued on all special formula food benefits that shall be ordered through the Distribution Center, unless a proration situation exists.

4) Rules for the proration of formula for special formulas:

a. If the parent / legal guardian / proxy / caretaker are up to 10 days late picking up food benefits, he / she shall not lose any cans of formula.

b. If the parent / legal guardian / proxy / caretaker is 11 to 20 days late, he / she shall lose 1/3 the number of cans.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 3 of 15

c. If the parent / legal guardian / proxy / caretaker are > 20 days late, up to the day before the next food instrument pickup day, the client shall lose 2/3 of his / her number of cans.

d. A parent / legal guardian / proxy / caretaker shall not pick up his / her special formula WIC food benefits for the next month until 10 days prior to their next food benefit pickup date.

5) All special formula food benefits shall be issued before preparing the Special Formula Shipping Request, WIC-396

6) A separate WIC-396 shall be completed for each participant special formula line item. Only one special formula may be ordered per each WIC-396. All information on the WIC-396 is required and shall be completed to order any special formula.

7) The full product name of the formula shall be written on the WIC-396 (i.e. w / iron, w/o iron, w / fiber, 20 calorie, 24 calorie and flavor).

8) The WIC-396 shall exactly match the information for the issued food benefits (i.e. participant ID, formula name, quantities and food benefit issuance number) before obtaining the parent or legal guardian’s signature.

9) Obtain the parent / legal guardian / proxy’s signature for the special formula issued to the participant. The local agency may be held financially liable for payment of any special formula food benefits flagged as “State Ordered” that do not have a signature from the parent / legal guardian / proxy.

10) The price box area on the food benefit shall be left blank. Local agency personnel shall not issue food benefits for special formula that have been flagged in the Crossroads system as “State Ordered” to the parent / legal guardian / proxy.

11) If the participant is to receive other WIC approved foods, then these food benefits shall be issued to the parent / legal guardian / proxy. The parent / legal guardian / proxy / caretaker shall sign for the WIC food benefits as per normal procedures.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 4 of 15

12) An alternate method to ordering by Crossroads transmission is by telephone. All information contained on the WIC-396 shall be provided when an order is placed by telephone. The Distribution Center telephone number is 1-717-293-0187.

13) If local agency personnel have any questions regarding your order, directly contact the Distribution Center. When leaving an inquiry about an order, leave a message containing the participant’s name, the participant’s ID number, a phone number including area code, and a brief description of the nature of the question. With that information, Distribution Center personnel may be able to call you back quickly with the answer. The Distribution Center order-processing deadline during a business day shall be 2:00 PM. Orders received after 2:00 PM may be processed the next business day.

14) Local agency personnel shall confirm the successful transmission of the WIC-396 in Crossroads.

15) Local agency personnel shall not retransmit a previously sent WIC-396 unless instructed to do so by the Distribution Center.

16) If the local agency is unsure the WIC-396 was successfully transmitted, they shall call the Distribution Center to confirm the receipt of the order prior to re-sending the transmission. Local agency personnel shall not transmit a 2nd attempt without contacting the Distribution Center.

17) The local agency shall be held financially liable for duplicative orders processed by the Distribution Center, if multiple orders for the same prescription were sent to the Distribution Center and issuance from on-hand inventory cannot be used.

18) The State WIC Office shall follow up and confirm that a duplicative order processing error exists.

19) The WIC-396 shall be kept in the participant’s file.

20) Duplicate special formula orders received at the parent / legal guardian / proxy / caretaker home or local agency shall only be charged against a submitted order and the issued food benefit for that order. Arrangements with the Distribution Center to off set the cost of duplicate orders with future orders and/or unrealized food benefits issuances are prohibited.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 5 of 15

C. Payment for Special formula

1) Payment for special formula orders submitted to the Distribution Center shall be made by sending the food benefit issuance from Crossroads to the Distribution Center. The Distribution Center, after receiving an issuance, deposits it and receives payment from the WIC Program for the special formulas ordered by the local agencies.

2) Local agency personnel shall send the signed WIC food benefit issuance from Crossroads to CAP.

3) The State WIC Office shall follow up with local agencies when a food benefit issuance is not received for a submitted order. The local agency shall be held financially liable when a pattern of non-compliance is documented during three consecutive months.

4) The Distribution Center will not contact the local agency when a food benefit issuance is not received or deemed as past due. The State WIC office shall conduct a follow up with local agencies when a food benefit issuance is not received for a submitted order.

D. Special Formula Shipment to Participant’s Home

1) When formula is sent to the parent / legal guardian / proxy’s home, the Distribution Center shall have a physical address, an apartment number, suite or trailer lot number (not a Post Office Box). A physical address shall be documented in the Crossroads system for that parent / legal guardian / proxy.

2) A person shall be at the parent / legal guardian / proxy’s home during the daytime to sign for receipt of the formula. (It is important that parent / legal guardian / proxy / caretaker understand they should only request home delivery if a person is home to accept delivery). The commercial delivery service is not under any obligation to obtain a signature if the delivery is attempted and no one is available to sign for the special formula.

3) Local agency personnel shall inform the parent / legal guardian / proxy / caretaker they shall verify that delivered formula is not damaged or broken prior to signing for delivery.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 6 of 15

4) When formula containers are damaged, the parent / legal guardian / proxy / caretaker shall refuse to accept the shipment at the time of delivery and shall not sign for the order as received.

5) Damaged formula shall be refused in total quantity and not signed for at the time of delivery. The parent / legal guardian / proxy / caretaker shall refuse only the damaged box of a special formula order. Boxes not damaged in a special formula order shall be accepted. The parent / legal guardian / proxy / caretaker shall contact the local agency for a total quantity replacement order.

6) Local agency personnel shall inform the parent / legal guardian / proxy / caretaker when to expect delivery. This shall normally be 2-4 business days after the order is placed.

7) The parent or legal guardian shall be instructed that if the order is not received within (5) five business days after being placed, the local agency shall be contacted. The local agency shall contact the Distribution Center within 8 business hours at 1-717-509-7962 to trace the order. Local agency personnel shall not give the Distribution Center’s phone numbers to the parent / legal guardian / proxy.

8) Instruct the parent / legal guardian / proxy / caretaker that should the need for formula change or be discontinued, they shall immediately notify the local agency and return the unused portion of the formula before receiving food benefits for a new formula.

9) Notify the parent / legal guardian / proxy / caretaker that if formula is out-of date when received from the Distribution Center then he / she shall return it to the local agency site for replacement.

10) Formula in glass bottles shall not be shipped to the participant’s home and shall be shipped to the ordering local agency.

E. Special Formula Shipment to Local Agency

1) The special formula shall be delivered to the local agency when it is not feasible to send it to the parent / legal guardian / proxy’s home.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 7 of 15

2) All formula in glass bottles shall be shipped to the local agency. This is due to the high possibility of breakage with glass and to the extremely narrow range of acceptable temperatures for formula.

3) Local agency personnel shall verify that the delivered formula is not damaged or broken prior to signing for delivery.

4) Local agency personnel shall have the option to refuse the entire shipment or accept partial shipments at the time of delivery when formula containers are found to be damaged.

5) Local agency personnel shall verify that the delivered formula is not damaged or broken immediately after taking possession of delivery when the delivery company does not allow inspection prior to signing for delivery.

6) The parent / legal guardian / proxy / caretaker shall either contact the site when the product is due in (normally 2-4 business days after the order is placed) or have local agency personnel call when the product has been received.

7) Instruct the parent / legal guardian / proxy / caretaker that should the need for formula change or be discontinued they shall immediately notify the local agency and return the unused portion of the formula before receiving food benefits for a new formula.

8) Local agency personnel shall inspect delivered formula to ensure the formula is not out–of–date before issuing to the participant.

9) Local agency personnel shall maintain a Special Formula Order Log (WIC-389), and record all formula orders placed and received through the Distribution Center. Please refer to the WIC-389.

F. Damaged / Broken Formula

1) The Distribution Center shall only replace damaged formula after receiving a Special Formula Replacement Request Form (WIC-397) from the local agency or State WIC Office.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 8 of 15

2) For damaged / broken formula the local agency personnel shall complete and send the Damaged / Breakage or Outdated Report for Special Formula WIC-394 to the Distribution Center. This documentation shall include product type and quantity.

3) Local agency personnel shall report, by submitting a WIC-394 to the State WIC Office within 24 hours, from the date of receipt of any damaged special formula.

4) Local agency personnel shall send the WIC-394 to the Distribution Center within 24 hours from the date of receipt. The original shall be maintained by the local agency in the participant’s file.

5) Once documentation is completed, the damaged formula shall be discarded or destroyed.

6) If the local agency accepts delivery of damaged / broken special formula and formula is identified after receipt, then the formula shall be replaced by, the Distribution Center in accordance with damaged and replacement formula procedures.

7) Local agency shall be held financially responsible for reimbursing the State WIC Office for the cost of the damaged special formula replacement when the local agency fails to submit a WIC-394 within the stated timeframe.

G. Replacement of Special formula

1) Special formula shall only be replaced and paid for by the Virginia WIC Program for the following reasons:

a. If formula is damaged and the WIC-394 and WIC-397 are submitted to the Distribution Center, or

b. Out-of date, or

c. Non-receipt of initial order (in this case the replacement order shall be sent to the local agency site), or

d. Incorrect order shipped / received (delivery shall be refused).

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 9 of 15

2) The top of the Special Formula Shipping Request Form WIC-397 shall be marked void and filed in the participant’s record with a notation of non-receipt or damaged, date returned and WIC personnel initials.

3) The local agency personnel shall complete the WIC-397. All information requested on the form shall be completed.

a. All replacement requested for formula not damaged shall preferably be done through the Crossroads. An alternate ordering method is to telephone all information using the Distribution Center 1-717-509-7962 telephone number. The Distribution Center processing deadline for a business day shall be 2:00 PM.

b. All replacement requests for damaged formula shall be submitted to the Distribution Center using the WIC-397.

c. A copy of the WIC-397 shall be maintained with the voided original WIC-396 in the participant’s file.

H. Usage of Returned Formula

1) Special formula that is returned by the parent / legal guardian / proxy / caretaker or is not needed once received from the Distribution Center shall be issued to another participant.

2) If the product shall go out of date within ninety (90) days, or if usage of the formula at the local agency is considered unlikely, notify only local sites within your health district that the formula is available.

a. The local agency (requesting site) prior to accepting the formula shall insure there is sufficient formula to fill a participant’s entire food prescription (either partial month or complete month).

b. The local agency (sending site) shall make arrangements to ship the formula to the requesting location. Use only a carrier that shall track or trace package delivery.

4) The parent / legal guardian / proxy / caretaker shall sign a Special Formula Acknowledging Form (WIC-388) which confirms receipt of the special formula.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 10 of 15

The signed statement shall include the parent / legal guardian / proxy’s name, participant ID and product. Place the signed WIC-388 in the participant’s file.

5) If the requesting local agency does not receive the formula within five business (5) days, notify the sending local agency to trace the shipment. If medically necessary, order the formula using standard procedures from the Distribution Center.

6) If formula is received in damaged / broken condition, follow the procedure for ordering the formula using standard procedures from the Distribution Center.

I. Distribution Center Processing of Orders

1) If the order is received by telephone, the Distribution Center personnel shall transcribe the order on to a WIC-396 to have a paper copy of the order. This copy shall be exactly matched with the local agency’s WIC-396 which shall be mailed / faxed to the Distribution Center at a later time.

2) The Distribution Center shall determine if requested product is in stock. If the product is in stock, the requests shall be processed as follows:

a. Verify the WIC-396 contains a 10-digit WIC food instrument number. For any order that is missing a food benefit issuance number, participant ID or critical processing information, the Distribution Center shall make two attempts to contact the local agency to obtain the missing information. The Distribution Center shall return the WIC-396 to the local agency if it is not successful after two attempts to obtain a missing benefit issuance number, participant ID or any other critical information needed to process a special formula order request. The WIC participant shall not receive any formula until a correct and complete form has been submitted.

b. Enter orders into the XLN inventory software and create a pick sheet.

c. Pull the required quantity of the formula. If loose containers are requested, they shall be packaged separately or with other cases, as most appropriate.

d. In some cases, multiple packages shall be required for a single request depending on the weight requirements of the shipper.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 11 of 15

e. Strapped shipments shall be weighed and data from the WIC-396 shall be entered into the UPS or FedEx shipping computer system.

f. Determine the most reasonable shipping carrier based on ship-to- location and cost of shipping.

g. Appropriate shipping labels shall be placed on strapped parcels and the shipping confirmation label shall be placed in the lower left corner of the WIC-396

h. Distribution Center processing deadline for a business day shall be 2:00 PM. The Distribution Center shall process and ship all requests received within one business day of receipt.

3) If the product is not available from the Distribution Center, the local agency shall fax a copy of the WIC-396 to a designated person at the State WIC Office at 1- 804-864-7854 attn: Vendor Management - special formula order. If the State WIC Office approves, the State WIC Office shall send authorization to the Distribution Center to purchase the product and a copy to the local agency acknowledging the outcome.

4) If approved by the State WIC Office, Distribution Center personnel shall special order the product from the manufacturer, in a quantity equal to two (2) times the requested order. Special shipping arrangements may be authorized by the State WIC Office to expedite the delivery process. This authorization shall be provided to the Distribution Center in writing. The local agency site that ordered the product shall be notified by telephone of the expected arrival date by the Distribution Center.

5) If the product is normally stocked by the Distribution Center but is temporarily out of stock, the Distribution Center personnel shall research when and if the product has been ordered from the manufacturer.

a. If the product has not been ordered, it shall be ordered from the manufacturer.

b. If the product has been ordered and is due in, the Distribution Center personnel shall contact the manufacturer for an expected delivery date and then notify the local agency site.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 12 of 15

c. If under any circumstances a special formula is determined to be out of stock from the manufacturer, the Distribution Center personnel shall notify the local agency as soon as possible that the product is out of stock and when it is expected to become available from the manufacturer.

