West Virginia WIC Policy & Procedure 10.03 Effective Date: 12/29/20 10.03

WIC/EPSDT Program Referral

1 of 3 POLICY:

The West Virginia WIC Program will provide referrals to the West Virginia Maternal and Child Health Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. These referrals can prevent the duplication hemoglobin testing for children participating in both programs.

PROCEDURE:

A. Referrals from the EPSDT Program to WIC

1. The WIC Program will receive referrals from the EPSDT Program with the use of a referral form.

a. The WIC Local Agency will:

i. Include the local WIC clinic address and telephone number on the back of the referral form - “Local WIC Agency Stamp”;

i. Distribute the referral forms to each EPSDT provider in the Local Agency service area;

ii. Accept the completed referral from the WIC applicant/participant;

iii. Enter the hemoglobin value, date performed and source of measurement into the Crossroads Anthro/Lab Screen if it was taken less than ninety (90) days prior to the WIC certification appointment (see Policy 2.13 Hematological Testing); and

iv. Assist the State Agency, as requested, with data gathering for referral feedback to the EPSDT Program.

b. The EPSDT Program will:

i. Provide current lists of EPSDT providers and addresses for distribution to the WIC Local Agencies;

ii. Complete the referral form, including the hemoglobin value and date performed, and give it to the applicant to take to the WIC clinic; and

iii. Make periodic requests to the State Agency for feedback on the WIC referrals given.

B. Referrals from WIC to the EPSDT Program

West Virginia WIC Policy & Procedure 10.03 Effective Date: 12/29/20 10.03

WIC/EPSDT Program Referral

2 of 3 1. The EPSDT Program will receive referrals from the WIC Program using the Crossroads generated WIC Program Referral Form (WIC-35).

a. The WIC Local Agency will:

i. During each certification appointment, the parent/guardian/caretaker will be asked to provide the participant’s medical home and the date of their most recent visit. This information will be documented on the Crossroads Health Information Screen.

ii. If the child does not currently have a healthcare provider and the parent/guardian agrees to the EPSDT referral, complete the Crossroads generated WIC Program Referral Form (WIC-35). Include the most recent hemoglobin on the referral. A parent/guardian signature is not required for referral to the EPSDT Program;

iii. If the parent/guardian refuses the referral, the parent/guardian’s reason for refusal must be documented under Referral Refused Reason on the Referral Follow-Up screen;

iv. Send the completed referral form via mail, fax, or email to the State Outreach Coordinator. The State Outreach Coordinator will send the referral to the State EPSDT Program; and

v. Document the referral to EPSDT on the Crossroads Referral Program Screen.

b. The EPSDT Program will:

i. Contact the participant to inform, enroll and schedule them with a provider should health care services be accepted;

ii. Accept the completed referral from the WIC Program and use the WIC participant information included according to EPSDT policy; and

iii. Restrict the use or disclosure of the WIC participant information as stipulated in the Agreement Between Bureau for Medical Services and Bureau for Public Health (see Policy 10.02 Coordination of Program Services Attachment # 3).

REFERENCES:

1. USDA Nutrition Services Standards, Standard 10, Program Coordination 2. USDA Nutrition Services Standards, Standard 11, Participant Referral

West Virginia WIC Policy & Procedure 10.03 Effective Date: 12/29/20 10.03

WIC/EPSDT Program Referral

3 of 3 3. WIC Consolidate Regulations, Revised January 1, 2017, 7 CFR 246.7, Certification of Participants.