J. Distribution Center Processing of Non-Receipt of Shipped Special formula

1) When the Distribution Center is notified by the local agency of non-receipt of formula, the Distribution Center shall pull the order form and trace the shipment through the carrier. The local agency shall be notified of the status of the order, as reshipment shall be sent to them, not the parent / legal guardian / proxy’s address.

2) The Distribution Center shall reconcile the original shipment with the shipper either through reimbursement, if the shipment was lost, or return of the shipment.

K. Distribution Center Processing of Requested Replacement of Special Formula

1) The Distribution Center shall match the replacement request with the original order form and ship the replacement order to the local agency.

2) The Distribution Center shall hold all replacement orders regarding formula losses due to damage / breakage until the WIC-394 is received.

3) If the WIC food benefits issuance for the original order has not been reconciled, the additional shipping costs and extra costs of the replacement formula shall be added to the original food benefit issuance. The Distribution Center shall check the appropriate checkbox on the WIC-397. If the WIC food benefits issuance for the original order has been reconciled, the additional cost (which includes shipping and product replacement) shall be billed to the State WIC Office in a separate billing manner. The Distribution Center shall check the “Bill To: local agency” checkbox on the WIC-397. The Distribution Center shall submit to the State WIC Office the WIC-397 the corresponding WIC-394, and original WIC- 396 within 14 calendar days after shipping all replacement requests.

L. Distribution Center Processing of WIC Food Benefit Issuances

1) The Distribution Center shall match and reconcile WIC food benefit issuances they receive against the Formula Shipping Request forms processed. The form

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 13 of 15

shall be an exact match of quantity ordered against a specific Crossroads food issuance number. The Distribution Center shall not add on a single Crossroads food issuance payment for duplicate orders processed. The Distribution Center will not contact the local agency when a food benefit issuance is not received or deemed as past due. The State WIC office shall conduct a follow up with local agencies when a food benefit issuance is not received for a submitted order.

2) Within thirty (30) calendar days of shipping a special formula order request, the Distribution Center shall bring any outstanding and / or unmatched Formula Shipping Requests that do not have a corresponding Crossroads benefit issuance number to the attention of the designated State WIC Office contact. This follow up with the State WIC Office contact person shall be completed by the Distribution Center within 14 calendar days after the formula shipping forms had been identified as unaccounted for / missing. These unmatched / unaccounted-for Shipping Request forms shall be mailed by overnight delivery and sent to the State WIC Office. The State WIC office shall follow up with local agencies for payment.

3) The price the Distribution Center shall place on the WIC food benefit issuance shall be made up of the wholesale price for the formula shipped, plus the actual shipping cost, multiplied by 1.09 for an effective overhead charge of 9%. If any portion of the shipped formula had been returned by a local agency, that portion of the shipment shall have a zero (0) wholesale cost.

4) The wholesale price shall be used for the formula shipped. The wholesale price for the formula is defined as the Distribution Center purchase price for the formula shipped.

5) The overhead charge shall be 9.0% and it may be recalculated each year and the Special Formula Agreement adjusted to reflect the revised overhead cost.

6) The Distribution Center shall determine the shipping cost from the “shipping confirmation label” on the WIC-396.

7) All signed WIC food benefit issuances shall be deposited in the Virginia WIC Program Banking Contractor system. All Distribution Center receipts and expenditures shall be accounted for separately by the Virginia WIC Program Banking Contractor. The Distribution Center shall provide banking information to establish a direct deposit account for transfer of payment to their bank account.

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 14 of 15

8) Weekly, the Distribution Center shall gather all food benefit issuances submitted without a signature or stale dated and return them overnight to the Virginia WIC Program State WIC Office. These food benefit issuances shall be paid through the ACH banking process.

M. Maintenance of Documentation

1) The Distribution Center shall maintain the following documentation:

a. All formula orders to the manufacturers

b. All shipping receipt documents from the manufacturers

c. All processed WIC-396 received, and

d. All shipping information for formula orders sent by Distribution Center to local agencies or participants

N. State WIC Office Responsibilities:

1) Review inventory and / or redeemed WIC Food benefit documentation. A copy of inventory documentation shall be made available to the State WIC Office, upon request.

2) Perform monthly monitoring of local agency activity regarding the usage of the Distribution Center.

3) Communicate to the Distribution Center management any problems or concerns relating to the operations of the special formula Distribution Center.

4) Maintain an authorized vendor profile for the Distribution Center, which shall allow deposit of WIC food instruments with local banks and clearance through Virginia’s Banking Contractor system.

5) Perform a post payment edit of food benefits to ensure that no computation or clerical errors have resulted in an inadvertent overcharge. Any overcharge or processing errors shall be resolved with the Distribution Center.

6) Provide 2 business days turn around on WIC food benefits sent to the Distribution Center without the parent or legal guardian’s signature or stale dated, which the

Division of Community Nutrition

Subject: Special Formula Ordering Policy: FDS 03.2.2 Reference: §C.F.R. 246.2 Effective: August 1, 2018 Supersedes: August 12, 2013

Page 15 of 15

Distribution Center have batched, bundled and express mailed to the State WIC Office.

O. Local Agency Responsibilities:

1) Maintain all required documentation at the local agency.

2) Ensure that all Shipping Request Forms exactly match the corresponding Crossroads food benefit issuance sent to the Distribution Center.

3) Be responsible for ordering of Special formula from Distribution Center.

4) Make the State WIC Office aware of any service delivery problems or concerns relating to the operations of the special formula Distribution Center using procedures set forth in Retailer Compliant Handling Policy VEN 07.0.

5) Ensure special formula WIC food benefit issuances are signed prior to ordering special formula. The State WIC Office shall charge the local agency a $5.00 administrative fee for every unsigned special formula WIC food benefit issuance sent to the Distribution Center.

(fds-03.2.3)Virginia WIC Policy and Procedures Manual FDS 03.2.3: Formula/Medical Foods for Medicaid Participants#

(fds-03.2.3)(document-1)#

Division of Community Nutrition

Subject: Formula /Medical Foods For Medicaid Participants Policy: FDS 03.2.3 Reference: N/A Effective: August 12, 2013 Supersedes: August 1, 2009

Page 1 of 2

I. Policy:

Medicaid is the primary payer for all Virginia WIC approved contract and Special Exempt Formulas and Medical Foods for WIC participants receiving Medicaid. The quantity received may exceed the maximum amount allowed by WIC as prescribed by a physician in accordance with FDS 02.2.

II. Procedure(s):

a. The applicant / participant shall currently be receiving Medicaid at the time of the certification or subsequent certification visit. A current Medicaid number shall be entered in Crossroads.

b. Verify Medicaid in Crossroads and in First Health Automated Response System in accordance with FDS 03.2.4.

1) If a participant has a co-pay or third party liability (additional insurance), they shall not receive over the maximum amount of formula.

c. The Virginia Request for Special Food Package (WIC-395) shall be completed in accordance with FDS 03.2.

d. The following medical reasons must be indicated on the WIC-395 to provide over the maximum amount of any formula:

1) Contract Formula

B. Concentrating calories C. Gastro-esophageal Reflux Disease (GERD) D. Tube Feeding (formula is sole source of nutrition)

2. Special Exempt Formula

B. Concentrating calories C. Gastro-esophageal Reflux Disease (GERD) D. Tube Feeding (formula is sole source of nutrition) E. Malabsorption F. Metabolic Disorders G. Diseases that impair ingestion, digestion or absorption of nutrients

Division of Community Nutrition

Subject: Formula /Medical Foods For Medicaid Participants Policy: FDS 03.2.3 Reference: N/A Effective: August 12, 2013 Supersedes: August 1, 2009

Page 2 of 2

e. For contract formula:

1) If the amount of formula required exceeds the maximum amount allowed by WIC, the formula may be redeemed at the local retailer.

f. For Pediasure, Alimentum and Nutramigen:

1. If the amount of formula required exceeds the maximum amount allowed by WIC, the formula cannot be redeemed at a local store. Select the “State Ordered” box in Crossroads and order a one month supply through CAP. Issue only one food prescription for each CAP order in accordance with FDS 03.2.2.

(fds-03.2.4)Virginia WIC Policy and Procedures Manual FDS 03.2.4: Medicaid Verification Over the Maximum of Formula#

(fds-03.2.4)(document-1)#

Division of Community Nutrition Subject: Medicaid Verification for Over the Maximum of Formula Policy: FDS 03.2.4 Reference: N/A Effective: November 1, 2014 Supersedes: August 12, 2013

Page 1 of 3

I. Policy

Medicaid enrolled WIC participants shall undergo an external verification of Medicaid enrollment before receiving additional formula.

II. Procedure

These instructions are related to Crossroads and use of the Automated Response System(ARS) only for Medicaid benefit plan confirmation.

A. Crossroads – Medicaid Eligibility

1) WIC staff shall perform procedures set forth in CRT 05.1 to verify if the participant is Medicaid eligible or ineligible using the Crossroads system.

B. ARS / Crossroads – Benefit Plan Confirmation

1) The completion of the Crossroads benefit confirmation screen is required before Crossroads will allow additional formula over the maximum. To complete the screen in Crossroads, an online inquiry using the ARS shall be performed. WIC staff will verify in ARS and respond in the Crossroads Benefit Plan Confirmation screen that the following statements are true:

a) The participant is Medicaid eligible

2) The participant has an eligible Medicaid Benefit Plan

3) The participant’s Benefit Plan has no required Co-Pay

4) The participant is Date of Service eligible

5) The participant has no Insurance Carrier Plan

6) The participant has no Insurance Carrier Plan and Coverage Type.

C. ARS Logon - Query

1) ARS provides 24 hour a day, seven day a week internet access. The following procedures are a guide to accessing and using the ARS Web Portal on the Medicaid Web Portal.

a) To check participant eligibility and benefit plan, log on to the ARS system at http://virginiamedicaid.dmas.virginia.gov on the Virginia Medicaid Web Portal b) Select from the “ARS” drop-down menu “Secure Logon” c) Enter User ID and Password (Obtained from SWO) d) Select Provider “Virginia Department of Health” e) Select Provider Number from the drop down

Division of Community Nutrition Subject: Medicaid Verification for Over the Maximum of Formula Policy: FDS 03.2.4 Reference: N/A Effective: November 1, 2014 Supersedes: August 12, 2013

Page 2 of 3

f) Select “Eligibility Benefit Verification and Services Limits” from the ARS main menu g) Enter the enrollee Medicaid number (ID Code) assigned by DMAS; OR enter any two of the following: i. Enrollee social security number (without dashes) ii. Enrollee date of birth (MMDDYYYY) iii. Enrollee name (middle initial optional) h) Enter the Enrollee Service Date: Enter current date (MMDDYYYY) i) Enter the Provider’s Control Number: Enter the WIC participant ID number j) Service Type Code leave blank k) Constant Reference Designators and Description leave blank l) Press “Submit Query” after entering the data m) The system will display the Enrollee results

2) If the participant is not enrolled in Medicaid or the information is incorrect, a red error message will be displayed at the top of the form.

3) If the participant is not currently enrolled in Medicaid, over the maximum amount of formula shall not be prescribed.

D. ARS Result Screen

1) Verify the participant’s Medicaid Eligibility and ensure the enrollee number, name and birth date are correct. If all are correct, select the check box in Crossroads to validate statement number one.

2) Verify that the Benefit Plan is a plan listed below and within the date of service. If the plan is on the list and service date covers the date of the food benefits, select the check box in Crossroads to validate statement two and four.

Benefit Plan List

Short Name Medicaid FFS FAMIS PLUS XIX Central XIX Halifax XIX M-3 CDPR XIX M-3 LSWV XIX M-3 MCO XIX M-3 Nor VA XIX Northern XIX M-3 PCP XIX Tidewater XIX USWVA Benefit Plan Coverage Description Medicaid Fee-For-Service Children Enrolled in Medicaid

Medicaid, Medallion II Central Area Medicaid, Medallion II Halifax County Medicaid, Medallion III Charlottesville, Danville, Pittsylvania Region Medicaid Medallion III Lower Southwest Virginia Region Medicaid, Default Medallion III MCO Medicaid, Medallion III MCO Northern Virginia Area Medicaid Services Northern Virginia Medicaid, Medallion III MEDALLION PCP Medicaid, Medallion II Tidewater Area Medicaid, Medallion II Upper Southwest Virginia Area

Division of Community Nutrition Subject: Medicaid Verification for Over the Maximum of Formula Policy: FDS 03.2.4 Reference: N/A Effective: November 1, 2014 Supersedes: August 12, 2013

Page 3 of 3

3) Verify the Benefit Plan Co-pay indicator using the list below. When no co-pay is required, select the check box in Crossroads to validate statement number three.

Co-Pay Indicator List

A = No Co-Pay B = No Co-Pay C = Co-Pay required

4) TPL (Third Party Liability) Information

a) If the participant has no Insurance Carrier, select the check box in Crossroads to validate statement number five.

b) If the participant has no Carrier Code and Coverage Type, select the check box in Crossroads to validate statement number six.

5) Select the exit button and log out of ARS.

E. Once all statements are validated in Crossroads, prescribe additional formula over the maximum amount. If all statements cannot be validated, over the maximum amount of formula shall not be given.

(fds-04.2)Virginia WIC Policy and Procedures Manual FDS 04.2: Food Benefits Issuance#

(fds-04.2)(document-1)#

Division of Community Nutrition

Subject: Food Benefits Issuance Policy: FDS 04.2 Reference: C.F.R. §246.2 Effective: March 15, 2019 Supersedes: August 1, 2017

Page 1 of 2

I. Policy:

All food benefits shall be issued through the Crossroads system after eligibility has been documented and only when the participant, parent / legal guardian, caretaker, or proxy is physically present at the local agency to have their food benefits loaded, except when there is a system outage or system issue. The participant, parent / legal guardian, caretaker, or proxy is required to complete an electronic signature to acknowledge receipt of all food benefits, or complete a delayed signature form authorizing local agency staff to sign for benefits on their behalf.

II. Procedure(s):

A. Food prescriptions shall not be loaded prior to the participant, parent / legal guardian, caretaker, or proxy being physically present at the local agency except as specified in policy FDS 04.2.1.

B. Local agency personnel are responsible for reviewing the entire food prescription with the participant, parent / legal guardian, caretaker, or proxy to ensure complete accuracy of the food prescription. Review shall include, but is not limited to the following:

1) Family ID number 2) Name 3) Dates 4) Signatures 5) Food prescription 6) Special formula ordering status

C. Food prescriptions shall be voided, in accordance with FDS 04.6, if any information in the food prescription is incorrect.

D. An “X” signature is allowed for persons unable to sign their name. WIC personnel shall note “witnessed by” and place their initials beside the “X”.

E. If the participant, parent / legal guardian, caretaker, or proxy fails to sign complete the electronic signature, personnel shall note “Failed to Sign”, the date, and personnel initials in the Crossroads system. While this documents awareness of omission, it remains an audit exception. This should only be used when all other efforts to comply have failed.

F. Inform the participant, parent / legal guardian, caretaker, or proxy that failure to attend the initial nutrition education appointment may result in reduced WIC food benefits for that month in accordance with FDS 04.4, Prorating of Food Prescriptions.

Division of Community Nutrition

Subject: Food Benefits Issuance Policy: FDS 04.2 Reference: C.F.R. §246.2 Effective: March 15, 2019 Supersedes: August 1, 2017

Page 2 of 2

G. Verbally inform participant, parent / legal guardian, caretaker, or proxy that failure to receive food benefits within ninety (90) days of the last date to spend on the most recently issued eWIC benefits shall result in an automatic termination from the Program.

(fds-04.2.1)Virginia WIC Policy and Procedures Manual FDS 04.2.1: Food Benefit Issuance without Physical Presence#

(fds-04.2.1)(document-1)#

Division of Community Nutrition

Subject: Food Benefit Issuance without Physical Presence Policy: FDS 04.2.1 Reference: N/A Effective: August 1, 2017 Supersedes: N/A

Page 1 of 2

I. Policy:

WIC personnel are allowed under specified conditions to upload participants’ food benefits to their eWIC account without the participant/parent/guardian/caretaker/proxy being physically present at the clinic.

II. Procedure(s):

A. A Delayed Benefits Signature Authorization form (WIC-318) shall be completed and scanned into Crossroads for every family.

1) WIC staff shall verbally explain the purpose of the form and its uses to the participant/parent/guardian/caretaker prior to signature.

2) The form is in effect for 1 year from the date of signature.

3) Once completed and signed, the Delayed Benefits Signature Authorization (DBSA) form shall be scanned into the family record in Crossroads. The original of the form shall be provided to the participant.

4) A Family Alert shall be entered in Crossroads stating when the form expires and whether or not authorization was given. This alert shall be deactivated when a new form takes effect and a new alert shall be entered.

B. Benefits to the eWIC account by WIC personnel in the absence of the participant as follows:

1) System issues/outages that prohibit the entering or issuing of food benefits

2) Food prescription changes

3) Formula change without in-hand formula to return/exchange

4) Incorrect initial benefit issuance

5) Benefits issued on a one month interval in months when a Secondary Nutrition Education contact is not required

6) Breastfeeding status change and/or formula increase for a participant who does not have a breast pump that needs to be returned

7) Staff is not accessible for meeting separation of duty requirements

Division of Community Nutrition

Subject: Food Benefit Issuance without Physical Presence Policy: FDS 04.2.1 Reference: N/A Effective: August 1, 2017 Supersedes: N/A

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C. Benefits may not be uploaded to the eWIC card by WIC personnel in the absence of the participant when:

1) Secondary Nutrition Education, to include group, individual, and High Risk contacts, is due

2) HealthBites on-line Secondary Nutrition Education has been completed

3) Formula change involves formula in-hand to return/exchange

4) Breastfeeding status changes and/or formula increases for a participant who has been issued a breast pump that needs to be returned

5) Authorization was not allowed by the participant on the DBSA or there is not a current DBSA on file

6) Determination of subsequent certification eligibility is due

D. In all cases where the WIC staff sign for food benefits the reason why the participant did not sign for benefits shall be entered under the staff signature.

1) For situations involving changes in formula, the participant shall be contacted by a CPA and informed of the details of the change. An entry shall be placed in the Care Plan Summary Screen of Crossroads with information on the participant contact, including who was spoken to and any questions addressed regarding the formula change and/or benefit issuance.

2) For situations that involve CAP orders, the participant shall be contacted and shipping information shall be verified. Information about who was spoken to and shipping location preference shall be added to the Family Alerts.

3) For situations that involve breastfeeding participants, the Breastfeeding Peer Counselor, Breastfeeding Coordinator, or Designated Breastfeeding Expert (DBE) shall be contacted before the prescription is changed to ensure that all breastfeeding complications and concerns have been addressed. Information about this shall be entered into either the Care Plan Summary or Breastfeeding Peer Counseling Care Plan.

(fds-04.7)Virginia WIC Policy and Procedures Manual FDS 04.7: Replacing eWIC Cards#

(fds-04.7)(document-1)#

Division of Community Nutrition

Subject: Replacing eWIC Cards Policy: FDS 04.7 Reference: N/A Effective: November 1, 2014 Supersedes: FDS 04.8 and FDS 04.8.1

Page 1 of 2

Policy:

Replacement eWIC Cards may be issued when the participant, parent / legal guardian, or caretaker informs the WIC clinic that the card has been lost, stolen, damaged or destroyed.

II. Procedure(s):

A. WIC personnel shall refer the participant, parent / legal guardian, or caretaker at initial certification to the eWIC Cardholder Booklet instructions on what to do if their eWIC Card has been lost, stolen, damaged or destroyed.

B. WIC personnel shall refer the participant, parent / legal guardian, or caretaker at initial certification to the eWIC Cardholder Booklet instructions on safeguarding their PIN at all times.

C. WIC personnel shall inform the participant, parent / legal guardian, or caretaker at initial and subsequent certifications that when an eWIC Card is replaced it is possible that food benefits may be prorated.

D. WIC personnel shall inform the participant, parent / legal guardian, or caretaker at initial and subsequent certifications that a replacement eWIC Card is not able to be reissued until 24 hours after it has been deactivated with Xerox and the clinic is notified.

E. Upon issuance of a third lost card replacement within a year, not including cards reissued due to the documented circumstances specified in Procedure F, the participant shall be placed on recurring replacement card list, placed on a one month issuance cycle, and have their eWIC card usage monitored for the next year.

F. Food benefits reported as lost shall be replaced under the following circumstances with the specified documentation:

1) Food benefits that are lost due to a participant leaving home because of family violence. This shall be documented by self-declaration.

2) Food benefits are lost due to a change in full legal custody, including when infants / children are removed from home and placed in foster care or parental custody is changed. Documentation of a change in full legal custody shall be required from the Department of Social Services, a court order, or a military change of custody form. A copy of the documentation shall be scanned into Crossroads.

Division of Community Nutrition

Subject: Replacing eWIC Cards Policy: FDS 04.7 Reference: N/A Effective: November 1, 2014 Supersedes: FDS 04.8 and FDS 04.8.1

Page 2 of 2

3) eWIC Cards damaged, destroyed, or lost due to an event out of the control of the participant, such as a fire or natural disaster. Documentation from news reports, insurance claims, fire/police reports, or any public document shall be accepted and scanned into Crossroads.

G. eWIC Cards reported as stolen shall only be replaced when a police report is provided which states that WIC food benefits were stolen.

1) The police report requirement for stolen food benefits may be waived if the police department charges a fee that the participant cannot pay. This waiver shall only be granted once.

2) WIC personnel shall cancel the eWIC Card, scan the police report into Crossroads, and arrange for issuance of a replacement eWIC Card.

H. If food benefits cannot be replaced to meet infant needs, then the local agency shall refer the participant to a Food Bank or other resources for assistance.

1) Documentation of all such referrals shall be made in Crossroads.

(int-01.0)Virginia WIC Policy and Procedures Manual INT 01.0: Processing Standards and Appointments#

(int-01.0)(document-1)#

Division of Community Nutrition

Subject: Processing Standards and Appointments Policy: INT 01.0 Reference: N / A Effective: August 12, 2013 Supersedes: July 15, 2012

Page 1 of 2

I. Policy:

Local agencies are required to notify all applicants of their eligibility or ineligibility within a specific number of calendar days of the request for WIC benefits based on their category of eligibility.

II. Procedure(s):

A. Required time periods for processing WIC applications are as follows:

1) Pregnant women, infants under six (6) months of age, migrants and their family members, homeless persons and participants who present a valid WIC Verification of Certification (VOC) Card or Department of Defense WIC Overseas transfer document, CRT 13.1.1, shall be given an appointment and notified of their eligibility or ineligibility within ten (10) calendar days of the request for WIC benefits.

2) All other applicants shall be notified of their eligibility or ineligibility within twenty (20) calendar days of the request for WIC benefits.

B. Local agencies shall give an specific appointment to anyone who contacts them regarding WIC benefits.

C. Local agency staff shall communicate to applicants the kinds of information they need to bring to their certification appointments.

D. Local agencies shall use the Appointment Scheduler in Crossroads to document all appointments.

E. Appointments shall be scheduled as follows:

1) Participants shall be given a nutrition education appointment at each certification and subsequent certification visit. All appointments shall be written on the eWIC card holder booklet.

a. Nutrition education appointments shall be made up to thirty (30) days prior to the family issuance date.

b. All family members shall be given simultaneous appointments for nutrition education.

2) A subsequent certification appointment shall be given during the participant’s last nutrition education appointment. Local agency personnel shall remind participants at each certification what documents to bring to their subsequent certification appointment in accordance with CRT 01.1. This verbal reminder shall include a statement that failure to be certified will result in loss of benefits.

Division of Community Nutrition

Subject: Processing Standards and Appointments Policy: INT 01.0 Reference: N / A Effective: August 12, 2013 Supersedes: July 15, 2012

Page 2 of 2

F. Local agency personnel shall remind all participants at each appointment to notify the local agency of a change in contact information.

G. The local agency shall contact all applicants/participants who missed their appointment within 72 hours to arrange for rescheduling by their preferred method of contact.

1) Local agencies shall run the Daily Appointments to be Rescheduled report in Crossroads and follow up with clients on the report by their preferred method of contact to reschedule appointments.

H. Local agency personnel shall utilize on a monthly basis the Crossroads report listing participants who did not receive food benefits in the previous month and document they have contacted and rescheduled them to reduce the number of participants who become inactive or drop out of the WIC program.

I. Walk-in clinics may be offered as follows:

1) Walk-in clinics shall be utilized only for the following situations:

a. For those applicants / participants who simply arrive at the local agency, without prior contact, and bring all the required information; or,

b. For participants who have missed an appointment.

2) Any applicant / participant, who, for whatever reason, does not complete a walk-in clinic, shall be given an appointment within the time-frame for their category in accordance with processing standards requirements. Local agency personnel shall not simply tell them to come to the next walk-in clinic.

(ned-01.0)Virginia WIC Policy and Procedures Manual NEd 01.0: Nutrition Education Overview#

(ned-01.0)(document-1)#

Division of Community Nutrition

Subject: Nutrition Education Overview Policy: NEd 01.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: July 1, 2010

Page 1 of 2

I. Policy:

The primary goal of the WIC Program is to provide quality preventive nutrition services that improve health outcomes in a cost-effective manner. This is accomplished through the three core services - nutrition education, nutritious supplemental foods and referrals to other health care and social service programs.

Nutrition education is a valuable benefit of the WIC Program and begins during the initial certification. Local agencies shall make nutrition education available to all participants and the parents / legal guardians/ caretakers or proxy of infant and child participants at no cost. Nutrition education shall be presented in a way that is easily understood by participants and has practical relevance to the participant's nutritional needs, household situation, and cultural preferences.

Nutrition education shall be coordinated and integrated with other clinics and services. Nutrition education shall relate to identified risks. Nutrition education shall be designed to meet the basic goals of teaching participants the relationship between proper nutrition, physical activity and good health; and assisting participants in making positive changes in their food habits.

II. Procedure(s):

Nutrition Education shall follow the Value Enhanced Nutrition Assessment (VENA) model and embrace the following principles to ensure effectiveness and quality:

A. Interactive 1) Nutrition education shall involve families in self-assessment and self-directed goal setting and help families move toward their desired level of wellness.

2) Develop a rapport by employing active listening skills, asking open ended questions and identifying the participant’s stage of change. (The stages of change include pre-contemplation, contemplation, preparation, action and maintenance.)

B. Flexible 1) Use multiple strategies and techniques to effectively reach and impact participants and their family.

C. Relevant 1) Impart appropriate and relevant education that is reflective of the interest of the participant and/or family.

Division of Community Nutrition

Subject: Nutrition Education Overview Policy: NEd 01.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: July 1, 2010

Page 2 of 2

2) Education offered to participants shall be in a positive and interactive manner through developmentally and culturally appropriate teaching aids.

D. Supportive Environment 1) Education shall be offered in a family friendly environment for optimal learning. Personnel shall support the family’s needs and build a rapport with families to promote good health.

E. Trained Personnel 1) Education shall be facilitated or taught by qualified, well-trained and equipped personnel.

F. Culturally Supportive 1) Education shall acknowledge and support differences in cultures and languages and be sensitive to cultural food choices, when possible.

G. Targeted Concept 1) Education shall cover only the relevant messages and issues that are important to participants and the family.

H. Community Based 1) Allow personnel to connect, build and nurture relationships with other community entities to integrate and normalize good health practices into the lives of families.

(ned-02.1)Virginia WIC Policy and Procedures Manual NEd 02.1: Nutrition Education Contact - Initial#

(ned-02.1)(document-1)#

Division of WIC & Community Nutrition Services

Subject: Nutrition Education Contact-Initial Policy: NEd 02.1 Reference: CFR §246.11 Effective: August 12, 2013 Supersedes: September 15, 2012

Page 1 of 2

I. Policy:

Initial nutrition education shall be provided during the certification visit to all participants. The objective of the initial contact is to provide assistance to the participant and the parent / legal guardian or caretaker of the infant(s) and child (children). Nutrition education shall follow the basic principles outlined in NEd 01.0.

II. Procedure(s):

A. At initial certification, participants, parents / legal guardians or caretaker shall receive individual counseling.

B. Levels 3 and 5 personnel shall provide nutrition education initial and subsequent certification visits.

C. Nutrition education shall be interactive and involve an exchange of information between the participant and educator using VENA.

D. An individualized nutrition care plan shall be developed for all participants. The individualized care plan shall include the identification of all nutrition-related problems, participant concerns and goals. These shall be documented in the Care Plan section of Crossroads. Nutrition information shall be relevant to each category, based upon health outcomes:

1) Pregnant- The desired health outcome is to deliver a healthy, full-term infant while maintaining optimal health status.

a. Health Determinants 1. Receives ongoing preventive health care including prenatal care 2. Achieves a recommended maternal weight gain 3. Remains free from nutrition or food-related illness, complications or injury 4. Avoids alcohol, tobacco and illegal drugs 5. Consumes a variety of foods to meet energy and nutrient requirements 6. Makes an informed decision to breastfeed her infant

2) Breastfeeding-The desired health outcome is to achieve optimal health during the childbearing years and reduces the risk of chronic diseases.

a. Health Determinants 1. Receives ongoing preventive health care including early postpartum care 2. Achieves desirable postpartum weight or BMI 3. Remains free from nutrition or food related illness, complications, or injury 4. Avoids alcohol, tobacco, and illegal drugs

Division of WIC & Community Nutrition Services

Subject: Nutrition Education Contact-Initial Policy: NEd 02.1 Reference: CFR §246.11 Effective: August 12, 2013 Supersedes: September 15, 2012

Page 2 of 2

5. Consumes a variety of foods to meet energy and nutrient requirements 6. Breastfeeds her infant(s) successfully

3) Post-Partum-The desired health outcome is to achieve optimal health during the childbearing years and reduces the risk of chronic diseases.

4) Infant- The desired health outcome is to achieve optimal growth and development in a nurturing environment and develops a foundation for health eating practices.

a. Health Determinants 1. Receives ongoing preventive health care including screenings and immunizations 2. Achieves a normal growth pattern 3. Remains free from nutrition or food-related illness, complications or injury 4. Consumes breast milk and/or iron-fortified infant formula and other foods as developmentally appropriate to meet energy and nutrient requirements. 5. Establishes a trusting relationship with parent(s) that contributes to positive feeding experiences.

5) Children- The desired health outcome is to achieve optimal growth and development in a nurturing environment and begins to acquire dietary and lifestyle habits associated with a lifetime of good health.

a. Health Determinants 1. Receives ongoing preventive health care including screenings and immunizations 2. Achieves a normal growth pattern 3. Remains free from nutrition or food-related illness, complications or injury 4. Consumes a variety of foods to meet energy and nutrient requirements 5. Achieves developmental milestones including self-feeding.

(ned-02.3)Virginia WIC Policy and Procedures Manual NEd 02.3: Nutrition Education Contact - Follow-Up, High Risk#

(ned-02.3)(document-1)#

Division of Community Nutrition

Subject: Nutrition Education Contact-Follow-Up, High Risk Policy: NEd 02.3 Reference: CFR §246.11 Effective: August 12, 2013 Supersedes: July 1, 2010

Page 1 of 2

I. Policy:

High risk secondary nutrition education shall be made available to all high-risk participants during each certification period. Follow up education shall be based on the participant's needs, interests, cultural and language needs.

II. Procedure(s):

A. Nutrition education shall follow the basic principles outlined in NEd 01.0.

B. The determination of high risk shall be made by a Competent Professional Authority (CPA) based upon medical and nutritional need.

1) Only Level 5 personnel are authorized to provide follow up education to high- risk participants. Personnel shall provide assessment, counseling and follow up to a high-risk participant within 90 days of the certification visit at which the participant is determined to be at high risk. If the participant remains at high risk, schedule another follow-up appointment within 90 days. Continue to schedule follow-up appointments until the high risk indicator has been resolved.

C. An individualized nutrition care plan shall be developed to document a high-risk participant.

1) The individualized care plan shall include the identification of high risk nutrition- related problem(s), participant goals, appropriate referrals and a plan for follow up. These shall be documented in the Care Plan section of Crossroads.

D. Individual counseling shall be used to provide follow up education to high-risk participants.

1) Telephone contacts are allowed but only as a supplement to individual counseling.

2) Group education is not an appropriate method for high-risk participants.

3) Web based education is not an appropriate method for high-risk participants.

E. High Risk Conditions by Category

1) Pregnant Women a. Hyperemesis Gravidum b. Medical condition or nutritional deficiency c. Very low hemoglobin / hematocrit (at or below 9.9 Hgb or 28.9 Hct) d. Other deficiency anemias e. Multi-fetal gestation

Division of Community Nutrition

Subject: Nutrition Education Contact-Follow-Up, High Risk Policy: NEd 02.3 Reference: CFR §246.11 Effective: August 12, 2013 Supersedes: July 1, 2010

Page 2 of 2

f. Low maternal weight gain g. Maternal weight loss during pregnancy h. Pre-pregnancy underweight (BMI< 18.5) i. Very overweight (BMI >30) j. Fetal growth retardation k. Use of alcohol or drugs

2) Breastfeeding Women / Postpartum Women a. Very low hemoglobin / hematocrit (at or below 10.9 Hgb or 32.9 Hct) b. Medical condition or nutritional deficiency c. Breastfeeding complications or potential complications d. Use of alcohol or drugs

3) Infant / Child a. Medical condition or nutritional deficiency b. Very low hemoglobin / hematocrit (at or below 9.9 Hgb or 28.9 Hct) c. High blood lead or lead poisoning d. Low birth weight (at or below 2,500 grams or 5 1/2 pounds) e. Small for gestational age (up to age one) f. Very overweight (at or above 95th percentile wt / ht / length) g. Very underweight (at or below 5th percentile wt / ht / length)

F. Once the high risk factor has been resolved, the participant shall be deemed as low- risk.

1) System assigned high risk factor cannot be unassigned in Crossroads. If a system assigned high risk factor has been resolved, documentation shall be added to the participant’s Nutrition Assessment section within the Care Plan Summary of Crossroads.

2) CPA assigned high risk factors shall be unassigned from the Assigned Risk Factor screen of the Certification section of Crossroads if the factor has been resolved.

(ned-04.0)Virginia WIC Policy and Procedures Manual NEd 04.0: Nutrition Staffing Levels#

(ned-04.0)(document-1)#

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 1 of 10 I. Policy

Five levels of nutrition interventions have been developed for staff that provides nutrition education. Levels 1, 2, 3, 4 and 5 correspond to increasing levels of complexity of the nutrition intervention as well as increasing competency and technical skills required to provide the intervention.

The five levels are defined as:

Level 1: Nutritionist Assistant Non CPA Lowest Intervention Level – Limited assessment, cannot certify participants. Provides follow up education to low risk participants under nutritionist's supervision. Must complete designated WIC Web Based Paraprofessional Training Program Modules. Level 2: Breastfeeding Peer Counselor

Moderate Intervention Level – Limited assessment, cannot certify participants. Provides WIC pregnant and breastfeeding participants with education, counseling, and support on maintaining a positive breastfeeding relationship with their infants through the first year. Basic breastfeeding services are rendered under the Breastfeeding Coordinator’s supervision. Must complete Virginia’s Loving Support Through Peer Counseling© Training Program modules as part of orientation. Level 3: Nutritionist Associate (Paraprofessional CPA) Moderate Intervention Level – Expanded assessment, can certify all participants. Provides initial nutrition education to all participants and follow up education to low risk participants under nutritionist’s supervision. Must complete all of WIC Web Based Paraprofessional Training Program Modules. Includes LPNs, dietetic technicians and home economists with a general bachelor's degree. Level 4: Nutritionist (Professional CPA) High Intervention Level – Expanded assessment, can certify all participants. Provides initial and routine follow up nutrition education to low risk participants. Functions as local agency breastfeeding coordinator (if applicable). Includes home economists with a major in food/nutrition, nutritionists, registered nurses, nurse practitioners, physician assistants and physicians. Level 5: Registered Dietitian Highest Intervention Level – Can assess and provide initial and follow up nutrition education to high risk participants. Required provider for required high risk counseling. Reinforces medical care plan provided by the health care system and provides Medical Nutrition Therapy (MNT)* services. Functions as local agency breastfeeding coordinator (if applicable). Works with other community programs to integrate nutrition services. In some settings, may perform management functions (i.e. supervise WIC nutrition and administrative staff). Must be Registered Dietitian

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 2 of 10 with the Commission on Dietetic Registration. * MNT involves assessment of the participant's nutritional status and diet modification, counseling and specialized nutrition therapies such as diabetes and renal services, performed by Registered Dietitians if funded beyond WIC funding.

The following tables define the roles of Level 1 through Level 5 staff in more detail:

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 3 of 10

TABLE 1

NUTRITION SERVICE LEVEL 1 Nutritionist Assistant/Non CPA Lowest intervention level Assessment Limited assessment  Maintains and calibrates equipment  Explains procedure for collecting measurements to clients  Collects height, weight and blood work  Documents measurements (i.e. anthropometrics and blood work)  Collects identification information  Conducts assessment of income and residency eligibility Education  Assists nutritionist in providing general information about healthful foods, food buying and food preparation  Presents nutrition education classes using established curriculum under close supervision and specialized training provided by Level 4 or 5 personnel  Orders and maintains nutrition education outreach materials/aids and supplies  Creates a breastfeeding friendly environment Record Keeping  Collects and records routine information  Assists with the issuing, recording and security of food instruments Outreach  Explains WIC services to (potential) clients

Staff Qualifications  High school graduate or equivalent Staff Requirements Completes WIC Web Based Nutrition Paraprofessional Training Program Modules as part of orientation  Basic Education – Module 3  Nutrition for WIC Participants- Module 4  Nutrition Education – Module 7  Breastfeeding – Module 10 Continuing Education Requirement  Receives a minimum of 3 hours a year of nutrition training.  Receives a minimum of 5 hours a year of lactation education training.

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 4 of 10

TABLE 2

NUTRITION SERVICE LEVEL 2 Breastfeeding Peer Counselor Moderate intervention level Assessment  Receives referrals from Health Department and WIC personnel.  Completes Breastfeeding Referral/Contact Form (WIC-386) for pregnant and breastfeeding WIC participants.  Collects and documents weight and length for breastfeeding infants.  Collects breastfeeding, health, and nutrition information pertinent to breastfeeding family.  Identifies the needs and concerns of breastfeeding family.  Identifies high risk breastfeeding families and refers to Breastfeeding Coordinator.  Utilizes information collected to assess and document breastfeeding status in Crossroads. Counseling and Education  Promotes breastfeeding as the preferred infant feeding method.  Provides basic level information on breastfeeding, infant feeding, and nutrition.  Provides WIC pregnant and breastfeeding participants with continual education, counseling, and support on maintaining a positive breastfeeding relationship with their infant through the first year.  Works individually, in groups, and/or in classes with pregnant and breastfeeding WIC participants.  Contacts participants on the phone from home or in person at the hospital, clinic setting, or their home.  Creates a breastfeeding friendly environment Record Keeping  Completes Breastfeeding Referral/Contact Form (WIC-386)  Completes Breastfeeding Peer Counselor Activity Report (WIC-385)  Collects and records routine information in Crossroads Outreach  Explains WIC breastfeeding services to (potential) participants.

Staff Qualifications  High School graduate or equivalent.  Has successfully breastfed one or more infants for 6 months or more. Staff Requirements  Completes Virginia’s Loving Support Through Peer Counseling© as part of orientation.  Completes WIC Web Based Nutrition Paraprofessional Training Program Modules as part of orientation:

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 5 of 10 Basic Nutrition Education- Module 3 Nutrition for WIC Participants-Module 4 Providing Nutrition Education-Module 7 Information about Other Cultures-Module 8 Communication and Counseling with WIC Participants-Module 9  Promoting Breastfeeding-Module 10 Continuing Education Requirement  Receives a minimum of 5 hours continuing lactation education annually.

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 6 of 10

TABLE 3

NUTRITION SERVICE LEVEL 3 Nutritionist Associate/CPA Moderate intervention level Assessment Expanded assessment  Collects height, weight and blood work  Documents measurements (i.e. anthropometrics and blood work)  Conducts dietary assessment  Assesses for health risks  Refers high risk clients to registered dietitian for follow-up education Counseling and Education  Provides certification counseling to all clients  Prescribes an appropriate WIC food package  Assists and/or conducts nutrition education activities  Provides appropriate referrals  Determines frequency /content of follow-up nutrition education  Presents nutrition education classes using established curriculum  Monitors client care follow up recommendations and referrals  Creates a client friendly environment  Creates a breastfeeding friendly environment Record Keeping  Collects and records routine information Outreach  Explains WIC services to (potential) clients

Staff Qualifications  High school graduate or equivalent Staff Requirements  Completes WIC Web Based Nutrition Paraprofessional Training Program Modules (to include activities and certification) Continuing Education Requirement  Receives a minimum of 5 hours a year of nutrition training  Receives a minimum of 5 hours a year of lactation education training

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 7 of 10

TABLE 4

NUTRITION SERVICE

LEVEL 4 Nutritionist High intervention level Assessment Expanded assessment  Collects and documents height, weight and blood work  Conducts dietary assessment  Assesses for health risks Counseling and Education  Provides nutrition certification counseling to clients/families  Prescribes appropriate WIC food package  Determines frequency /content of follow-up nutrition education  Provides appropriate referrals  Monitors client care follow up recommendations and referrals  Prepares nutrition education materials/aids  Creates a client friendly environment  Creates a breastfeeding friendly environment  Plans and schedules nutrition education classes Record Keeping  Collects and records information  Completes Local Agency Coordinator’s Quarterly Activity Report (WIC-398) (if functioning as local agency breastfeeding coordinator) Consultation  Provides limited nutrition consultation to internal/external customers  Coordinates client care to improve health care outcomes  Consults with health care providers to develop care plan  Provides in-service education to paraprofessionals and record review  Provides in-service training to paraprofessionals regarding scheduled low-risk group nutrition education contacts Planning & Evaluation  Defines the market and number and characteristics of customers served  Assists with development, implementation and evaluation of WIC Services Plan  Assesses, plans, and evaluates the local agency’s breastfeeding activities annually (if functioning as local agency breastfeeding coordinator)

Staff Qualifications  Nutritionist - See Code of Virginia §54.1-2731 and Board of Health Professions 18 VAC 75-30-10: Regulations Governing Dietitians and Nutritionists. (Appendix 3). Staff Requirements  Completes WIC Web Based Nutrition Paraprofessional Training

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 8 of 10 Program Modules as part of orientation. Level 4 staff may test out of Modules and have the option of not completing the activities. Continuing Education Requirement  Receives a minimum of 10 hours a year of nutrition training  Receives a minimum of 5 hours a year (8 hours if functioning as local agency breastfeeding coordinator) of lactation education training which may be included in the total of the ten hours of yearly training.

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 9 of 10

TABLE 5

NUTRITION SERVICE LEVEL 5 Registered Dietitian Highest intervention level Assessment  Conducts a comprehensive nutritional assessment to develop care plan  Conducts a comprehensive community assessment  Assesses productivity/cost effectiveness of nutrition services Counseling and Education  Provides nutrition counseling to high-risk clients/families  Provides reimbursable Medical Nutrition Therapy upon health care provider's request and with funding beyond the Virginia WIC Program  Assures and coordinates the client's nutrition care needs as identified by the family and health care team  Prepares nutrition education materials/aids  Creates a client friendly environment  Plans and evaluates nutrition education Record Keeping  Collects and records information in the Crossroads system  Completes Local Agency Coordinator’s Quarterly Activity Report (WIC-398) (if functioning as local agency breastfeeding coordinator) Consultation  Provides nutrition consultation to internal/external customers  Coordinates client care to improve health care outcomes  Consults with health care providers to develop care plan  Provides in-service education to paraprofessionals and nutritionists  Provides in-service training to paraprofessionals regarding scheduled low-risk group nutrition education contacts  Provides record reviews of paraprofessionals Planning & Evaluation  Assists with determining health priorities and in developing goals and objectives  Plans, implements and evaluates community interventions  Analyzes and interprets data to monitor nutrition programs  Assists with development, implementation and evaluation of WIC Services Plan  Assesses, plans, and evaluates the local agency’s breastfeeding activities annually (if functioning as local agency breastfeeding coordinator)

Staff Qualifications  Registered Dietitian – See Code of Virginia §54.1-2731 and Board of Health Professions 18 VAC 75-30-10: Regulations Governing

Division of Community Nutrition

Subject: Nutrition Staffing Levels Policy: NEd 04.0 Reference: CFR 246.11 Effective: August 12, 2013 Supersedes: October 1, 2002

Page 10 of 10 Dietitians and Nutritionists. (Appendix 3). Staff Requirements  Completes WIC Web Based Nutrition Paraprofessional Training Program Modules as part of orientation. Level 5 staff may test out of Modules and have the option of not completing the activities Continuing Education Requirement  Receives a minimum of 15 hours a year of nutrition training.  Receives a minimum of 5 hours a year (8 hours if functioning as local agency breastfeeding coordinator) of lactation education training which may be included in the total of the fifteen hours of yearly training.

(ned-09.0)Virginia WIC Policy and Procedures Manual NEd 09.0: Mid-Certification Assessment#

(ned-09.0)(document-1)#

Division of Community Nutrition

Subject: Mid-Certification Assessments Policy: NEd 09.0 Reference: CFR §246.7 Effective: October 1, 2022 Supersedes: August 12, 2013

Page 1 of 2

I. Policy:

Mid-certification assessments shall be completed for all infant, child, and breastfeeding participants with certifications longer than six months in length.

II. Procedure(s):

A. Mid-certification assessments shall be completed for all infant, child, and breastfeeding participants with certifications longer than six months in length. 1) Although the provision of food benefits stops six months after delivery for partially breastfeeding women whose infant receives formula from WIC in amounts that exceed the maximum monthly allowances (MMA), their certification continues twelve months after delivery and they remain eligible for all other WIC benefits and therefore must be scheduled for mid-certification assessments.

B. Mid-certification appointments shall be scheduled approximately six months from certification date. 1) If a mid-certification appointment is missed, the participant and their family shall have their benefit issuance frequency reduced to 1-month until the assessment can be completed or the participant’s current certification period ends.

C. Mid-certification assessments shall include the following:

1) Anthropometric measurements, performed and documented in accordance with policy CRT 06.1 2) Hematological testing for anemia screening, performed and documented in accordance with policy CRT 06.2 3) Health and Dietary assessment i. Review of the information collected on the Diet & Health Screen in Crossroads at the most recent certification appointment, determine if any changes have occurred ii. Dietary assessment, following Value Enhanced Nutrition Assessment (VENA) methodology iii. Confirmation the participant is receiving ongoing care from a health care provider iv. Follow-up on previous referrals and assessment for current referral needs

Division of Community Nutrition

Subject: Mid-Certification Assessments Policy: NEd 09.0 Reference: CFR §246.7 Effective: October 1, 2022 Supersedes: August 12, 2013

Page 2 of 2

v. Follow-up on previous goals vi. Follow-up immunization screening, for participants under age 2 only 4) Nutrition education, to include breastfeeding promotion and support as applicable, following VENA methodology 5) Provision of identified referrals

D. Documentation for mid-certification assessments shall be entered in the Individual Nutrition Assessment section of the Crossroads’ Care Plan Summary screen.

(prr-02.0)Virginia WIC Policy and Procedures Manual PRR 02.0: Proxy#

(prr-02.0)(document-1)#

Division of Community Nutrition Services

Subject: Proxy Policy: PRR 02.0 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: November 1, 2015

I. Policy:

A participant, parent or legal guardian (“participant”) may have the privilege, but not the right, to designate a maximum of two (2) proxies. A proxy may accept and redeem food instruments. The proxy must attend nutrition education to obtain food benefits. The participant and proxy are not required to be present together when the participant designates the proxy. The parent is always encouraged to be the primary recipient of all WIC benefits for their infants / children.

II. Procedure(s):

A. Local agency personnel shall only discuss the option of designating a proxy if the participant, parent / legal guardian indicates one of the following situations:

1) The participant, parent / legal guardian expresses difficulty with attending the local agency for nutrition education, or shopping for WIC food benefits, or

2) The local agency determines difficulty with the participant, parent / legal guardian attending the local agency through objective methods such as the no show reports, missed appointments, or frequently rescheduled appointments.

3) The local agency determines difficulty with the participant, parent / legal guardian attending the local agency during established alternative hours.

B. If the participant elects to designate a proxy, the participant shall read and sign the Proxy Designation Form, WIC-314A. The local agency shall sign and retain this form.

1) The participant’s signature on the WIC-314A confirms that s/he has been informed of the following:

a. The proxy is required to attend all nutrition education sessions prior to obtaining food benefits.

b. The proxy is required to share all nutrition education and health care referrals with the participant.

c. The participant shall be legally responsible for all actions of the proxy, including actions that would terminate her / him from the WIC Program.

Division of Community Nutrition Services

Subject: Proxy Policy: PRR 02.0 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: November 1, 2015

d. The State WIC Office shall establish a claim against the participant for the full value of Program benefits which have been improperly obtained or disposed by the proxy.

e. A proxy shall not have the requisite knowledge and therefore shall not be permitted to bring an infant/child in for any mid-certifications.

C. The participant and proxy are not required to be present together when the participant designates the proxy.

D. The local agency shall verify that the proxy is over 18 years of age. Proxies under the age of 18 may only be approved at the discretion of the CPA.

E. The proxy shall read, check each box, and sign the Proxy Signature Form, WIC-314B. The local agency shall retain this form in the participant’s record.

1) The proxy’s signature on the WIC-314B confirms that s/he has been informed of the following:

a. S/he is responsible to follow all Program rules;

b. S/he is required to attend all nutrition education sessions before receiving food benefits.

c. S/he is responsible for sharing all received nutrition education, and / or other health related and public assistance program information received from WIC with the participant;

d. S/he is responsible for following food benefits usage procedures and failure to do so will be considered Program abuse;

e. S/he may be a proxy for a maximum of (3) families;

f. S/he has the right to file a Program complaint about improper vendor and agency practices;

g. S/he is required to pick up the food benefits in person when scheduled for nutrition education, unless the alternative issuance system is appropriate; and

Division of Community Nutrition Services

Subject: Proxy Policy: PRR 02.0 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: November 1, 2015

h. S/he shall bring proof of identification in accordance with CRT 03.0, which will be checked prior to any services being provided.

F. Review food benefits usage procedures with the proxy and provide a WIC Participant Handbook to the proxy.

G. Local agency personnel shall sign the Proxy Designation Form, WIC-314A, and the Proxy Signature Form, WIC-314B and document the Proxy’s name in the Proxy section in WICNET.

H. To designate a proxy in hardship cases dealing with disability see policy CRT 01.0.

I. File both the WIC-314A and WIC-314B by scanning the form into the participant’s record in Crossroads.

1) If the proxy is serving for more than one participant, file a copy of the Proxy Signature Form, WIC-314B in each participant’s record. An individual cannot serve as proxy for more than three (3) families.

J. A proxy may be changed as necessary. For a proxy change, the participant and new proxy shall return to the local agency to complete both Proxy Forms and sign a new WIC ID Folder.

K. Infants and children may be added without re-designating the proxy by updating the current Proxy Form.

(prr-02.1)Virginia WIC Policy and Procedures Manual PRR 02.1: Caretaker#

(prr-02.1)(document-1)#

Division of Community Nutrition

Subject: Caretaker Policy: PRR 02.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: August 15, 2016

Page 1 of 4

I. Policy: A parent or legal guardian may designate one (1) caretaker per Family ID number to certify an infant and/or child, to obtain and/or redeem WIC food benefits, and to attend nutrition education.

A caretaker may be any person 18 years of age or older who has detailed knowledge of the nutritional needs and eating habits of the infant / child. A caretaker shall be designated only when the local agency cannot accommodate the needs of the parent. In the absence of a parent or legal guardian, a caretaker shall provide reasonable documentation of their status as primary caregiver. The local agency will verify proof of identification of the caretaker in accordance with CRT 03.0, prior to signing the Caretaker Designation form, WIC-311. Caretakers under the age of eighteen may only be approved at the discretion of the CPA.

The caretaker shall accept full legal responsibility in understanding and adhering to program policies and guidelines. As primary caregiver, the caretaker will be required to attend all nutrition and certification appointments as mandated by relevant policies. The authority to implement this portion of the policy will be granted individually to local agencies by the SWO.

The designation of a caretaker is a privilege, not a right. The parent is always encouraged to be the primary recipient of all WIC benefits.

II. Procedure: A. Designation of a caretaker shall be determined in one of two ways:

1) A parent or legal guardian’s declaration of hardship, or

2) The caretaker providing reasonable documentation of role as such in the absence of parent/legal guardian

B. Local agency personnel shall discuss the option of designating a caretaker if the participant, parent/legal guardian indicates hardship such as the following:

1) The participant/parent / legal guardian expresses difficulty with attending appointments for certification / subsequent certification, / nutrition education, and/or food benefits issuance during established alternative and regular hours due to conflict of work /school schedules, or incarceration.

2) The participant/parent / legal guardian expresses difficulty with attending the local agency for certification/re-certification appointments, WIC benefits,

Division of Community Nutrition

Subject: Caretaker Policy: PRR 02.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: August 15, 2016

Page 2 of 4

nutrition education, and/or food benefits issuance during established alternative and regular hours due to lack of transportation.

3) The participant/parent / legal guardian expresses difficulty with attending the local agency certification/re-certification, WIC benefits, nutrition education, and/or food benefits issuance during established alternative and regular hours due to infant/child residing with family member/caretaker.

4) The parent / legal guardian has been sanctioned from the program and a caretaker is needed for the infant or child to still receive benefits.

C. In the absence of a parent or legal guardian, a caretaker may be designated for an infant or child to receive benefits. The Caretaker shall provide reasonable documentation to substantiate their relationship with the infant/child and their role as primary caretaker. Reasonable documentation may include but is not limited to the following:

1) Signed Caretaker Designation Form, WIC-311, indicating designation of caretaker that may be obtained prior to first certification/visit

2) Signed and witnessed letter from legal guardian designating a caretaker and reason for legal guardians’ difficulty with attending enrollment, subsequent certification, nutrition education, and food benefit issuance appointments for an infant/child

3) Documentation of legal guardians’ enrollment, residence, or confinement in hospital treatment programs, shelters, penal institutions or other institutions. Whenever possible the caretaker should supply documentation that contains both entry and exit date from such an institution that will be placed in the participant’s file.

D. The local agency shall determine if the caretaker has knowledge of the nutritional needs and eating habits of the infant or child and is involved with feeding the infant or child on a regular basis. To qualify, the caretaker shall have knowledge of the following example characteristics about the infant / child:

1) Food Preferences 2) Feeding Patterns 3) Feeding Frequency 4) Size of Portion Preferences 5) Interaction with Medications 6) Reaction with allergies 7) Number of Meals

Division of Community Nutrition

Subject: Caretaker Policy: PRR 02.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: August 15, 2016

Page 3 of 4

E. The local agency shall explain the Caretaker Designation form to the parent or caretaker. By signing the WIC-311 the parent or caretaker confirms that s/he understands the following:

1) The caretaker is able to certify the infant / child

2) The caretaker is able to obtain and redeem WIC food benefits

F. The caretaker shall share all nutrition education and health care referrals with the parent.

G. In the absence of the parent/legal guardian the caretaker shall assume legal responsibility and adhere to the rules and regulations of the program. If a parent/legal guardian is present to designate authority to a caretaker both parties shall assume equal legal responsibility including action that would terminate the parent/caretaker from the program.

H. A caretaker can designate a proxy for nutrition education if and when they are not able to be present.

I. A claim shall be established against the caretaker for the full value of program benefits improperly obtained or disposed by the caretaker.

J. After the parent signs the WIC-311, if the parent and caretaker are not present at the same time, the caretaker shall visit the local agency and sign the WIC-311.

K. The local agency shall verify that the Caretaker is 18 years of age or older, unless approved by the CPA.

L. The local agency shall review proper WIC food benefits usage procedures with the caretaker and provide a WIC Participant Handbook to the caretaker.

M. The signature by local agency personnel on the Caretaker Form confirms that the assessment has been completed and the person qualifies.

N. The caretaker’s name shall be listed in the Caretaker section of the Family Demographics screen section in Crossroads.

O. The WIC-311 shall be signed and scanned into the family’s record.

P. A designated caretaker may sign subsequent Rights and Responsibilities Form, WIC-310, on behalf of the parent.

Q. A caretaker shall remain in effect until the parent / legal guardian terminates the caretaker but may be changed as necessary.

Division of Community Nutrition

Subject: Caretaker Policy: PRR 02.1 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: August 15, 2016

Page 4 of 4

1) For a caretaker change, the parent / legal guardian shall complete a new Caretaker Designation Form, WIC-311

2) The parent / legal guardian shall sign the termination clause on the bottom of the Caretaker Designation Form, WIC-311, for the previous caretaker

(prr-03.0)Virginia WIC Policy and Procedures Manual PRR 03.0: Confidentiality and Release of Information#

(prr-03.0)(document-1)#

Division of Community Nutrition

Subject: Confidentiality and Release of Information Policy: PRR 03.0 A Reference: CFR 246.26 Effective: August 1, 2025 Supersedes: November 1, 2018

Page 1 of 2

I. Policy:

Confidential applicant and participant information is any information about an applicant or participant, no matter how it is obtained, that identifies an applicant or participant and/or family member(s). Applicant or participant information is confidential, regardless of the original source. Local agency personnel shall restrict the use and disclosure of confidential applicant and participant information to persons directly connected with the administration or enforcement of the WIC Program.

II. Procedure:

A. Privacy shall be provided to all applicants and participants when determining eligibility and during nutrition counseling.

B. The Participant Release of Information Form (WIC-309) shall be signed at initial and subsequent certifications. Local agency personnel shall review contents of the form with the participant, parent, legal guardian, or caretaker. A copy of the form shall be given to the participant, parent, legal guardian, or caretaker at their request.

C. If the participant, parent, legal guardian, or caretaker chooses not to give permission for release of information, a copy of the form shall be provided for the participant, parent, legal guardian, or caretaker to mark an X next to the statement on the form that states they do not allow sharing information. The form shall then be signed and scanned into Crossroads, with a copy of the form to be given to the participant, parent, legal guardian, or caretaker. An alert shall be prepared in Crossroads to inform WIC personnel of the refusal, and the Confidentiality box shall be checked in the Crossroads Family Demographics screen.

D. Local agency personnel may use confidential applicant and participant information in the administration of its other programs that serve persons eligible for the WIC Program as follows:

1) Local agency personnel and SWO staff are required by State law to report known or suspected child abuse or neglect and may disclose confidential applicant and participant information without the consent of the participant or applicant to the extent necessary to comply with such law. The WIC Coordinator shall contact the Assigned SWO Operations Liaison in order for the information to be reported to the proper authorities.

E. When a retail store contacts local agency or SWO personnel and requests participant information, this information shall not be provided. The store making this inquiry shall be directed to call the Assigned Vendor Liaison for guidance.

Division of Community Nutrition

Subject: Confidentiality and Release of Information Policy: PRR 03.0 A Reference: CFR 246.26 Effective: August 1, 2025 Supersedes: November 1, 2018

Page 2 of 2 F. Local agency personnel shall permit applicants and participants to refuse to sign the Participant Release of Information Form. Personnel shall convey that signing the form is not a condition of eligibility and refusing to sign the form will not affect the applicant’s or participant’s participation in the WIC program.

G. Local agency personnel shall provide applicants and participants access to all information provided to the WIC Program. In the case of an applicant or participant who is an infant or child, the access may be provided to the parent or legal guardian of the infant or child, assuming that any issues regarding custody or guardianship have been settled.

1) The individual requesting access must provide documentation, such as court issued guardianship or government social service agency documentation verifying legal custody.

H. Local agency personnel shall address being served with a valid subpoena or search warrant to disclose confidential applicant or participant information as follows:

1) The local agency shall immediately notify the SWO Operations Liaison.

2) For a search warrant, the local agency is to comply with the search warrant

3) For a subpoena, the SWO will notify legal counsel for the state of the subpoena and inform the local agency as to the determination of whether or not the information may be released.

4) The following steps are to be taken by the local agency when providing information in response to a subpoena or search warrant:

a. Inform the recipient of the information that the information being sought is confidential b. Provide only the specific information requested in the subpoena or search warrant c. Limit to the greatest extent possible the public access to the confidential information disclosed

I. If the Crossroads system is not accessible, the Participant Release of Information form (WIC-309) in the local agency’s printed version of the WIC Policy & Procedure Manual shall be used. The parent, legal guardian, or caretaker shall sign a form for each infant or child. Signed forms shall be scanned into Crossroads when the system is accessible. A copy of the form shall be given to the participant, parent, legal guardian, or caretaker at their request.

(prr-04.1)Virginia WIC Policy and Procedures Manual PRR 04.1: Complaints and Civil Rights Procedures#

(prr-04.1)(document-1)#

Division of Community Nutrition

Subject: Complaints and Civil Rights Procedures Policy: PRR 04.1 Reference: C.F.R. § 246.8 Effective: May 1, 2018 Supersedes: August 15, 2016

Page 1 of 3

I. Policy:

A participant, parent, legal guardian, caretaker, proxy or local agency personnel member has the right to file a complaint against an authorized store, local agency or another participant.

Local agency personnel shall ensure that there is public notification of the nondiscrimination policy and complaint rights of participants and applicants. Local agency personnel shall review and monitor activity to ensure compliance with the WIC program nondiscrimination laws and regulations. Local agency personnel shall follow grievance procedures for handling complaints based on sex and handicap. The nondiscrimination policy must be reviewed with participants and applicants in the appropriate language.

II. Procedure(s):

A. To file a complaint against a store, the Complaint Against Store Form, WIC-345A shall be completed and sent to the State WIC Office for investigation.

B. To file a complaint against a participant or local agency, the Complaint Against Participant or Local Agency Form, WIC-345B shall be completed and sent to the State WIC Office for investigation.

C. At the time of certification, local agency personnel shall inform the applicant and participants through review of the Rights and Responsibilities in Crossroads that no person shall, on the grounds of race, color, national origin, age, sex or handicap, be excluded from participation in, be denied benefits of, or be otherwise subjected to discrimination. Religion and faith must also be considered in this category.

D. Display the USDA “And Justice for All” poster in a public area. A ‘public area’ is defined as an area of the WIC site where a client or potential applicant would easily be able to see the poster.

E. Public notification can include, but is not limited to posters, pamphlets, bulletin boards, and items on display promoting WIC. Publications produced for public view must have the nondiscrimination statement, obtained through http://www.fns.usda.gov/cr/and-justice-all-posters. All publications must be submitted for review and approval to the SWO Outreach Coordinator prior to implementation.

F. Non-English materials shall be provided where a significant proportion of the population eligible to be served needs service or information in a language other than

Division of Community Nutrition

Subject: Complaints and Civil Rights Procedures Policy: PRR 04.1 Reference: C.F.R. § 246.8 Effective: May 1, 2018 Supersedes: August 15, 2016

Page 2 of 3

English. SWO personnel, and local agency personnel, shall take reasonable steps considering the size and concentration of such population, to provide information in appropriate languages to such persons. This requirement applies with regard to required program information except certification forms which are used only by local agency staff.

G. Local agency personnel shall collect and report racial and ethnic participation data through Crossroads for required reporting to SWO and USDA.

H. Local agency personnel shall report all complaints based on discrimination to the assigned Operation Liaison, and provide guidance to the participant or applicant filing the complaint.

1) SWO and local agency personnel shall provide an updated address to the SWO and/or USDA to the participant or applicant. Complaints shall be taken by phone, e mail, or mail. The preferred number to call for complaints is (877)835- 5942. Participants can also use this number to communicate suggestions, comments and concerns on how WIC can better meet their nutritional needs.

2) Local agency and SWO personnel shall document in the family alert and/or the comment section of Crossroads the status of complaints.

3) SWO personnel will refer discrimination complaints based on race, color, national origin, or age to the appropriate federal agency after researching and addressing the complaint.

4) SWO personnel shall process and resolve locally those based on sex or handicap.

I. Local agency personnel shall record training using form WIC-375C on an annual basis of civil rights topics in accordance with guidance from the VDH Training Division. New employees shall complete the training within 90 days from the date of hire. Activity must be monitored in Crossroads to ensure compliance with Virginia WIC policy and USDA regulations.

J. Tell-WIC posters and pads shall be placed in public view so participants can have easy access to the TELL-WIC telephone number.

K. Local agencies shall ensure all voice mail messages for client services at each clinic include the toll free “TELL-WIC” (877-835-5942) number with the conditional statement “if you have difficulty receiving a return phone call within 48 hours, please call the TELL-WIC number”. “TELL-WIC” is not to be used as

Division of Community Nutrition

Subject: Complaints and Civil Rights Procedures Policy: PRR 04.1 Reference: C.F.R. § 246.8 Effective: May 1, 2018 Supersedes: August 15, 2016

Page 3 of 3

an alternate number until the participant is having difficulty communicating with the site.

(prr-06.0)Virginia WIC Policy and Procedures Manual PRR 06.0: Fair Hearings#

(prr-06.0)(document-1)#

Division of Community Nutrition

Subject: Fair Hearings Policy: PRR 06.0 Reference: C.F.R. § 246.9 Effective: August 13, 2013 Supersedes: August 1, 2008

Page 1 of 2

I. Policy:

The Virginia WIC program shall provide a hearing procedure for participants or applicants to appeal a SWO or local agency action which results in a claim for repayment of the cash value of improperly issued benefits or in the individual’s denial of participation or disqualification from the program. Local agency personnel shall inform each individual of the right to a fair hearing through the Fair Hearing brochure at the time of a claim against the individual or at the time of participation denial or disqualification form the Program.

II. Procedure(s):

A. A request for a hearing is defined as any clear expression by the participant or applicant that they desire an opportunity to present the case to the SWO hearing officer within 60 days from the date the agency gives the applicant or participant the notice of adverse action. Local agency personnel shall not interfere with the individual’s freedom to request a hearing. Local agency personnel shall notify the Operations Liaison of the intent of a hearing. SWO hearing officer will follow federal guidelines for processing the hearing.

B. The SWO or local agency personnel shall deny or dismiss a request for a hearing if the request is not received within the 60 day timeframe, the request is withdrawn by the participant or applicant, the appellant fails to appear at the scheduled hearing, or the appellant has been denied participation from a previous hearing fair hearing.

C. Participants who appeal the termination of benefits within 15 days of the adverse action shall continue to receive benefits until the hearing official reaches a decision or the certification period expires, whichever occurs first.

D. Fair hearings are guided by the SWO hearing officer, and officiated by an impartial hearing officer designated by the Virginia Department of Health. Information gathered should be retained, and communication with the appellant shall be clear detailing the incident, dates and personnel involved.

E. All fair hearing requests shall be reviewed by the SWO hearing officer, or operation liaison, whichever SWO management assigns within 10 days of receipt. Family alert or notes shall document the status of the fair hearing. All fair hearing requests shall be addressed with the participant or applicant within 3 days of receipt in a prehearing conversation.

F. All hearing requests that involve ineligible participants or applicants shall have an operation liaison review the documentation to verify validity, and that there are no changes in policy that may deem the applicant eligible for WIC.

Division of Community Nutrition

Subject: Fair Hearings Policy: PRR 06.0 Reference: C.F.R. § 246.9 Effective: August 13, 2013 Supersedes: August 1, 2008

Page 2 of 2

G. Fair hearings are conducted at the convenience of the appellant, and can be done through a conference call. Local agency personnel shall adhere to the decision and guidance given by the hearing office, operation liaison, or SWO hearing officer.

(remote-wic-services)Virginia WIC Policy and Procedures Manual: Remote WIC Services#

(remote-wic-services)(document-1)#

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 1 of 11

I. Policy: In response to the COVID-19 pandemic, Virginia WIC shall temporarily suspend all in- person WIC services and transition to remote WIC services. Local Agencies shall make alterations to standard operating procedures to safeguard the health of WIC applicants, participants, staff, and the community through social distancing while ensuring the quality and continuity of WIC services. These temporary provisions will be in place until the WIC waivers allowed under the Public Health Emergency expire at which time this policy will become obsolete.

In cases where WIC staff who speak the preferred language are not available, over the phone interpreter services must be used. b. Procedures for over the phone interpreter services are provided in a supplemental document. 3. Remote WIC services require access to the Crossroads system.

B. When completing remote WIC services, WIC staff shall: 1. Call the telephone number(s) listed in the applicant/participant’s Crossroads record. a. If there is no answer and a voicemail can be left, leave contact information for the clinic and request a return phone call. 2. Verify that they are speaking to the applicant/participant, or an authorized representative listed in Crossroads. 3. If the applicant/participant or an authorized representative is on the phone, continue with the remote WIC services. 4. If the applicant/participant or an authorized representative is not available, leave contact information for the clinic and request a return phone call.

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 2 of 11 a. Identify themselves by name and title, explain that they are calling to complete remote WIC services and confirm that the applicant/participant or authorized representative is able to complete the call at that time. i. Let the applicant/participant or their authorized representative know you will be asking questions about potentially personal information so they can decide if they are in an area, they can answer these questions. ii. WIC services do not include all the components of in-person WIC services and therefore may be able to be completed in less time, the below are estimations of the time required for each remote WIC appointment type: 1) Initial certification: 45 minutes 2) Subsequent certification: 30 minutes 3) Mid-certification: 15 minutes 4) Nutrition education: 5 minutes iii. If the applicant/participant or an authorized representative can complete the call at that time, continue with the remote WIC services. iv. If the applicant/participant or an authorized representative is not able to complete the call at that time, reschedule their appointment. b. Create a Family Alert in Crossroads the first-time remote WIC services are attempted or provided. i. The alert shall be titled COVID-19 Remote Services. ii. Each time additional remote WIC services are attempted or provided; the alert shall be edited to provide information about that contact. iii. Each entry on the alert shall include whether or not the contact was successful, the type of service that was provided, the name of who the WIC staff member spoke with, and the details of any information that needs to be collected at the next in-person WIC appointment. C. Requirements for physical presence of applicants, participants, and/or approved representatives shall be waived for all remote WIC services.

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 3 of 11 1. WIC staff shall ensure that physical presence for applicants is accurately documented in Crossroads for all initial and subsequent certification appointments a. “No” shall be selected for Physical Presence on the Participant Demographics screen in Crossroads b. “COVID-19” shall be selected as the Physical Presence Exception Reason on the Participant Demographics screen in Crossroads

D. Requirements for the following shall be deferred for all remote initial, subsequent, and mid-certifications: 1. Anthropometric data a. Anthropometric data shall be collected when possible, through the use of the WIC-349 and/or WIC-395 forms. When data is collected, it shall be entered into Crossroads. b. If anthropometric data is unable to be obtained, Length/Height and Weight fields on the Anthro/Lab Screen in Crossroads shall be left blank. 2. Bloodwork data a. Bloodwork data shall be collected when possible, through the use of the WIC-394 and/or WIC-395 forms. When data is collected, it shall be entered into Crossroads on the Anthro/Lab screen. b. If bloodwork is required but unable to be obtained, “COVID-19” shall be selected as the reason for deferment on the Anthro/Lab screen in Crossroads.

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 4 of 11 ii. “COVID-19” shall be selected as proof of identification on both the Family Demographic Screen and the Participant Demographic Screen in Crossroads. This information will be collected at the first face-to-face meeting with the participant. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. 2. Proof of residency a. Allowable forms of proof of residency, as outlined in policy CRT 04.0 shall be collected through encrypted emails or other approved collection methods. b. If proof of residency is unable to be collected, staff shall receive verbal consent to sign an Affidavit recording the information. i. Staff shall verbally communicate to the applicant that this information will be required at their first face-to- face visit and that the information must be factual or they could face financial liability for any benefits they received based on false information. ii. “COVID-19” shall be selected as proof of residency on the Family Demographic Screen in Crossroads. This information will be collected at the first face to face meeting with the participant. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. 3. Proof of income, for applicants/participants who are not adjunctively eligible a. Adjunctive income eligibility shall be used when possible, as outlined in policy CRT 05.1. b. When adjunctive eligibility is not applicable, allowable forms of proof of income, as outlined in policy CRT 05.2.1 shall be collected through encrypted emails or other approved collection methods. c. If adjunctive income eligibility is not applicable and proof of income is unable to be collected, staff shall receive verbal consent to sign an Affidavit recording the information. i. Staff shall verbally communicate to the applicant that this information will be required at their first face-to- face visit and that the information must be factual or they could face financial liability for any benefits they received based on false information. ii. “COVID-19” shall be selected as proof of income when adjunctive eligibility is not applicable or

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 5 of 11 cannot be verified. Proof of income will be verified and collected at the first face to face visit with the participant. iii. The WIC-383 Affidavit shall be scanned into the participant record once completed and signed. F. Remote Certifications 1. Eligibility staff shall: a. Provide a brief description of the WIC program and the certification process to the applicant/participant or authorized representative and inform them that staff will enter the information into a computer so they’re aware of what is occurring in the clinic during telephone call. b. Complete all required information on the Family Demographic Screen i. If the applicant would like to register to vote, the staff shall direct them to the U.S. Election Assistance Commission website: https://www.eac.gov/voters/national-mail-voter- registration-form. ii. Interpreter shall be checked for ALL applicants/participants and/or authorized representatives whose preferred spoken language is NOT English. iii. For the telephone number designated as “primary”, ensure that the following information is entered: 1) Telephone type (ex. Home, cellular, etc.) 2) Carrier for all cellular numbers (ex. Verizon, AT&T, etc.) 3) Designation of Auto Dialer or Text for WIC appointment reminders c. Ensure that BOTH the physical and mailing address are correct i. In cases where the physical and mailing address are the SAME, the mailing address section shall be left blank. d. Complete the Family Assessment Screen e. Complete the Participant Demographic Screen

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 6 of 11 i. Verbally obtain race and ethnicity information for all applicants and participants. f. Complete all required information on the Income Information Screen i. Adjunctive eligibility shall be used for all applicants who are currently enrolled in an eligible adjunctive program g. Complete all required information on the Certification Signature Screen. i. Read the complete Rights and Responsibilities and provide information on the options for Release of Information: 1) If an applicant/participant or authorized representative declines to release their information, the confidentiality box shall be checked on the Family Demographics Screen of Crossroads. 2) An alert shall be added to the applicants Crossroads record to ensure that the WIC- 309 is completed and scanned into their record the next time they are in clinic. ii. Applicants/participants and authorized representatives shall be verbally informed, and staff shall ensure that they understand that all information provided to determine WIC eligibility must be true and that they could be held financially liable for obtaining benefits under false pretense should it be determined that falsified information was provided. iii. Ensure that staff alias is selected as the person signing and sign own signature for the certification signature. 1) Write COVID-19 under signature h. For initial certifications ONLY: i. Complete the Issue EBT Card Screen 1) Ensure that the appropriate individual is selected as the cardholder. 2) Assign an eWIC card.

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 7 of 11 3) Explain how to set-up the eWIC card. ii. Inform the participant or their authorized representative that they will mail or permit pick-up from a local office (if allowable by local agency) the following items: 1) Participant Handbook 2) Copy of their WIC Right and Responsibilities 3) eWIC Card 4) eWIC brochure 5) Appointment card with details of next appointment 6) 2020 Food List 7) LA Referral List 8) Shopping list 9) Listing of local WIC-approved vendors 10) Nutrition and/or breastfeeding education materials (as applicable) iii. If the participant chooses to have the eWIC card and accompanying documents mailed, staff shall: 1. Mail the items listed above within 1 business day 2) Inform the participant that the above items may arrive within 3-5 business days

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 8 of 11 i. All risks not automatically assigned by the system shall be added by the CPA/CPPA. f. Complete the Certification Summary Screen. i. The applicant shall be verbally informed of their assigned risks, the end date of their certification, and that once the certification expires they will need to complete a subsequent certification in order to continue to receive WIC benefits. g. Complete the Issue Benefits Screens i. Verbally explain milk substitution options available for women and children and update the food prescription to reflect desired benefits. ii. Verify all food prescriptions in the carousel for accuracy, ensuring all needed corrections are made iii. Issue Food -benefits 1) Benefits should be issued for 3 months EXCEPT in cases where there are special formulas, CAP ordered formulas and/or Over-the-Max (OTM) amount of formula issued. 2) Benefits that contain special formulas, CAP orders and/or OTM amounts of formula MUST be issued on a 1-month interval. C) Ensure that staff alias is selected as the person signing and sign own signature to acknowledge the issuance of Food Instruments D) Write COVID-19 under signature h.Schedule the next appointment for the participant and/or other participants in the family. i. Schedule the next appointment and inform the participant or authorized representative of the appointment details, including which individuals and items/information need to be present.

i. For Initial Certifications ONLY:

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 9 of 11 i. Additional information shall be provided on the WIC foods that have been issued, shopping with WIC benefits, and local WIC- approved vendors. j. Thank the participant for participating in WIC and offer a phone number for questions. k. Document COVID-19 Cert in the Care Plan followed by standard care plan documentation following the “ABCDEFGHI” format. l. Document WIC breastfeeding referrals on the Referral screen for all pregnant and breastfeeding women as is routinely required i. Ensure access to accurate and timely breastfeeding education and support is an increased priority at this time. ii. Refer postpartum women who are not currently breastfeeding but are interested in increasing their milk supply and/or re-lactating to a Designated Breastfeeding Expert (DBE).

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 10 of 11 i. Make any needed updates to prescriptions. i. Issue food benefits. i. Benefits should be issued for 3-months EXCEPT in cases where there are special formulas, CAP ordered formulas and/or Over-the-Max (OTM) amount of formula issued. ii. Benefits that contain special formulas, CAP orders and/or OTM amounts of formula MUST be issued on a 1-month interval. iii. Ensure that staff alias is selected as the person signing and sign own signature with COVID-19 written under it to acknowledge the issuance of Food Instruments j. Schedule next appointment and inform the participant or authorized representative of the appointment details k. Thank the participant for participating in WIC and offer a phone number for questions. l. Document COVID-19 MC in the Care Plan followed by standard care plan documentation required for mid-certifications.

Division of Community Nutrition

Subject: Remote WIC Services Effective: November 1, 2022 Reference: Families First Coronavirus Response Act of 2020 (H.R. 6201)

Page 11 of 11 program, and that additional formula will need to be purchased monthly beyond what is provided by WIC v.For Breastfeeding participants, emphasis shall be placed on continued breastfeeding and provision of resources for any expressed questions or concerns. vi. For child participants, emphasis shall be placed on any concerns included in previous care plan entries, age- appropriate feeding skills, Division of Responsibility and family meals. b. Document COVID-19 NEd in the Care Plan followed by standard documentation required for individual nutrition education.

I. Remote High Risk 1. The Registered Dietitian shall: a. Conduct remote High Risk appointments as described in the procedure above for remote Nutrition Education appointments. b. If the Local Agency has a Registered Dietitian on staff, all efforts shall be made for the Registered Dietitian(s) to complete the High Risk appointments regardless of their clinic location within the local agency. c. If/when a Registered Dietitian is unavailable to complete the High Risk appointment, the appointment shall be completed by a nutritionist (CPA). d. Document COVID-19 HR in the Care Plan followed by standard documentation required for high risk appointments.

(ven-01.0)Virginia WIC Policy and Procedures Manual VEN 01.0: Inadequate Participant Access Assessment#

(ven-01.0)(document-1)#

Division of Community Nutrition

Subject: Inadequate Participant Access Assessment Policy: VEN 01.0 Reference: Vendor Manual 15.0-15.4 Effective: August 12, 2013 Supersedes: April 2, 2007

Page 1 of 3

I. Policy:

The Division of Community Nutrition requires that local agencies have an active role in providing participant impact feedback related to the Inadequate Participant Access (IPA) process. It is critical to the delivery of food benefits that adequate participant access of authorized retail stores exists within a specific trade or geographic area. In accordance with federal regulations the State WIC Office shall complete a written IPA assessment prior to a retail store being disqualified for documented program abuse. This type of assessment shall be completed for an applicant being denied program authorization, if it has requested any type of appeal.

To augment this assessment process it is vital to obtain timely feedback from the local agency whom may have special knowledge about local conditions, such as physical barriers based on their familiarity of the community and on-going association with eligible participants. However, feedback such as participants’ preference and convenience are not considered legitimate issues for the local agency to raise when providing their inadequate participant response. All responses submitted should be objective statements of fact pertaining to potential participant impact.

All information provided as part of this evaluation process shall be complete and accurate. The information contained in the written assessment may be subject to further review by the State WIC Office, retail store managers, a store’s legal counsel or other personnel involved in the decision-making process, i.e., adjudication officer.

II. Definition(s):

• Applicant means a sole proprietorship, a partnership, cooperative association or a corporation that is not currently authorized to process eWIC transactions. This term may be used interchangeably with “retailer” or “retail store” in this policy.

• Authorization is the process by which the State WIC Office assesses, selects and enters into an Agreement with stores that apply or subsequently reapply to be authorized.

• Disqualification means the State WIC Office may take administrative actions to terminate with cause a store’s status to continue processing eWIC transactions due to documented Program non-compliance.

• Peer Group means the grouping or classification assigned to each retail store that participates in the WIC Program. Each retailer / applicant is assigned to a peer group based upon certain criteria, i.e., geographic location, number of cash registers and WIC sales, if applicable.

Division of Community Nutrition

Subject: Inadequate Participant Access Assessment Policy: VEN 01.0 Reference: Vendor Manual 15.0-15.4 Effective: August 12, 2013 Supersedes: April 2, 2007

Page 2 of 3

• Unique Participant means the number of unduplicated individuals that have initiated one or more eWIC purchasing transactions at a retail store during a specific period. Although multiple eWIC transactions may have been initiated by a participant at a single store location, the individual’s usage of any particular store is counted only once.

III. Procedure(s):

A. Inadequate Participant Access is determined and documented on a case-by-case basis when considering whether the State WIC Program should:

1) Retain a retail store in lieu of Program disqualification;

2) Make an authorization exception decision; or

3) Waive the selection criteria for the initial authorization of an applicant.

B. The State WIC Office has the final decision-making authority to establish criteria used to determine what constitutes Inadequate Participant Access.

C. There are certain times in which the State WIC Office and / or its Vendor Liaisons will not obtain local agency feedback when making IPA decisions. For instance, the State WIC Program will not solicit feedback from the local agencies when the following occurs:

1) The number of unique participants served by the local agency falls below the authorized retailer's designated peer group classification.

2) The retailer is being retained in lieu of disqualification because the geographic location of the next nearest authorized retail store location exceeds a reasonable driving distance.

D. Prior to taking disqualification actions against an authorized retail store, the Vendor Liaison assigned to that store completes an Inadequate Participant Access Form (IPA) WIC-410. Specific background information related to the affected store is sent (i.e., fax or email) directly to the WIC Coordinator. Along with the completed IPA form, other optional attachments included for his/her review may consist of a geographic map. E. All store status and background information contained on the IPA form is completed by the Vendor Liaison who sent the form. F. The WIC Coordinator or his/her designee shall review and respond to the State WIC Office’s request for feedback regarding the completed IPA assessment in the Comment sections as identified below.

Division of Community Nutrition

Subject: Inadequate Participant Access Assessment Policy: VEN 01.0 Reference: Vendor Manual 15.0-15.4 Effective: August 12, 2013 Supersedes: April 2, 2007

Page 3 of 3

1) This written response from the WIC Coordinator shall be returned within 5 work days of receipt. In the “comments” section, the WIC Coordinator shall indicate in their completed response their agreement and / or disagreement to the recommendations being made by the Vendor Liaison. 2) The local agency shall retain and maintain file copies of all responses and paperwork submitted to State WIC Office related to IPA assessments. Documentation of the responses shall be made available for review as a component of LAME audits as required. 3) The WIC Coordinator is expected to submit any supplementary information that supports the local agency's position / Vendor Liaison’s recommendation; which may be derived from a general knowledge of the area or by a physical evaluation of the retail store’s location. Examples of acceptable (supplementary) information may include: a. The names of low income housing developments in close proximity to the store location b. Knowledge of WIC eligible population that reside in these low income housing units c. Geographical / natural barriers that exist (major highways, rivers, bridges, etc.), or d. Any other service barriers which may affect WIC participants, including but not limited to documented complaints against authorized stores serving the trade area under consideration G. If no response is received from the WIC Coordinator or his/her designee within five work days after transmittal, then the Vendor Liaison shall document in the Comments section the non-response and proceed with the recommendation made by him/her. H. Under no circumstances should the WIC Coordinator or any local agency personnel inform a retailer and / or store personnel that administrative action is under consideration by the State WIC Office. All information contained in the IPA assessment is considered confidential. I. In certain situations for denial authorization decisions (i.e., Vendor Liaison is unfamiliar with the applicant’s store location / immediate trade area) the WIC Coordinator may be contacted and their feedback requested in making an authorization exception decision. J. The WIC Coordinator may request in the Comments section that the Vendor Liaison contact him/her, once the final outcome of the administrative actions being taken against the authorized retail stores has been resolved.

(ven-04.0)Virginia WIC Policy and Procedures Manual VEN 04.0: Solicitation Issues#

(ven-04.0)(document-1)#

Division of Community Nutrition

Subject: Solicitation Issues Policy: VEN 04.0 Reference: §C.F.R. 246.12 Effective: August 12, 2013 Supersedes: June 21, 2005

Page 1 of 1

I. Policy:

To identify guidelines and limitations for authorized or applicant stores soliciting WIC participants’ business.

II. Procedure:

A. Local agency personnel shall not give permission to any retail store and / or applicant to distribute flyers, business cards, or any other self-promotional materials to WIC participants on the premise / property.

B. Local agency personnel shall immediately remove and discard any flyers, pamphlets, business cards, petitions or any other type of promotional materials that promote shopping at a particular WIC authorized store.

C. Local agency personnel shall not encourage or initiate petitions on behalf of retail store applicants that are seeking WIC Program authorization.

D. Local agency personnel shall not accept inducements or “freebies” which may give the public and / or WIC participants the impression that a special business relationship exists between the WIC Program and any authorized store or applicant.

E. Local agency personnel shall not engage in any behavior that directs or encourages participants to shop at a particular WIC authorized store.

F. Local agency personnel shall provide a list of WIC authorized stores that are available in a desired shopping location to each WIC participant.

G. Local agency personnel shall advise participants which stores are more likely to stock and have available special formulas which are not normally carried by all authorized stores. In this situation, at least two (2) different store choices must be given to the WIC participant.

H. Local agency personnel shall not discourage participant’s choice to shop at any WIC authorized store location.

I. Local agency personnel shall encourage participants to report any aggressive marketing efforts that either intimidate or unduly pressure them to shop at particular store.

(ven-04.1)Virginia WIC Policy and Procedures Manual VEN 04.1: Solicitation of Gifts and Retail Stores#

(ven-04.1)(document-1)#

Division of Community Nutrition

Subject: Solicitation of Gifts and Retail Stores Policy: VEN 04.1 Reference: §C.F.R. 246.2 Effective: August 12, 2013 Supersedes: June 21, 2005

Page 1 of 1

I. Policy: The solicitation of gifts or benefits from either unauthorized and / or authorized WIC retailers is prohibited. The Federal Anti-Kickback Statute Title 42.1001.952 prohibits the knowing and willful solicitation or receipt, offer or payment of, overtly or covertly, of any remuneration (anything of value) in cash and / or in-kind in return for patient, product, or service referrals, or to induce such referrals.

II. Procedure(s):

A. Local agency personnel shall not solicit from either an unauthorized / authorized retailer and / or potential applicant the donation of gifts and / or benefits. B. Local agency personnel shall not encourage the solicitation of gifts and / or benefits for the purpose of distribution, transfer or gain by a participating WIC client, caregiver or parent. C. Solicitation of either unauthorized / authorized WIC Program retailers or retailer applicants, in conjunction with locally sponsored special projects, grants, outreach initiatives, community wide fundraising or public activities shall be approved in advance by the state Division Director or designee. D. Local agency requests shall be submitted in writing to the Division Director at least sixty (60) calendar days prior to the planned implementation date. 1) The written solicitation request shall include the following elements: purpose / background, type of gift / benefits being sought, expected deadline response date from the Division Director, time line / duration of the solicitation request, identification of any technical assistance needed from the State WIC Office. E. The Division Director shall provide a written response within thirty (30) calendar days after receiving the solicitation request.

(ven-05.0)Virginia WIC Policy and Procedures Manual VEN 05.0: WIC Shopping Options#

(ven-05.0)(document-1)#

Division of Community Nutrition

Subject: WIC Shopping Options Policy: VEN 05.0 Reference: N / A Effective: August 12, 2013 Supersedes: August 1, 2008

Page 1 of 1

I. Policy:

Local agency personnel shall fairly and consistently present shopping alternatives to participants, parents / legal guardians, caretakers and proxies.

II. Procedure:

A. Local agency personnel shall provide to participants, parents / legal guardians, caretakers and proxies a current listing of authorized retail stores based upon the participants, parents / legal guardians, caretaker and proxies preference at certification or subsequent certification. Conversely, for participants that have access to the internet, local agency personnel can offer as an alternative to receiving a paper listing the web address for using the Authorized Store Locator application to identify authorized stores.

1) This preference can be based upon: a. Store location; b. Zip code; c. Product availability; d. Type of store (i.e., Commissary)

2) The listing shall be provided to participants, parents / legal guardians, caretakers and proxies without any personal preference and / or bias towards any authorized store location.

B. Local agency personnel shall not encourage or discourage participants, parents / legal guardians, caretakers and proxies to shop at one authorized retail store over another.

C. Local agency personnel shall not encourage or discourage participants, parents / legal guardians, caretakers and proxies to shop at stores that have a eWIC integrated point of sales system versus stand beside devices being used for processing eWIC transactions.

D. Local agency personnel may inform participants, parents / legal guardians, caretakers and proxies of limitations a retail store may have in carrying a full selection of optional contract and / or WIC approved special formulas.

E. Local agency personnel that abuse his / her role in objectively advising participants, parents / legal guardians, caretakers and proxies about his / her shopping choices may be subject to administrative disciplinary action from a State WIC Office investigation.

(ven-07.0)Virginia WIC Policy and Procedures Manual VEN 07.0: Retailer Complaint Handling#

(ven-07.0)(document-1)#

Division of Community Nutrition

Subject: Retailer Complaint Handling Policy: VEN 07.0 Reference: CRT §246.12(h)(iii) Effective: August 12, 2013 Supersedes: September 26, 2005

Page 1 of 2

I. Policy:

It is the policy of the Division of Community Nutrition that local agencies play an active role in the processing of all complaints submitted by participants / proxies / legal guardians and / or local agency personnel regarding retail stores.

II. Procedure(s):

A. Determine if the incident is a valid complaint.

1. Common types of complaints

a. Store personnel refuses to sell eligible WIC approved food(s) to participants

b. Participant feels s/he was not treated with courtesy and respect

c. Cashier requires additional identification to use their eWIC card

d. Participant is required to purchase a store brand or the store limits the purchasing choice of WIC approved foods and/or formula, and

e. Cashier or store personnel refuse to allow participant to leave store with purchase, charges cash or takes the cardholder’s eWIC card.

B. Local agency personnel shall screen all participant complaints and assist when necessary in completing the Complaint Against a Store form, WIC-345A. Local agency personnel shall send the completed form and related attachments to the WIC Coordinator within two (2) days of receipt for review. The WIC Coordinator will fax or e-mail the complaint and attachments to the State WIC Office for follow-up within five (5) days.

C. For verbal complaints (over the phone), local agency personnel shall complete a WIC- 345A Complaint Against a Store form, and obtain as much information as possible from the participant. Whenever practical, include the receipt(s) and participants daytime phone number. The same processing timeframes apply to verbal complaints (see B).

D. Urgent complaints by local agency personnel only, may be called in directly to the State WIC Office. The assigned Vendor Liaison will contact the store and inform the local agency of the outcome within 24 hours. When necessary the State WIC Office may need to contact the participant to aid in resolving the issue and / or advise them of the outcome.

Division of Community Nutrition

Subject: Retailer Complaint Handling Policy: VEN 07.0 Reference: CRT §246.12(h)(iii) Effective: August 12, 2013 Supersedes: September 26, 2005

Page 2 of 2

E. Complaints against retailers shall be pre-screened by local agency personnel. Do not refer participant(s) directly to the State WIC Office.

(adm-01.0)Virginia WIC Policy and Procedures Manual ADM 01.0: Caseload Assignment and Funding Allocations#

(adm-01.0)(document-1)#

(adm-01.0)Virginia WIC Policy and Procedures Manual ADM 01.0: Caseload Assignment and Funding Allocations#

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(adm-02.0)Virginia WIC Policy and Procedures Manual ADM 02.0: Interruption of Benefits#

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(adm-02.1)Virginia WIC Policy and Procedures Manual ADM 02.1: Waiting Lists#

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(adm-03.0)Virginia WIC Policy and Procedures Manual ADM 03.0: Funding Principles#

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(adm-03.3)Virginia WIC Policy and Procedures Manual ADM 03.3: Fiscal Year Conversion#

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(adm-03.4)Virginia WIC Policy and Procedures Manual ADM 03.4: Shared Purchases / Expenses#

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(adm-03.5)Virginia WIC Policy and Procedures Manual ADM 03.5: Allowable WIC Expenditures and Allocations#

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(adm-03.6)Virginia WIC Policy and Procedures Manual ADM 03.6: Unallowable Spending Costs#

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(adm-03.7)Virginia WIC Policy and Procedures Manual ADM 03.7: Time & Effort Reporting#

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(adm-03.8)Virginia WIC Policy and Procedures Manual ADM 03.8: Capital Expend., Eqpmnt. Cmptr. Purchase Requirements#

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(adm-03.9)Virginia WIC Policy and Procedures Manual ADM 03.9: Cost Allocation for Shared Expenses#

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(adm-03.10)Virginia WIC Policy and Procedures Manual ADM 03.10: Fiscal Record Keeping: General Guidelines#

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(adm-03.11)Virginia WIC Policy and Procedures Manual ADM 03.11: CARDINAL State Accounting System#

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(adm-04.0.1)Virginia WIC Policy and Procedures Manual ADM 04.0.1: WIC Services Plan (WSP) & Memorandum of Agreement#

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(adm-04.0.2)Virginia WIC Policy and Procedures Manual ADM 04.0.2: Participant Surveys#

(adm-04.0.2)(document-1)#

(adm-04.1)Virginia WIC Policy and Procedures Manual ADM 04.1: State Technical Assistance Review (STAR)#

(adm-04.1)(document-1)#

(adm-04.2)Virginia WIC Policy and Procedures Manual ADM 04.2: Audits/Reviews#

(adm-04.2)(document-1)#

(adm-05.0)Virginia WIC Policy and Procedures Manual ADM 05.0: Program Abuse and Sanctions#

(adm-05.0)(document-1)#

(adm-05.1)Virginia WIC Policy and Procedures Manual ADM 05.1: Dual Participation#

(adm-05.1)(document-1)#

(adm-05.2)Virginia WIC Policy and Procedures Manual ADM 05.2: Collection of Improp. Issued Benefits / Claims Against Participants#

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(adm-06.0)Virginia WIC Policy and Procedures Manual ADM 06.0: Separation of Duties#

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(adm-06.1)Virginia WIC Policy and Procedures Manual ADM 06.1: Conflict of Interest#

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(adm-08.0)Virginia WIC Policy and Procedures Manual ADM 08.0: Program Accessibility#

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(adm-08.1)Virginia WIC Policy and Procedures Manual ADM 08.1: Marketing and Media Outreach#

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(adm-09.0)Virginia WIC Policy and Procedures Manual ADM 09.0: National Voter Registration Act#

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(adm-10.0)Virginia WIC Policy and Procedures Manual ADM 10.0: Emergency Procedures#

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(adm-11.0)Virginia WIC Policy and Procedures Manual ADM 11.0: Record Retention#

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(adm-11.1)Virginia WIC Policy and Procedures Manual ADM 11.1: Clinic Closure – Relocation#

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(adm-12.0)Virginia WIC Policy and Procedures Manual ADM 12.0: Full Disclosure#

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(adm-13.0)Virginia WIC Policy and Procedures Manual ADM 13.0: System Outage#

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(bf-01.0)Virginia WIC Policy and Procedures Manual BF 01.0: Breastfeeding Promotion and Support#

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(bf-01.1)Virginia WIC Policy and Procedures Manual BF 01.1: Local Agency Breastfeeding Coordinator#

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(bf-01.2)Virginia WIC Policy and Procedures Manual BF 01.2: Designated Breastfeeding Expert (DBE) Qualifications and Responsibilities#

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(bf-01.3)Virginia WIC Policy and Procedures Manual BF 01.3: Breastfeeding Peer Counselors Qualifications and Responsibilities#

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(bf-01.4)Virginia WIC Policy and Procedures Manual BF 01.4: Breast Feeding Contact Guidelines#

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(bf-02.0)Virginia WIC Policy and Procedures Manual BF 02.0: Breastfeeding Education#

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(bf-04.0)Virginia WIC Policy and Procedures Manual BF 04.0: Breastfeeding Supplies#

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(bf-04.1)Virginia WIC Policy and Procedures Manual BF 04.1: Manual Breast Pump#

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(bf-04.2)Virginia WIC Policy and Procedures Manual BF 04.2: Personal Use Electric Breast Pump#

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